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TRANSACTIONS 


OF  THE 


WORLD’S  CONGRESS 


OF 


nr 


Held  under  the  Auspices  of  the  M^orld’s  Congress  Auxiliary 
of  the  World’s  Columbian  Exposition,  in 

/ 

CHICAGO,  ILL.,  MAY  29  TO  JUNE  3,  1893. 


PUBLISHED  BY  THE  AMERICAN  INSTITUTE  OF  HOMOEOPATHY, 

AND  EDITED  BY  ITS  GENERAL  SECRETARY, 


PEMBERTON  DUDLEY,  M.D. 


\ 


PHILADELPHIA: 

Sherman  & Co.,  Printers,  Seventh  and  Cherry  Streets. 
18  94. 


AUTHORIZED  DEFINITION, 


At  the  Annual  Session  of  1881,  the  American  Institute  of  Homoeo- 
pathy ordered  as  follows : 

1.  That  the  President’s  definition  of  the  words  “ Regular  ” 
and  “ Irregular/’  as  applied  to  schools  and  practitioners  of 
medicine,  be  adopted  by  this  Institute  as  correct, 

2.  That  hereafter  this  definition  be  conspicuously  printed  in 
all  published  documents  and  Transactions  of  this  Institute, 
in  order  that  the  profession,  of  all  schools,  may  the  sooner  be 
familiarized  with,  and  led  to  adopt  it. 


“A  Regular  Physician. — A graduate  of  a regularly  char- 
tered medical  college.  The  term  also  applies  to  a person  practicing 
the  healing  art  in  accordance  with  the  laws  of  the  country  in  which 
he  resides .” 


See  Transactions  of  1881,  pp.  23,  68  and  71. 


(o\b  t 


CONTENTS. 


Preliminary  Session. 


Address  by  Hon.  C.  C.  Bonney, 

Address  by  Mrs.  Charles  Henrotin, 

Address  by  Dr.  J.  H.  McClelland, 

Address  by  Dr.  Julia  Holmes  Smith,  . " 

Address  by  Dr.  Alfred  E.  HaWkes, 

Address  by  Dr.  J.  Cavendish  Molson,  . 
Address  by  Dr.  Carl  Bojanus, 

Address  by  Dr.  P.  C.  Majumdar,  , 

Telegram  from  Dr.  Theodore  Kafka, 
Telegram  from  Dr.  Alexander  Villers, 
Address  by  Eev.  T.  G.  Milsted,  D.D., 
Inaugural  Address  by  Dr.  J.  S.  Mitchell,  Chai 


rman  of  the 


Congress, 


First  Day’s  Session. 

Introduction  of  President  Mitchell  by  Dr.  I.  T.  Talbot,  the  Honorary  Presi- 
dent,   

Preparations  for  the  Congress  Described  by  President  Mitchell 
Buies  and  Order  of  Business  Adopted, 

Address  by  Dr.  William  Tod  Helmuth  on  “Surgery  in  the' Homoeopathic 
School,”  .... 

Discussion  on  “Surgery  in  the  Homoeopathic  School,” 

Address  by  Dr.  Richard  Hughes  on  “The  Further  Improvement  of  Our 
Materia  Medica,”  .... 

a ,,D'SC!ISSi°ri  0n  “Tbe  Farther  Improvement  of  Our  Materia  Medica,” 
Address  by  Dr.  F.  Parke  Lewis  on  “The  Value  of  Specialties  in  Medicine,” 
Meeting  of  the  Section  in  Surgery, 

Second  Day’s  Session. 

Report  on  Foreign  Correspondence;  by  Dr.  W.  A.  Dunn,  Secretary, 

Discussion  on  “The  Value  of  Specialties  in  Medicine,” 

Address  by  Dr.  J.  P.  Dake  on  “ The  Future  of  Homoeopathy 

Discussion  on  “The  Future  of  Homoeopathy,” 

Address  by  Dr.  I.  Tisdale  Talbot  on  “ Medical  Education  in  the  Homoeo- 
pathic Hospitals  and  Colleges  of  the  United  States,” 

Discussion  on  “Medical  Education  in  the  United  States,”  .’ 

Address  by  Dr.  Alexander  Villers  on  the  “History  of  Homoeopathy  in' Ger- 
many,” .... 

Discussion  on  “ Homoeopathy  in  Germany,” 

Meetings  of  the  Sections  in  Surgery  and  in  Ophthalmology,  etc., 


Third  Day’s  Session. 

Address  by  Dr.  T.  F.  Allen  on  “ The  Selection  of  the  Homoeopathic  Remedy,” 
Discussion  on  “ 1 he  Selection  of  the  Homoeopathic  Remedy,”  . 


PACE 

17 

20 

22 

23 

26 

27 

29 

30 
32 
32 
32 
35 


47 

47 

48 

49 
65 

69 

74 

82 

91 


91 

93 

94 
105 

108 

114 

117 

123 

123 


125 

131 


IV 


CONTENTS. 


PAGE 

Address  by  Dr.  E.  Ludlam  on  “ Homoeopathy  and  the  Public  Health/'  . . 136 

Discussion  on  “Homoeopathy  and  the  Public  Health,”  * ....  143 

Address  by  Dr.  Alfred  E.  Hawkes  on  “ Homoeopathy  in  Great  Britain/’ . . 148 

Greetings  to  the  World’s  Congress  from  Dr.  E.  E.  Dudgeon,  of  London,  Eng.,  * 
with  Presentation  of  a Copy  of  his  new  Translation  of  Hahnemann’s 

Organon, ...  151 

Address  by  Dr.  P.  C.  Majumdar  on  the  “ History  of  Homoeopathy  in  India,”  . 152 

Address  by  Dr.  Charles  F.  Fischer  on  “ Homoeopathy  in  Australia,”  . . 159 

Address  by  Dr.  E.  Vernon  on  the  “ Progress  of  Homoeopathy  in  Ontario,”  . 161 

Address  by  Dr.  J.  Caver. dish  Molsou  on  “ Homoeopathy  in  London,  England,”  163 

Meetings  of  the  Sections  in  Materia  Medica  and  in  Obstetrics,  . . . 166 

FoupfH  Day’s  Sessio^. 

Address  hy  Dr.  David  A.  Strickler  on  “Comparative  Vital  Statistics — Hom- 
oeopathy vs.  Allopathy,”  167 

Discussion  on  “Comparative  Vital  Statistics,” 189 

Address  by  Dr.  Martha  A.  Canfield  on  “The  Development  of  Medical  Sci- 
ence through  Homoeopathy,” 193 

Discussion  on  “The  Development  of  Medical  Science  through  Homoeop- 
athy/’   204 

Meetings  of  the  Sections  in  Clinical  Medicine  and  in  Mental  and  Nervous 

Diseases, 204 

Fifth  Day’s  Session. 

Eesolutions  of  Thanks  Adopted,  205 

Presentation  of  a Letter  from  Dr.  Carlos  Plata, 205 

Address  by  Dr.  Carlos  Plata  on  “Observations  on  Some  of  the  Axioms, 

Aphorisms  and  Eules  of  Homoeopathy,”  .......  207 

Meetings  of  the  Section  in  Ehinology  and  Laryngology,  and  of  the  Section 

in  Paedology,  . 209 

Adjournment  of  the  Congress, 209 

Eeports  of  the  Sections. 

Report  of  the  Section  in  Surgery— Minutes  of  the  Sectional  Meetings,  . . 213 

Sectional  Address  in  “Surgery;”  by  W.  B.  Van  Lennep,  M.D.,  . . 215 

“ Ether  or  Chloroform  /’  by  Horace  Packard,  M.D., 227 

Discussion, 240 

“Surgical  Shock  hy  T.  L.  McDonald,  M.D., 251 

Discussion, . ....  258 

“A  Contribution  to  Thoracic  Surgery  by  Henry  L.  Obetz,  M.D.,  . . 265 

“Thoracoplasty;”  by  H.  F.  Biggar,  M.D .286 

“ Vivisection  and  Pulmonary  Surgery;”  by  Walter  F.  Knoll,  M.D.,  . . 294 

Discussion 299 

“The  Treatment  of  Epilepsy,  Idiocy  and  Allied  Disorders  by  Cranial 

Excision  and  Incision hy  G.  F.  Shears,  M.D.,  , 305 

Discussion,  315 

“A  Eeport  on  Orificial  Surgery,  Including  an  Analysis  of  1000  Cases;” 

by  E.  H.  Pratt,  M.D., 324 

Discussion, 343 


CONTENTS. 


V 


PAGE 

Report  of  the  Section  in  Ophthalmology  and  Otology — Minutes  of  the  Sec- 
tional Meetings, 347 

Sectional  Address;  by  A.  B.  Norton,  M.D., 349 

“ Ophthalmic  Therapeutics;”  by  E.  H.  Linnell,  M.D.,  ....  357 

Discussion, 368 

“ The  Refraction  of  the  Eye ;”  by  Thomas  M.  Stewart,  M.D.,  . . . 376 

Discussion, 391 

“Ophthalmic  Surgery;”  by  Elmer  J.  Bissell,  M.D., 399 

Discussion,  ............  410 

“The  Study  and  Correction  of  Heterophoria  ;”  by  Harold  Wilson,  M.D.,  415 

Discussion,  ............  428 

“The  Efficacy  of  the  Vibrometer  in  Applying  Vibratory  Massage  in 

Aural  Diseases;”  by  Henry  F.  G-arey,  M.D., 434 

Discussion, 437 

“The  Homoeopathy  of  Aural  Therapeutics;”  by  C.  F.  Sterling,  M.D.,  . 444 

Discussion, 449 

“ Aural  Therapeutics;”  by  Henry  C.  Houghton,  M.D.,  ....  451 

“Some  Recent  Advancements  in  Otology;”  by  Howard  F.  Bellows,  M.D.,  457 

Discussion,  464 

“Ocular  Reflex  Neuroses;”  by  James  A.  Campbell,  M.D.,  ....  467 

Report  of  the  Section  in  Gynaecology — Minutes  of  the  Sectional  Meetings,  . 478 

• Sectional  Address — “ The  Sine-qua-non  ;”  by  O.  S.  Runnels,  M.D.,  . . 480 

“ Homoeopathy  in  Gynaecology ;”  by  L.  A.  Phillips,  M.D.,  ....  487 

Discussion,  493 

“ Some  of  the  Clinical  Aspects  of  Septic  Invasion ;”  by  Edward  Blake,  M.D.,  501 

Discussion, 510 

“The  Relation  of  Surgery  to  Gynaecology;”  by  Charles  E.  Walton,  M.D.,  512 

Discussion,  , 516 

“Plastic  Surgery  of  the  Vagina;”  by  W.  E.  Green,  M.D.,  ....  521 

Discussion, 528 

“Caesarian  Section  ;”  by  H.  F.  Biggar,  M.D., 536 

Discussion, 551 

“ Uterine  Fibroids ;”  by  John  W.  Streeter,  M.D., 558 

Discussion, 565 

“ Vaginal  Hysterectomy ;”  by  J.  M.  Lee,  M.D., 570 

Discussion,  ............  577 

“Removal  of  the  Entire  Uterus,  Together  with  the  Appendages,  for 

Uterine  Fibroids ;”  by  Homer  I.  Ostrom,  M.D.,  ....  580 

Discussion, 585 

Report  of  the  Section  in  Materia  Medica — Minutes  of  the  Sectional  Meeting,  588 

Sectional  Address — “The  Present  Condition  of  the  Homoeopathic  Ma- 
teria Medica ;”  by  A.  C.  Cowperth  waite,  M.D.,  . . . . . 589 

“ A Study  of  Sepia,  Pathological,  Clinical  and  Comparative ;”  by  A.  L. 

Monroe,  M.D., 594 

Discussion,  . 597 

“My  Bryonia  Day ;”  by  Frank  Kraft,  M.D.,  601 

Discussion, 607 

“The  Revival  of  Therapeutics;”  by  William  E.  Leonard.  M.D.,  . . 608 

Discussion, 612 

“ Practical  Psychology  in  its  Relation  to  Pathogenesy  ; ” by  Eldridge  C. 

Price,  M.D., 615 

Discussion, 621 


VI 


CONTENTS. 


PAGE 

“ Primary  and  Secondary  Symptoms  ; or  the  Opposite  Action  of  Large 

and  Small  Doses by  Charles  Mohr.  M.D., 625 

‘‘Phytolacca — Leaf,  Fruit  and  Root. — The  Value  of  Each;”  by  Robert 

Boocock,  M.D., 643 

Report  of  the  Section  in  Obstetrics — Minutes  of  the  Sectional  Meeting,  . 649 

Sectional  Address  ; by  T.  Griswold  Comstock,  M.D., 651 

“Scarlatina  in  the  Gestative  and  Puerperal  States;”  by  John  C.  San- 
ders, M.D., 663 

Discussion,  666 

“The  Levator  Ani  as  Related  to  Parturition;”  by  Henry  E.  Spalding, 

M.D., 671 

“A  Comparative  Study  of  the  Operative  Procedures  Applicable  to  the 
Commoner  Varieties  and  Degrees  of  Pelvic  Deformity;”  by  L.  L. 

Danforth,  M.D., 679 

“The  Rational  Treatment  of  Certain  Puerperal  Disorders;”  by  George 

B.  Peck,  M.D., 691 

Discussion,  . 693 

“ The  Year’s  Progress  in  Obstetrics ,”  by  Sheldon  Leavitt,  M.D.,  . . 700 

Discussion, 706 

“ Puerperal  Fever ;”  by  J.  B.  Gregg  Custis,  M.D., 709 

“Puerperal  Eclampsia;”  by  L.  C.  Grosveuor,  M.D., 718 

“Puerperal  Insanity  ;”  by  M.  D.  Youngman,  M.D., 723 

Discussion  on  Puerperal  Disorders,  .......  726 

“Some  of  the  Diseases  Preventing  and  Complicating  Pregnancy;”  by 

Henry  C.  Aldrich,  M.D., 728 

Report  of  the  Section  in  Clinical  Medicine — Minutes  of  the  Sectional  Meet- 
ing,   734 

Sectional  Address. — “ Recent  Discoveries  in  the  Treatment  of  Disease  by 
the  Use  of  Disease-Products,  and  their  Relations  to  Homoeopathy;” 

by  Charles  Gatchell,  M.D., 736 

“ A Plea  for  Early  Operation  in  Pleurisy  with  Effusion  ;”  by  J.  Montfort 

Schley,  M.D., 746 

“ Prophylaxis  in  Cholera;  ” by  B.  N.  Banerjee,  M.D.,  ....  765 

Discussion,  ............  767 

“Cholera — Its  Curative  Treatment ;”  by  P.  C.  Majumdarr M.D.,  . . 768 

Discussion,  780 

“ Some  Observations  on  Neurasthenia  and  Its  Treatment ;”  by  Conrad 

Wesselhoeft,  M.D.,  781 

Discussion,  798 

“ Bright’s  Disease;”  by  P.  Jousset,  M.D.,  803 

Discussion, 819 

“ The  Scientific  Clinician ;”  by  J.  P.  Sutherland,  M.D.,  ....  825 

Discussion, 830 

“Biliousness  ;”  by  F.  H.  Orme,  M.D., 833 

“The  Curative  Action  of  Homoeopathic  Remedies  in  Cases  of  Organic 

Disease  of  the  Heart ;”  by  John  H.  Clarke,  M.D.,  ....  838 

“ Moist  Heat  as  a Therapeutic  Agent ;”  by  W.  A.  Edmonds,  M.D.,  . . 851 

“The  Study  of  Homoeopathy  as  a Distinct  and  Commanding  Department 

of  Medicine;”  by  John  C.  Morgan,  M.D., 858 

“ The  Homoeopathic  Treatment  of  Tabes  and  Pseudo-Tabes;”  by  Alexan- 
der Villers,  M.D., 913 


CONTENTS.  vii 

PAGE 

Report  of  the  Section  in  Mental  and  Nervous  Diseases — Minutes  of  the  Sec- 
tional Meeting, 923 

Sectional  Address — “Recent  Work»and  Progress  in  the  Field  of  Psy- 
chology by  Selden  H.  Talcott,  M.D., 925 

“Psychiatry  and  the  Homoeopathic  Medical  Colleges;”  by  N.  Emmons 

Paine,  M.D., 937 

“ The  Octave  (Septenary)  in  Nature  and  in  Man  as  the  Key  to  Psy- 
chology by  J.  D.  Buck,  M.D., 945 

“ Puerperal  Insanity by  A.  P.  Williamson,  M.D., 956 

“The  Causes  of  an  increase  in  Melancholia;”  by  William  Morris  Butler, 

M.D., 963 

“ Some  Statistical  Facts  Concerning  Insanity ;”  by  George  Allen,  M.D.,  . 969 

Report  of  the  Section  in  Rhinology  and  Laryngology — Minutes  of  the  Sec- 
tional Meeting,  977 

Sectional  Address — “ Recent  Progress  in  Rhinology  and  Laryngology;” 

by  Horace  F.  Ivins,  M.D., 979 

Discussion,  991 

“Nasal  Epithelioma;”  by  Wesley  A.  Dunn,  M.D., 993 

Discussion,  997 

“ Malignant  Growths  in  the  Larynx  ;”  by  H.  F.  Fisher,  M.D.,  . . . 999 

Discussion 1006 

“ New  Suggestions  in  the  Treatment  of  Constriction  of  the  (Esophagus;” 

by  D.  G.  Woodvine,  M.D., 1009 

Discussion, 1015 

“Massage  in  the  Treatment  of  Nasal  Stenosis;”  by  William  Dulaney 

Thomas,  M.D., 1018 

“ The  Treatment  of  Phthisis ;”  by  Charles  E.  Jones,  M.D.,  . . . 1020 

“ The  Treatment  of  Chronic  Rhinitis  by  the  Homoeopath ;”  by  Charles  E. 

Teets,  M.D., 1031 

Discussion, 1038 

“Nasal  Surgery — Its  Use  and  Its  Limitations;”  by  Eugene  L.  Mann, 

M.D., 1040 

Report  of  the  Section  in  Paedology — Minutes  of  the  Sectional  Meeting,  . . 1044 

Sectional  Address  in  Paedology ; by  Emily  V.  Pardee,  M.D.,  . . . 1046 

“ Pre-Natal  Medication ;”  by  Millie  J.  Chapman,  M.D.,  ....  1050 

Discussion, 1053 

“ Rachitis ;”  by  Robert  N.  Tooker,  M.D 1059 

Discussion,  . 1064 

“The  Awkward  Gait  of  Children  ;”  by  Sidney  F.  Wilcox,  M.D.,  . . 1066 

Discussion, 1068 

“ Contagion  in  Public  Schools  and  its  Prophylaxis;”  by  Lucy  Chaloner 

Hill,  M.D., 1070 

Discussion, 1074 

“Some  Notes  upon  Headache  in  Children  ;”  by  Gerard  Smith,  M.R.C.S.,  1076 

Discussion, 1082 

“ Albuminuria  in  Children ;”  by  Henry  C.  Aldrich,  M.D. , . . . . 1084 

“The  Treatment  of  Meningocele,  Encephalocele  and  Hydrencephalocele 

by  Means  of  a Collodion  Cap  ; ” by  J.  Martine  Kershaw,  M.D.,  . . 1092 

“Albuminuria  in  Children ;”  by  William  W.  Van  Baun,  M.D.,  . . 1094 

Index  to  the  volume, 1097 


HISTORICAL  NOTE. 


Soon  after  the  organization  of  the  Directory  of  the  World’s  Co- 
lumbian Exposition,  to  be  held  in  Chicago,  111.,  U.  S.  A.,  in  1893, 
it  was  suggested,  that  in  order  to  make  the  Exposition  complete,  and 
the  celebration  adequate,  the  wonderful  achievements  of  the  new  age, 
in  science,  literature,  education,  government,  jurisprudence,  morals, 
charity,  religion,  and  other  departments  of  human  activity,  should 
also  be  conspicuously  displayed  as  the  most  effective  means  of  in- 
creasing the  fraternity,  progress,  prosperity  and  peace  of  mankind. 

It  was  therefore  proposed  that  a series  of  World’s  Congresses  for 
that  purpose  be  held  in  connection  with  the  World’s  Columbian 
Exposition  of  1893,  and  the  World’s  Congress  Auxiliary  was  duly 
organized  to  promote  the  holding  and  success  of  such  congresses.  This 
organization  was  authorized  and  supported  by  the  Exposition  Man- 
agement, and  approved  by  the  United  States  Government.  Ample 
audience  rooms,  wdth  special  facilities  for  sectional  as  well  as  general 
meetings,  were  provided  by  the  Directory  of  the  Fair  in  a magnifi- 
cent Art  Building  erected  on  the  lake  front. 

Upon  the  establishment  of  the  World’s  Congress  Auxiliary,  as 
above  mentioned,  its  President,  Hon.  C.  C.  Bonney,  invited  the 
Homoeopathic  profession  to  hold  an  International  Congress  in  Chi- 
cago during  the  World’s  Columbian  Exposition  in  1893.  A local 
Committee  was  appointed  and  an  Advisory  Council  selected,  composed 
of  prominent  representatives  of  the  Homoeopathic  school  in  all  lands. 
Acceptances  were  received  from  nearly  all  these  physicians,  and  the 
plan  suggested  for  carrying  out  the  enterprise  was  cordially  endorsed. 
At  the  same  time  there  was  appointed  a committee  for  a Congress 
of  Women,  but  subsequently  it  was  agreed  to  hold  the  two  con- 
gresses together  as  one  body.  At  the  meeting  of  the  American  In- 
stitute of  Homoeopathy  held  at  Washington,  D.  C.,  in  June,  1892, 
it  was  unanimously  voted  to  hold  its  next  session  in  Chicago,  and  in 
conjunction  with  the  World’s  Congress;  and  instead  of  transacting 
its  usual  business,  to  devote  its  energies  to  the  promotion  of  the  sci- 
entific work  and  interests  of  the  Congress. 


X 


HISTORICAL  NOTE. 


At  the  request  of  the  Local  Committee,  the  Institute  also  appointed 
a committee  of  its  own  to  act  with  the  Local  Committee  in  the  inte- 
rests of  the  Congress.  At  a joint  meeting  of  the  Committees  of  the 
Congress  and  of  the  Institute  and  the  Advisory  Council,  held  in 
Washington  City,  there  was  appointed  a committee  consisting  of  the 
Chairman  and  Vice-Chairman  of  the  Congress  and  the  President 
and  Vice-President  of  the  American  Institute,  to  prepare  a general 
plan  for  the  Congress  and  to  invite  distinguished  representatives  of 
the  Homceopathic  school  to  deliver  addresses  before  it. 

The  committees,  after  many  meetings  and  consultations,  decided 
upon  the  plans  under  which  the  Congress  should  be  conducted,  and 
the  subjects  and  questions  to  which  its  consideration  should  be  de- 
voted. They  also  secured  the  aid  of  those  whose  addresses,  essays 
and  discussions  are  herein  presented.  The  title  by  which  the  con- 
vocation was  to  be  known  was  “ The  World’s  Congress  of  Homoeo- 
pathic Physicians  and  Surgeons,”  and  its  papers  and  discussions 
were  to  be  the  property  of  the  World’s  Congress  Auxiliary. 

At  the  meeting  of  the  American  Institute  of  Homoeopathy,  held 
in  Chicago,  111.,  during  the  continuance  of  the  Congress,  it  was  urged 
that  the  publication  of  the  papers  of  the  Congress  at  an  early  day 
was  much  to  be  desired,  and  a question  was  raised  as  to  the  proba- 
bility of  their  early  publication  by  the  Congress  Auxiliary.  After 
a careful , consideration  of  the  subject,  a motion  was  offered  and 
adopted  providing  : 

“ That  the  Executive  and  Publication  Committee  be  empowered 
to  confer  with  the  authorities  and  officials  of  the  Congress,  and  to  act 
as  circumstances  shall  permit  and  their  own  judgment  shall  dictate.” 

Under  the  authority  thus  conferred,  the  Executive  Committee  of 
the  Institute  received  the  manuscripts  of  the  Congress  from  its  offi- 
cials, and  ordered  that  they  be  published  and  copies  distributed  to 
all  persons  entitled  to  the  Institute  Transactions , and  to  all  foreign 
physicians  who  had  contributed  to  the  success  of  the  Congress. 


COMMITTEES 

OF  THE 

WORLD’S  CONGRESS 

OF 

HOMEOPATHIC  PHYSICIANS  AND  SURGEONS. 

Appointed  by  the  World’s  Congress  Auxiliary. 


LOCAL  COMMITTEES. 


Committee  of  the  World’s  Congress  Auxiliary  on  a Congress  of  Homoeopathic  Physicians 

and  Surgeons. 


J.  S.  Mitchell,  M.D.,  Chairman, 
R.  Ludlam,  M.D..  Vice-Chairman, 
W.  A.  Dunn,  M.D.,  Secretary, 

R.  N.  Foster,  M.D.. 

W.  F.  Knoll,  M.D., 

T.  S.  Hoyne,  M.D., 

J.  R.  Kippax,  M.D., 


J.  W.  Streeter,  M.D., 
T.  C.  Duncan,  M.D., 

J.  H.  Buffum,  M.D., 

A.  K.  Crawford,  M.D. 
L.  D.  Rogers,  M.D., 

C.  E.  Fisher,  M.D. 


Woman’s  Committee  on  Homoeopathic  Medicine  and  Surgery. 
Julia  Holmes  Smith,  M.D.,  Chairman,  Emma  C.  Geisse,  M.D., 
Elizabeth  McCracken,  M.D.,  Vice-  Isadore  Green,  M.D,, 

Chairman,  Corresta  T.  Canfield,  M.D,, 

Julia  Ross  Low,  M.D.,  Isabella  Hotchkiss,  M.D. 

Committee  of  Arrangements. 

A.  K.  Crawford,  M.D.,  Chairman,  T.  S.  Hoyne,  M.D., 

J.  H.  Buffum,  M.D.,  E.  A.  McCracken,  M.D., 

C.  E.  Fisher,  M.D.,  C.  T.  Canfield,  M.D. 


Committee  Appointed  by  the  American  Institute  of  Homoeopathy. 


J.  P.  Dake,  M.D.,  Chairman, 
A.  C.  COWPERTH WAITE,  M.D., 
Bushrod  W.  James,  M.D., 

T.  Y.  Kinne,  M.D.,  . 

T.  F.  Allen,  M.D.,  . 

I.  T.  Talbot.  M.D.,  . 

F.  H.  Orme,  M.D.,  . 

J.  H.  McClelland,  M.D., 

C.  E.  Fisher,  M.D.,  . 

Millie  J.  Chapman,  M.D., 

E.  M.  Kellogg,  M.D., 

Thos.  Franklin  Smith,  M.D. 
Pemberton  Dudley,  M.D., 

T.  M.  Strong,  M.D., 


Nashville,  Tenn. 

Chicago,  111. 
Philadelphia,  Pa. 
Paterson,  N.  J. 
New  York  City. 
Boston,  Mass. 
Atlanta,  Ga- 
Pittsburgh,  Pa. 

Chicago,  111. 
Pittsburgh,  Pa. 
New  York,  N,  Y. 
New  York,  N.  Y. 
Philadelphia,  Pa. 
Boston,  Mass. 


xii  world’s  homoeopathic  congress. 


THE  ADVISORY  COUNCIL. 


Foreign. 

Adolphus  Gerstel,  M.D  , .... 

Fr.  Klauber,  M.D., 

P.  Jousset,  M.D 

A.  Claude,  M.D., 

R.  E.  Dudgeon,  M.D.. 

J.  J.  Drysdale,  M.D., 

Richard  Hughes,  M.D., 

Ernest  H.  Stancomb,  M.B.C.M.,  . 

Alfred  C.  Pope,  M.D., 

D.  Dyce  Brown,  M.D., 

Alexander  Villers,  M.D.,  .... 

W.  Albert  Haupt,  M.D.,  .... 

Th.  Kafka,  M.D.,  . ... 

C.  Bojanus,  M.D., 

B.  N.  Banerjee,  M.D., 

Theophilus  Bruckner,  M.D., 

Oscar  Hansen,  M.D., 

Joaquin  Gonzalez,  M.D.,  .... 

Tommaso  Cigliani,  M.D.,  .... 

Garcia,  M.D., 

W.  R.  Ray,  M.D., 

Willis  C.  Hoover,  M.D.,  .... 

G.  Pompili,  M.D., 

Charles  W.  Clark,  M.D.,  .... 

E.  T.  Adams,  M.D 

C.  T.  Campbell,  M.D., 

G.  E.  Husband,  M.D., 

Thomas  Nichol,  M.D., 

George  Logan,  M.D., 

G.  G.  Gale,  M.D 

J.  J.  Gaynor,  M.D., 

John  Hall,  M.D 

F.  R.  Day,  M.D., 

George  Bollen,  M.D., 

American. 

F.  F.  De  Derky,  M.D., 

William  E.  Green,  M.D.,  .... 

Hugo  R.  Arndt,  M.D., 

George  E.  Davis,  MD, 

Eugene  F.  Storke,  M.D.,  .... 

Benjamin  H.  Cheney,  M.D.,  . 

Joseph  Paul  Lukens,  M.D. 

Franklin  A.  Gardner,  M.D., 

Tullio  S.  Verdi,  M.D., 

Henry  R.  Stout,  M.D., 

Francis  H.  Orme,  M.D., 

O,  S.  Runnels,  M.D., 

Allen  C.  Cowperthwaite,  M.D.,  . 

Peter  Diederick,  M.D., 


Vienna,  Austria. 
Vienna,  Austria. 
Paris,  France. 
Paris,  France. 
London,  England. 
Liverpool,  England. 
Brighton,  England. 
Southampton,  England. 
Grantham,  England. 
London,  England. 
Dresden,  Germany. 
Chemnitz,  Saxony,  Germany. 

Carlsbad,  Germany. 
Moscow,  Russia. 
Calcutta,  Ind. 
Basle,  Switzerland. 
Copenhagen,  Denmark. 
City  of  Mexico. 
. Rome. 

Montevideo. 
Melbourne,  Australia. 
. Iquique,  Chili,  S.  A. 

Rome,  Italy. 
. Winnipeg,  Manitoba,  Can. 

Toronto,  Can. 
London,  Can. 
Hamilton,  Can. 
Montreal,  Can. 
Ottawa,  Kan, 
Quebec,  Can. 
St.  John’s,  Can. 

Vancouver. 
Honolulu,  S.  I. 
South  Australia. 


Mobile,  Ala. 
Little  Rock,  Ark. 
San  Diego,  Cal. 
San  Francisco,  Cal. 

Denver,  Colo. 
New  Haven,  Conn. 
Wilmington,  Del. 
N.  W.,  Washington,  D.  C. 
Washington,  D.  C. 
Jacksonville,  Fla. 

Atlauta,  Ga. 
Indiauapolis,  Ind. 

Chicago,  111. 
Kansas  City,  Kan . 


COMMITTEES 


XI 1 1 


Andrew  L.  Monroe,  M.D., 

W.  H.  Holcombe,  M.D.,  . 

Rufus  Shackford,  M.D., 

F.  C.  Drane,  M.D.,  . 

John  Preston  Sutherland,  M.D., 

I.  Tisdale  Talbot,  M.D., 

Conrad  Wesselhoeft,  M.D.,  . 
Henry  C.  Obetz,  M.D.,  . 

Charles  Gatchell,  M.D., 

Chester  G.  Higbee,  M.D., 

H.  W.  Brazie,  M.D., .... 
James  Campbell,  M.D.,  . 

T.  G.  Comstock,  M.D., 

Moses  T.  Runnels,  M.D., 

Charles  S.  W.  Thompson,  M.D.,  . 

William  Henry  Hanchett,  M.D., 
Ezekiel  Morrill,  M.D., . 
Theodore  Y.  Kinne,  M.D.,  . 

Timothy  F,  Allen,  M.D., 

Asa  S.  Couch,  M.D.,  . 

William  Tod  Helmuth,  M.D., 
Edwin  M.  Kellogg,  M.D., 

Horace  M.  Paine,  M.D., 

Thos.  Franklin  Smith,  M.D., 

A.  R.  Wright,  M.D., 

Samuel  W.  Rutledge,  M.D.,  . 

T.  C.  Bradford,  M.D., 

D.  H.  Beckwith,  M.D.,  . 

J.  D.  Buck,  M.D.,  . 

H.  F.  Biggar,  M.D 

John  C.  Sanders,  M.D.,  . 

C.  J.  Jones,  M.D.,  .... 

Ammi  S.  Nichols,  M.D.,  . 

Thomas  L.  Bradford,  M.D.,  . 
John  C.  Burgher,  M.D.,  . 
Pemberton  Dudley,  M.D., 

A.  R.  Thomas,  M.D,, . 

Bushrod  W.  James,  M.D., 

J.  H.  McClelland,  M.D., 

George  B.  Peck,  M.D.,  . 

James  S.  Bell,  M.D., 

Owen  B.  Gause,  M.D., 


Jabez  P.  Dake,  M.D., 
Charles  E.  Fisher,  M.D., 

H.  H.  Crippen,  M.D., 

Henry  E.  Parker,  M.D., 
Frank  P.  Webster,  M.D., 
Charles  Y.  Young,  M.D., 

H.  B.  Bagley,  M.D., 

Oscar  W.  Carlson,  M.D., 
Austin  Frederick  Olmstea 
Lewis  Sherman,  M.D.,  . 


, M.D. 


Louisville,  Ky. 
New  Orleans,  La. 
Portland,  Me. 
Baltimore,  Mel.’ 
Boston,  Mass 
Boston,  Mass. 
Boston,  Mass. 
Detroit,  Mich. 
Ann  Arbor,  Mich. 
St.  Paul,  Minn. 
Minneapolis,  Minn. 
St.  Louis,  Mo. 
St.  Louis,  Mo. 
Kansas  City,  Mo. 
Helena,  Mont. 

Omaha,  Neb. 
Concord,  N.  H. 
Paterson,  N.  J. 
New  York  City. 
Fredonia,  N.  Y. 
New  York  City. 
New  York  City. 

Albany,  N.  Y. 
New  York  City. 
Buffalo,  N.  Y. 
Grand  Forks,  N.  D. 
Cincinnati,  O. 
Cleveland,  O. 
Cincinnati,  O. 
Cleveland,  O, 
Cleveland,  O. 
Cleveland,  O. 
Portland,  Ore. 
Philadelphia,  Pa. 

Pittsburgh,  Pa. 
Philadelphia,  Pa. 
Philadelphia,  Pa. 
Philadelphia,  Pa. 

Pittsburgh,  Pa. 
Providence,  R.  I. 
Canton,  S.  D. 
Aiken,  S.  C. 
Nashville,  Tenn. 
Chicago,  111. 
Salt  Lake  City,  Utah, 
Barre,  Yt. 
Norfolk,  Ya. 
Lynchburg,  Va. 

Seattle,  Wash. 
Milwaukee,  Wis. 
Green  Bay,  Wis. 
Milwaukee,  Wis. 


XIV 


WORLD  S HOMOEOPATHIC  CONGRESS. 


Woman’s  Council. 


Susan  A.  Edson,  M.D., 

Washington,  D.  C. 

Harriet  J.  Sartain,  M.D., 

Philadelphia,  Pa. 

Prof.  Adaline  B.  Church,  M.D., 

Boston,  Mass. 

Prof.  Sarah  E.  Sherman,  M.D., 

Salem,  Mass. 

Emily  V.  Pardee,  M.D., 

South  Norwalk,  Conn. 

Millie  J.  Chapman,  M.D., 

Pittsburgh,  Pa. 

Mrs.  H.  Tyler  Wilcox,  M.D., 

Eureka  Springs,  Ark. 

Anna  H.  Warren,  M.D., 

Dennison,  Tex. 

Genevieve  Tucker,  M.D., 

Pueblo,  Colo. 

Nellie  R.  Harris,  M.D 

Des  Moines,  la. 

Julia  C.  Jump,  M.D.,  . ’ 

Oberlin,  0. 

Sarah  Hicks,  M.D., 

Atlanta,  Ga. 

Sarah  J.  Millsop,  M.D., 

Bowling  Green,  Ky. 

Margaret  L.  Sabin,  M.D., 

Lincoln,  Neb. 

Gertrude  Gooding,  M.D., 

Bristol,  R.  I. 

Lizzie  G.  Gutherz,  M.D., 

St.  Louis,  Mo. 

Adele  S.  Hutchison,  M.D., 

Minneapolis  Minn. 

Flora  B.  Brewster,  M.D., 

Baltimore,  Md. 

Alice  Burritt,  M.D., 

Oakland,  Cal. 

Pauline  Emerson  Canfield,  M.D.,  .... 

Kansas  City,  Mo. 

Catharine  Parsons,  M.D., 

Cleveland,  0. 

ORGANIZATION. 


Hon.  C.  C.  Bonney,  President  of  the 
World’s  Congress  Auxiliary 
Mrs.  Potter  Palmer,  President  of  the  Woman’s 
Branch  of  the  World’s  Congress  Auxiliary. 

Honorary  Presidents. 

Richard  Hughes,  M.D.,  President  j 
International  Congress  of  1881,  J 

I.  T.  Talbot,  M.D.,  President  Inter-  ) 

national  Congress  of  1891,  i 

President. 

,T.  S.  Mitchell,  M.D., 

Vice-Presidents. 

R.  Ludlam,  M.D., 

Julia  Holmes  Smith,  M.D., 

Honorary  Vice-Presidents. 

J.  H.  McClelland,  M.D.,  President  Ameri- ) 

can  Institute  of  Homoeopathy,  J 

Galley  Blackley,  M.D.,  President  British  Homoeopathic  Society. 

E.  A.  Rushmore,  M.D.,  President  International  Hahnemannian  Society. 

And  Presidents  and  Ex-Presidents  of  all  other  National  Homoeopathic  Societies. 


Chicago,  111. 
Chicago,  111. 

Brighton,  Eng. 
Boston,  Mass. 

Chicago,  111. 

Chicago,  111. 
Chicago,  111. 

Pittsburgh,  Pa. 


W.  A.  Dunn,  M.D.,  . 


Secretary. 


Chicago,  111 


COMMITTEES. 


XV 


Honorary  Secretary. 

Pemberton  Dudley,  M.D.,  Secretary  Ameri-  j Philadelphia  Pa 

can  Institute  of  Homoeopathy,  J 

Secretary  World's  Congress  Auxiliary. 

Clarence  E.  Young, Chicago.  111. 

Recording  Secretary. 

T.  M.  Strong,  M.D., Boston,  Mass. 

Chairman  Committee  of  Registration  and  Statistics. 

T.  Franklin  Smith,  M.D., New  York,  N.  Y. 

Chairman  Committee  on  Foreign  Correspondence. 

Wesley  A.  Dunn,  M.D., Chicago,  111. 


SECTIONS. 

Surgery. 

Wm.  B.  Yan  Lennep,  M.D.,  Chairman,  .... 

Philadelphia,  Pa. 

Gynaecology. 

0.  S.  Runnels,  M.D.,  Chairman, 

Indianapolis,  Ind. 

Ophthalmology  and  Otology. 
A.  B.  Norton,  M.D.,  Chairman 

New  York,  N.Y. 

Materia  Medica. 

A.  C.  Cowperthwaite,  M.D..  Chairman, 

Chicago,  111. 

Obstetrics. 

T.  Griswold  Comstock,  M.D.,  Chairman, 

St.  Louis,  Mo. 

Clinical  Medicine. 

Charles  Gatchell,  M.D.,  Chairman,  . . . 

Ann  Arbor,  Mich. 

Mental  and  Nervous  Diseases. 
Selden  H.  Talcott,  M.D.,  Chairman,  . 

Middletown,  N.  Y. 

Rhinology  and  Laryngology. 
Horace  F.  Ivins,  M.D.,  Chairman,  .... 

Philadelphia,  Pa. 

Paedology. 

Emily  V.  Pardee,  Chairman, 

South  Norwalk,  Conn. 

Committee  on  Business. 

T.  Y.  Kinne,  M.D.,  Chairman, 

I.  T.  Talbot,  M.D., 

C.  G.  Higbee,  M.D., 

D.  H.  Beckwith,  M.D., 

Paterson,  N.  J. 

Boston,  Mass. 
St.  Paul,  Minn. 
Cleveland,  0. 

Committee  on  Resolutions. 

J.  P.  Dake,  M.D.,  Chairman, 

Bushrod  W.  James,  M.D.,  • 

0.  S.  Runnels,  M.D., 

R.  Ludlam,  M D., 

J.  A.  Albertson,  M.D., 

Nashville,  Tenn. 
Philadelphia,  Pa. 
Indianapolis,  Ind. 

Chicago,  111. 
San  Francisco,  Cal. 

RULES  OF  ORDER . 


1.  All  Homoeopathic  physicians  attending  the  Congress  shall 
have  equal  rights  as  members. 

2.  The  President  shall  appoint  and  announce  at  the  first  session 
of  the  convention,  committees  on  business  and  on  resolutions,  of  five 
members  each. 

3.  The  Committee  on  Business  shall  consider  and  report  such 
measures  as  it  may  deem  necessary  for  promoting  and  expediting  the 
work  of  the  Congress. 

4.  The  Committee  on  Resolutions  shall  consider  the  subject-mat- 
ter of  resolutions  and  all  other  business  that  may  be  submitted  to  it, 
and  shall  report  thereon  at  such  times  as  the  Congress  may  direct. 

5.  Addresses,  except  that  of  the  President,  shall  not  occupy  more 
than  thirty  minutes  in  their  delivery,  and  papers  in  each  section  not 
more  than  twenty  minutes,  except  by  general  consent  of  the  conven- 
tion. 

6.  Members,  announced  by  the  President  to  lead  in  discussions, 
shall  not  occupy  more  than  ten  minutes.  Other  members  partici- 
pating in  the  discussion  shall  not  consume  more  than  five  minutes. 
No  member  shall  speak  more  than  once  upon  any  subject  under  dis- 
cussion. The  author  of  the  paper  shall  have  the  privilege  of  closing 
the  discussion  thereon.  Debate  on  any  single  subject  shall  be  lim- 
ited to  one  hour. 

7.  Presentation  of  reports  on  the  condition  and  progress  of  Hom- 
oeopathy in  foreign  States  and  countries  shall  be  limited  to  twenty 
minutes  each. 

8.  Resolutions  and  motions  having  the  effect  of  resolutions  shall 
be  read  and  referred  to  the  Committee  on  Resolutions  for  acceptance. 
They  shall  be  open  for  discussion  when  reported  back  by  the  com- 
mittee. 

9.  Reports  and  recommendations  from  the  Committee  on  Business 
shall  be  first  in  order  at  the  opening  of  each  morning  session. 


PROCEEDINGS  OF  THE  CONGRESS. 


Chicago,  III.,  May  29,  1893. 

The  World’s  Congress  of  Homoeopathic  Physicians  and  Surgeons 
assembled  in  the  “Hall  of  Washington,”  in  the  Art  Institute  at 
eight  o’clock  p.m. 

The  officers  of  the  World’s  Congress  Auxiliary,  and  of  the  Con- 
gress of  Homoeopathy,  and  also  the  officers  of  the  American  Insti- 
tute of  Homoeopathy,  occupied  seats  upon  the  platform,  together 
with  several  delegates  to  the  Congress  from  foreign  countries.  The 
large  auditorium  was  well  filled  by  physicians  and  their  friends. 

The  meeting  was  called  to  order  by  Hon.  C.  C.  Bonney,  Presi- 
dent of  the  World’s  Congress  Auxiliary,  and  at  his  request,  Rev.  T. 
G.  Milsted,  chaplain  of  the  organization,  led  the  audience,  in  prayer,, 
which  was  followed  by 

President  Bonney’s  Opening  Address^ 

It  is  what  Mr.  Milsted’s  predecessor,  thebeloved  Robert  Collyer, 
would  call  the  simple  truth,  that  the  present  occasion  is  the  most 
interesting  and  in  some  respects  the  most  noteworthy  event  of  the 
history  of  Homoeopathic  medicine  and  surgery.  In  every  part  of 
the  world  in  which  this  body  of  the  medical  profession  exists,  the 
hearts  of  its  members  are  turned  towards  this  Art  Palace  to-night, 
with  earnest  wishes  for  the  most  brilliant  and  satisfactory  success. 

Many  are  here  to  participate  in  these  ceremonies,  but  for  every 
one  who  honors  them  by  his  presence  there  are  many  hundreds  who 
wish  they  were  here,  and  who,  though  absent  in  body  are  yet  with 
us  in  their  hearts. 

Homoeopathy  represents  in  the  medical  world'  that  which  may  be 
designated — borrowing  and  slightly  paraphrasing  a phrase  from  the 
new  movement  in  literature  in  our  kindred  republic  of  France — as 
the  spiritualization  of  thought  in  the  world  of  medicine. 

Entering  the  medical  world  at  a time  when  it  was  in  many 

2 


18 


world’s  homceopathic  congress. 


marked  respects  different  from  what  it  is  to-day.  Homoeopathy 
seemed,  to  the  casual  observer,  to  be  working  the  most  miraculous 
cures  with  nothing  ! It  was  so  startling  in  its  claims  and  the  re- 
sults were  so  marked  when  tested  by  the  logic  of  statistics,  that  the 
advent  of  Homoeopathy  into  the  world  of  medicine  presently  stimu- 
lated a new  and  zealous  inquiry  on  the  part  of  thoughtful  medical 
minds  into  the  mysteries  and  principles  of  the  science  and  the  art  of 
medicine. 

This  Homoeopathic  movement  emphasized,  as  nothing  else  had 
ever  done  before,  and  as  nothing  has  done  since,  the  marvellous 
medical  power  of  nature.  It  immediately  set  the  medical  world  to 
thinking  that  if  agencies  so  delicate  and  subtle  that  they  could 
neither  be  weighed  nor  measured ; neither  felt  nor  heard,  could  do 
so  much,  there  must  be  something  deeper  in  the  science  of  medicine 
than  they  had  heretofore  discovered;  and  to-day  it  is  not  my  voice 
nor  the  voice  of  Homoeopathic  physicians  only,  but  also  the  voices 
of  distinguished  members  of  the  general  profession  of  medicine  and 
surgery — as  the  presiding  officer  of  this  Congress  heard  in  my  pres- 
ence the  other  day — which  declare  that  of  all  the  blessings  which 
the  general  profession  of  medicine  and  surgery  has  received,  those 
derived  from  Homoeopathy  are  easily  first  and  most  useful. 

This  is  said,  not  in  a spirit  of  rivalry,  much  less  in  a spirit  of 
censure,  but  it  is  in  the  spirit  of  utmost  cordiality,  and  brotherhood. 
For  I can  testify  on  this  occasion,  that  of  the  persons  instrumental 
in  promoting  the  organization  of  this*  Congress,  some  were  members, 
not  of  the  Homoeopathic,  but  of  the  general  profession  of  medicine 
and  surgery. 

The  immense  influence  exerted  by  the  Homoeopathic  School  of 
medicine  and  surgery  on  the  general  profession,  did  not  end  its  in- 
fluence there.  It  exerted  at  the  same  time  a tremendous  influence 
on  the  mind  of  patients,  and  on  public  opinion  generally.  It  awak- 
ened curiosity;  it  stimulated  investigation;  it  excited  research,  and 
the  result  has  been  of  the  greatest  benefit  to  physicians  and  surgeons 
the  whole  world  over,  without  distinction  of  school.  This  agitation 
has  produced  an  intelligent  class  of  patients.  No  physician  can  deal 
most  successfully  with  disease,  without  the  co-operation  of  an  intelli- 
gent patient.  Ignorance  stands  the  greatest  barrier  in  the  way  of 
the  success  of  the  intelligent  physician  and  surgeon.  To  overcome 
that  ignorance ; to  substitute  for  it  a general  appreciation  of  the 


ADDRESSES. 


19 


nature  of  the  work  to  be  done,  a willingness  in  the  heart  of  the 
patient  to  co-operate  with  his  physician,  is,  as  every  wise  physician 
and  surgeon  knows,  of  immense  importance  to  the  desired  cure. 

We  do  not  seek,  the  medical  profession  does  not  desire,  that  every 
one  should  become  his  own  doctor  any  more  than  that  every  one 
should  become  his  own  blacksmith,  his  own  tailor,  his  own  dry- 
goods  merchant,  his  own  railway  carrier.  But  only  that  patients 
shall  be  possessed  of  that  degree  of  intelligence  which  will  enable 
them  to  co-operate  understandingly  with  the  efforts  made  in  their 
behalf. 

The  results  of  the  influences  to  which  I have  referred  in  other 
fields  have  been  to  promote  what  did  not  exist  fifty  years  ago  at  all 
in  any  school  of  a popular  nature,  the  study  of  the  general  princi- 
ples of  anatomy,  physiology,  and  hygiene,  which  has  now  become 
common  all  over  the  land.  To  know  something  of  the  laws  of  life 
and  health  ; to  have  some  intelligent  understanding  of  the  structure 
of  that  most  wonderful  of  all  creations,  the  human  body;  to  have 
some  knowledge  of  the  rules  which  must  be  obeyed  if  health  would 
be  preserved ; to  know  something  of  the  conditions  under  which 
great  toil  can  be  endured  and  the  system  yet  not  break  down  ; these 
are  things  which  every  intelligent  physician  and  surgeon  to-day 
desires  to  have  known  by  the  whole  body  of  the  people. 

The  organization  of  the  World’s  Congresses  of  1893  has  been 
effected  by  local  Committees  of  Organization,  one  of  men,  and  a cor- 
responding one  of  women.  Recognizing  the  fitness  of  the  advent  of 
women  into  so  many  new  fields  of  usefulness  and  honor,  the  World’s 
Congress  Auxiliary  in  cases  proper  for  the  participation  of  women 
has  appointed  a committee  to  co-operate  in  the  organization  of  the 
Congress  with  the  corresponding  committee  of  men.  The  two  local 
committees  which  had  the  organization  of  this  Congress  in  charge 
are  represented  respectively  by  Dr.  J.  S.  Mitchell  on  the  one  hand 
and  Dr.  Julia  Holmes  Smith  on  the  other.  These  local  Committees 
of  Organization  however,  could  not  undertake  to  organize  a World’s 
Congress  on  Medicine  and  Surgery  without  the  co-operation  of  repre- 
sentative minds  selected  from  all  countries  where  the  profession  has 
been  established.  For  this  reason  an  Advisory  Council  consisting 
perhaps  of  a hundred  or  more  of  physicians  and  surgeons,  located 
in  different  States  and  countries,  was  selected  to  constitute  the  non- 
resident branch  of  these  committees  of  organization. 


20 


world’s  homoeopath ic  congress. 


Medical  organizations  of  the  different  States  and  countries  were 
invited  to  appoint  Committees  of  Co-operation,  and  act  with  these 
committees  and  Advisory  Councils  in  perfecting  the  work. 

Nothing  remains  for  me  but  to  extend  to  you,  as  I now  do,  on 
behalf  of  the  World’s  Congress  Auxiliary,  and  on  behalf  of  the 
authorities,  municipal,  State  and  National  which  have  co-operated 
to  this  end,  a most  hearty  and  cordial  welcome  to  the  World’s  Con- 
gresses of  1893,  especially  to  the  World’s  Congress  on  Homoeopathic 
Medicine  and  Surgery.  It  is  also  fitting  that  the  representative  of 
the  Woman’s  Branch  of  the  World’s  Congress  Auxiliary  should 
extend,  in  behalf  of  the  women  whom  &he  represents,  the  women  of 
all  States  and  countries  represented  here,  her  own  welcome  on  this 
occasion.  I therefore  have  the  honor  of  introducing  to  you  Mrs. 
Charles  Henrotin,  who  will  now  address  you  on  behalf  of  the 
Woman’s  Branch  of  the  World’s  Congress  Auxiliary. 

Mrs.  Charles  Henrotin’s  Address. 

Mr.  Chairman , Ladies  and  Gentlemen:  Dr.  Julia  Holmes  Smith 
and  her  committee  have  kindly  given  me  this  opportunity  to  extend 
the  welcome  of  the  Woman’s  Branch  to  the  gentlemen  and  ladies 
participating  in  this  Congress,,  and  I have  been  asked  by  them  also 
to  speak  a few  words  on  medical  women,  from  the  standpoint  of  an 
outsider.  I shall  carefully  refrain  from  doing  that;  but  I may,  if 
you  will  bear  with  me,  try  to  voice  what  appears  to  me  to  be  the 
salient  points  of  the  participation  of  women  in  this  Congress. 

This  is  the  first  time  in  the  medical  profession  in  which  women 
have  obtained  an  equal  recognition  in  the  deliberations  of  any  con- 
gress. Being  represented  as  they  are  by  the  Woman’s  Committee 
of  the  Woman’s  Branch  of  the  World’s  Congress  Auxiliary,  which 
association  is  recognized  by  government,  they  are  therefore  taking 
part  in  the  deliberations  of  a governmental  congress.  The  congress 
of  representative  women  which  preceded  this  was  apsean  of  praise  as 
to  what  women  had  accomplished  since  the  discovery  of  America,  and 
also  voicing  their  hopes  for  the  future.  But  the  truth  of  the  matter 
is  that  women  will  be  judged  by  the  part  which  they  will  take  in 
the  series  which  is  now  inaugurated,  because  this  series  of  congresses, 
commencing  with  the  medical  congresses,  deals  with  specialized  lines 
of  light,  as  educational,  industrial,  professional,  and  it  is  along  that 
line  of  specialization  that  modern  life  is  tending.  By  their  perception 


ADDRESSES. 


21 


and  deliberations  in  these  congresses,  they  will  show  on  which  points 
they  are  weak  and  on  which  they  are  strong  ; and  they  will  thus 
emphasize  not  only  woman’s  attainments  but  also  what  she  has  done 
along  the  line  of  specialized  effort;  and  in  this  modern  civilization, 
if  women  hope  to  compete  at  all,  it  is  very  necessary  that  they  realize 
their  position  in  this  way. 

There  must  be  some  cause  for  the  few  women’s  names  which  ap- 
pear on  this  programme.  I leave  it  for  the  women  participating  in 
the  Congress  to  say  what.  Is  it  because  they  so  largely  devote  their 
professional  efforts  to  practice  among  women  and  children,  or  do 
they,  when  they  graduate,  give  up  their  studies,  contenting  themselves 
with  a fair  practice  and  without  making  their  profession  the  love  of 
their  lives  as  well  as  the  means  of  earning  their  daily  livelihood  ? 

This  generous  recognition  of  women  in  the  profession,  as  shown 
by  these  congresses,  should  be  the  greatest  incentive  to  them  to  prove 
themselves  to  be  worthy  of  it,  and  to  demonstrate  their  fitness  to 
take  an  equal  position  with  their  brother  physicians.  It  may  be, 
however,  that  the  future  of  the  professions  will  prove  that  the  love 
of  the  exact  sciences  is  not  ours,  but  that  we  will  take  up  rather 
the  general  practice  underlying  the  home,  the  perfection  of  medical 
appliances,  the  trained  nurses,  thus  bringing  into  the  profession  the 
practical  details  on  which  depend  after  all  half  the  success  of  the 
physician. 

With  all  modesty,  I leave  these  suggestions  to  the  women  taking 
part  in  the  deliberations  of  the  Congress,  and  I reiterate  my  wel- 
come to  you,  ladies  and  gentlemen. 

Mr.  Bonney  : With  a patience,  skill,  energy  and  devotion  to 
duty  worthy  of  the  highest  praise,  Dr.  J.  S.  Mitchell,  Chairman  of 
the  General  Committee  of  Organization  of  this  Congress,  has  pur- 
sued the  labor  of  organizing  it  during  the  past  three  years.  I have 
now  the  pleasure  and  honor  to  present  to  you,  as  the  presiding  officer 
of  this  Congress,  Dr.  J.  S.  Mitchell,  of  Chicago. 

Dr.  Mitchell,  on  taking  the  chair,  was  greeted  with  hearty  ap- 
plause. He  said : 

Ladies  and  Gentlemen:  I take  pleasure  in  introducing,  as  the  next 
speaker,  Dr.  James  H.  McClelland,  of  Pittsburgh,  Pennsylvania, 
President  of  the  American  Institute  of  Homoeopathy,  the  oldest 
national  medical  association  in  the  United  States. 


22 


world’s  homoeopathic  congress. 


Address  of  Dr.  J.  H.  McClelland. 

Mr.  Chairman , Ladies  and  Gentlemen,  Members  of  the  Congress:  It 
affords  me  very  great  pleasure  indeed  to  represent  the  American 
Institute  of  Homoeopathy  on  this  occasion,  and  to  add  my  words  of 
welcome  to  those  who  have  preceded  me.  You  will  all  agree  that 
our  grateful  acknowledgments  are  due  to  President  Bonney  and  to 
President  Palmer  and  her  able  coadjutor,  Mrs.  Henrotin,  God  bless 
them,  that  we  have  an  opportunity,  in  these  series  of  scientific  con- 
gresses that  have  been  inaugurated  as  a conspicuous  feature  of  the 
sublime  demonstration  that  will  go  into  history  as  the  Columbian 
Exposition.  That  there  has  been  a most  liberal  expenditure  of 
time  and  labor  and  money  to  complete  the  arrangements  for  this 
Congress,  we  well  know^,  and  the  committees  represented  by  Dr.  J. 
S.  Mitchell  and  SfasJ^Tul  ia  Holmes  Smith — God  bless  her  too — 
merit  our  unqualified  thanks.  The  work  has  been  well  and  truly 
done. 

This  Congress,  unlike  previous  ones  of  our  school,  has  been  con- 
vened under  the  auspices  and  fostering  care  of  the  World’s  Congress 
Auxiliary  ; yet  the  American  Institute  of  Homoeopathy  maintains  a 
cordial  interest  in  its  welfare,  as  the  parent  organization.  This  in- 
terest is  further  manifested  by  its  adjourning  over  its  scientific  work 
until  next  year,  that  all  efforts  might  be  concentrated  upon  the  work 
of  the  Congress.  Under  the  auspices  of  our  national  body,  which, 
many  of  you  know,  is  the  oldest  medical  association  in  this  country, 
now  entering  its  fiftieth  year,  there  was  held  the  memorable  Con- 
gress of  1876,  under  the  leadership  of  the  immortal  Dunham. 
Three  others  have  been  held  since,  the  last  under  the  leadership  of 
that  leader  of  men,  Dr.  I.  Tisdale  Talbot,  which  achieved  even 
greater  success  than  the  gathering  of  1876. 

We  now  inaugurate  the  Columbian  Congress  of  1893,  and  are 
gathered  this  evening  under  auspices  most  fair  and  auspicious,  under 
an  official  patronage  and  fostering  care  of  which  we  feel  justly  proud. 
We  take  our  place  in  a line  of  scientific  congresses  unequalled  in 
the  world’s  history,  and  from  which  will  flow  results  far  reaching 
and  of  great  good  to  mankind. 

This  Congress,  let  me  suggest,  stands  for  more  than  a report  upon 
the  medical  sciences  in  general,  great  and  important  as  they  are.  It 
stands  for  a reformation  in  the  science  of  therapeutics  more  far  reach- 
ing and  important  than  any  of  ancient  or  modern  times.  While 


ADDRESSES. 


23 


this  great  Exposition  represents  the  advance  in  every  branch  of 
human  knowledge  since  Columbus  touched  our  shores,  four  hundred 
years  ago,  this  Congress  will,  in  some  measure,  show  forth  the  ad-’ 
vance  in  medicine  since  Hahnemann,  our  veritable  Columbus,  made 
his  discoveries  a single  century  ago.  And  I am  not  overstating 
when  I say  the  changes  are  equally  great.  The  world,  indeed,  owes 
more  than  it  can  ever  repay  to  that  great  and  good  man  whose 
mighty  genius  brought  about  this  great  reformation. 

I noticed  in  that  imperial  dome,  which  this  wonderful  people  have 
erected  in  that  white  city  by  the  lake,  inscribed  the  names  of  such 
medical  heroes  as  Hippocrates  and  Galen  and  Harvey  and  Hunter 
and  so  on,  but  the  name  most  worthy  to  occupy  a conspicuous  place 
in  that  line  of  worthies  was  that  of  Samuel  Hahnemann  ; and,  my 
friends,  the  time  is  ripe  when  suitable  memorials  should  be  erected 
to  his  memory.  Not  only  in  the  interest  of  the  governing  princi- 
ples alluded  to,  however,  are  we  assembled  here  this  evening,  but  for 
the  advancement  of  each  and  every  branch  of  our  beloved  art ; and 
we  commit  this  great  task  to  the  Congress  now  assembled  with  great 
confidence.  It  is,  therefore,  with  the  greatest  good-will  that  the 
American  Institute  on  this  occasion  gives  place  to  the  World’s  Con- 
gress, and  joins  in  the  voice  of  welcome  which  flows  in  such  generous 
measure  here  to-night. 

The  Chairman  : It  is  well  known  that  these  congresses  have 
been  conducted  by  the  united  and  harmonious  labor  of  men  and 
women.  I now  introduce  Dr.  Julia  Holmes  Smith,  who  has  worked 
so  effectually  as  the  Chairman  of  the  Woman’s  Congress. 

Address  of  Dr.  Julia  Holmes  Smith. 

Mr.  Chairman , Members  of  the  American  Institute  and  Men  and 
Women  Who  are  Interested  in  What  is  Going  on  Here : I come  to 
greet  you,  and  I come  to  thank  you  for  your  presence,  because  that 
presence  means  your  interest,  and  I come  to  bespeak  in  your  behalf 
a charity.  A charity  for  what?  For  the  minority.  My  chief, 
Mrs.  Henrotin,  has  said  to-night  she  was  surprised  to  see  so  few 
names  of  women  on  the  programme.  Will  you  tell  me  why?  Mrs. 
Henrotin  is  not  a doctor.  She  does  not  know,  she  has  never  thought 
of  the  dark  days  and  the  anxious  nights,  and  the  hard  work  and 
the  earnest  toil  and  the  great  discouragement  and  the  intense  oppo- 
sition that  we  have  had  from  our  associates,  from  the  men  who  take 


24 


world’s  homceopathic  congress. 


care  of  us,  from  the  men  who  love  us,  from  the  men  who  thought 
we  were  most  charming,  and  from  the  men  who  did  not  wish  us  to 
do  anything  else  but  to  be  sweet.  Now  that  is  a fact,  and  that  is 
the  only  trouble  that  there  are  so  few  names  on  the  programme. 
We  had  rather  stay  at  home — the  majority  of  us.  We  had  rather 
be  taken  care  of— the  majority  of  us.  We  had  rather  do  nothing 
at  all  but  be  what  most  of  the  men  who  love  us  wish  us  to  be. 
It  means  a great  deal  when  a girl  says,  I will  be  a scientist,  I will 
be  a doctor,  I will  be  a chemist,  I will  be  as  Dr.  Talbot’s  daugh- 
ter has  said  she  would  be — a professor  of  coal  economics.  It  means 
putting  aside  a lot  of  nice  things — oh,  so  many  nice  things ! It 
means  the  sacrifice  of  so  much — so  much  that  we  women  love,  and 
it  means  a regular  travelling  on  to  a Gethsemane,  and  it  does  not 
unfrequently  happen  that  that  Gethsemane  ends  in  Calvary,  because 
a woman’s  ambition  killed  is  a woman  crucified. 

Now,  you  can  feel  that  yourselves,  and  you  know  that  yourselves, 
you  men  and  women  who  listen  to  me  to-night.  That  is  why,  Mrs. 
Henrotin,  there  are  few  names  on  the  programme  to-night.  It  means 
much  to  us.  This  century,  this  woman’s  century,  this  century  in 
which  woman  has  had  her  apotheosis,  and  the  apotheosis  has  been 
right  here,  in  the  city  by  the  lake,  in  this  new  and  unknown  city, 
in  the  city  which  fifty  years  ago  was  almost  a wilderness, — in  this 
city  women  have  had — what?  The  recognition  we  have  here  to- 
night from  my  peers.  They  have  not  had  it  before,  and  that  is  the 
reason  why  we  have  so  few  women’s  names  on  the  programme.  We 
are  rejoicing;  and  we  are  indebted  to  America,  we  are  indebted  to 
this  Congress,  we  are  indebted  to  this  nation,  we  are  indebted  to  the 
representatives  of  this  nation,  as  we  have  them  here  in  Mr.  Bonney 
and  Mr.  Henrotin,  that  we  women  have  an  opportunity  to  say  what 
we  think  here,  to  be  what  we  please  here,  and  to  tell  you  what  I am 
telling  you  now,  the  reason  why  there  are  so  few  women’s  names  on 
the  programme.  It  is  not  for  lack  of  ambition  or  study,  but  for  lack 
of  opportunity  heretofore,  and  which  now  is  open  to  us. 

This  is  our  opportunity.  This  is  what  we  have  been  waiting  for, 
and  when  we  have  the  leadership  of  a woman  like  this,  a woman 
who  is  ready  to  say  go,  and  to  hold  up  the  hands  and  the  heels  of 
the  woman  who  is  going,  because  some  of  the  most  beautiful  pictures 
in  the  World’s  Exposition  are  of  women  who  are  flying  along,  their 
arms  outstretched  and  their  feet  in  the  air,  because  of  her  ambition, 


ADDRESSES. 


25 


earnestly,  eagerly,  patiently,  painstakingly,  going  on  and  on ; and 
only  God  knows  where  she  will  succeed,  if  you  will  only  not  put 
weights  on  her  heels. 

There  are  few  names  on  the  programme;  but  it  is  the  fault  of  the 
past.  If  it  ever  happens — and  please  God,  Mrs.  Henrotin,  in  your 
time  and  mine  it  will — that  we  have  another  World’s  Congress  in 
Chicago,  or  anywhere  under  heaven,  there  will  be  many  a name,  so 
many  that  the  woman’s  congress — which  we  had  just  a little  while 
ago,  and  whose  badge  I wear  now,  the  confederated  congress  of 
women — will  be  a petty  thing  compared  to  what  we  shall  have  then, 
in  our  time  and  in  your  time. 

Now,  I wonder  if  there  are  doctors  down  here,  women  doctors, 
and  I wonder  if  they  know  just  exactly  what  I mean  by  these 
words?  I wonder  if  they  feel  as  I feel,  that  it  is  a lack  of  oppor- 
tunity? We  mothers — Mrs.  Henrotin  has  said  it  is  the  domestic 
practice  in  which  we  excel — we  mothers  sit  by  the  fire  and  spin. 
We  conserve  the  money  that  our  husbands  bring  in,  and  we 
do  not  say,  this  is  for  Jane,  and  this  for  Harriet.  What  do  we 
say?  John  must  go  to  college,  and  Harry  must  go  into  the 
navy;  and  so  we  save  and  we  toil.  Why?  Because  of  this  intense 
domestic  instinct.  I would  not  give  it  up;  not  for  one  moment 
would  I give  it  up ; but  it  has  been  a disadvantage  to  all  of  us ; and 
sometimes  it  is  a question  in  my  mind  whether  any  mother  has  a 
right  to  be  anything  but  a mother;  and  whether  any  wife  has  any 
right  to  be  anything  but  a wife.  I would  consecrate  the  professions 
to  women  who  are  in  love  with  the  professions.  I would  consecrate 
ambition  to  women  who  are  in  love  with  ambition.  I would  have 
women  married  to  the  thing.  I would  educate  my  children  to  the 
thing,  if  those  children  had  any  sort  of  sentiment  for  it.  It  must 
be  a love,  it  must  be  an  enthusiasm,  it  must  be  a consecration;  it 
may  be  a martyrdom,  for  we  have  no  right  to  say  to  any  man,  take 
this  part  of  a woman  to  be  your  wife.  I am  very  doubtful,  indeed, 
whether  a woman  can  succeed  as  a physician,  as  a surgeon,  as  a 
chemist,  if  she  rocks  the  cradle  with  her  foot  while  she  studies  her 
anatomy.  When  you  go  into  a medical  school  you  must  write  your- 
self a doctor.  I was  an  old  woman  when  I began,  so  I did  not  have 
the  temptation. 

Another  point,  and  it  is  a very  serious  point,  and  a very  impor- 
tant thing,  that  I have  come  to  say  to-night,  because  this  may  be  the 


26 


world’s  homceopathic  congress. 


last  time  that  I will  ever  talk  at  a world’s  congress,  and  I want  to 
have  my  opportunity : Have  women  failed  ? Have  they  really 

failed?  Have  they  never  been  surgeons?  Have  they  never  been 
alienists?  Have  they  never  been  chemists?  Have  they  never 
been  biologists?  Is  there  no  woman  anywhere  of  whom  we  can  say, 
she  is  a great  woman  in  this  line?  I know  a woman,  of  whom  I 
spoke  the  other  night  in  the  Women’s  Congress,  who  is  now  in  an 
important  position  in  the  Chicago  University ; Emily  Nunn  Whit- 
man. She  is  authority  in  biology,  and  all  the  scientific  journals  in 
America  and  Europe  accept  her  contributions.  She  is  typical.  There 
are  many  others.  I heard  the  other  day  of  a young  woman,  a very 
young  woman,  who  has  not  very  many  years  seen  the  ink  green  on 
her  diploma,  who  has  been  successful  in  ovariotomy  and  laparotomy. 
I know  a woman,  not  very  far  from  me,  who  does  very  good  work 
in  surgery,  and  we  have  name  after  name  that  we  accept  as  authority. 
We  teach  our  students  the  names  of  women  who  have  discovered 
important  matters  and  important  methods  in  various  branches  of 
medicine  and  practice.  We  have  not  failed.  We  have  done  our 
best  according  to  the  opportunity  that  was  given  us,  and  we  thank 
and  bless  and  pray  for  all  sorts  of  good  things  to  come  to  the  men 
who  have  given  us  that  opportunity. 

The  Chairman  : I have  the  honor  of  introducing  a distinguished 
representative  of  our  school  from  abroad,  Hr.  A.  E.  Hawkes,  of 
Liverpool,  England,  President-elect  of  the  British  Homoeopathic 
Congress. 

Address  of  Hr.  Alfred  E.  Hawkes. 

Mr.  Chairman , Ladies  and  Gentlemen:  I am  exceedingly  obliged 
to  you  for  your  kind  reception  of  me  as  representing  some  of  the 
Homoeopaths  of  my  own  country.  I am  exceedingly  glad  also  to 
have  had  the  opportunity  of  coming  to  see  this  great  gathering  of 
those  interested  in  Homoeopathy.  I come  from  the  city  of  Liver- 
pool where  fifty  years  ago  the  revered  Hr.  J.  J.  Hrysdale,  single- 
handed,  fought  the  battle  for  the  truth.  One  after  another  joined 
him  until  he  became  so  strong  in  that  city  that  some  few  years  ago 
one  of  our  greatest  merchants,  Henry  Tait,  offered  to  give  us  some 
twenty-five  thousand  pounds  to  build  a hospital  if  the  society  of 
which  I happened  to  be  President,  the  Homoeopathic  Medical  Soci- 
ety of  Liverpool,  would  carry  on  the  work.  That  hospital  was 


ADDRESSES. 


27 


built  and  is  now  in  good  working  order,  and  we  undertake  any 
kind  of  work  that  turns  up. 

I thank  you  for  your  kindness  and  I have  only  to  say  that  Homoe- 
opathy is  flourishing  in  Great  Britain,  or  in  the  part  of  it  with 
which  I am  familiar,  and  the  question  of  medical  women  and  their 
profession  is  being  not  very  slowly  settled.  The  Scotch  examining 
board  admit  them,  and  they  sometimes  have  to  confess  that  the  wo- 
men get  more  marks  than  the  men.  At  Cambridge,  as  you  know, 
Miss  Fawcett  obtained  sufficient  marks  to  head  the  head  wrangler. 
Women  are  being  examined  in  London  by  perhaps  the  stiffest  ex- 
amining board  in  the  whole  world,  possibly  with  the  exception,  as  I 
am  informed,  of  Vienna,  and  women  there  are  gaining  the  highest 
honors  that  the  University  can  give,  and  obtaining  their  degrees  in 
medicine.  I for  one,  wish  the  women  Godspeed  and  I am  quite 
sure  that  given  fair  play  they  will  give  a good  account  of  themselves. 
My  only  further  hope  is  that  those  women  who  graduate  in  medi- 
cine will  turn  their  attention  to  Homoeopathy,  which  in  so  very 
many  ways  they  are  specially  adapted  to  carry  out. 

The  Chairman  then  introduced  Hr.  J.  Cavendish  Molson,  physi- 
cian of  the  London  Homoeopathic  Hospital,  who  addressed  the 
meeting  as  follows  : 

Address  of  Hr.  J.  Cavendish  Molson. 

Ladies  and  Gentlemen : One  of  our  great  men  on  the  other  side 
of  the  water  said  years  ago,  “ some  men  are  born  to  greatness,  other 
men  achieve  greatness  while  others  have  greatness  thrust  upon 
them.”  I come  in  under  the  third  class.  The  President  of  the 
British  Homoeopathic  Society  wrote  to  me  only  a few  days  ago  ask- 
ing me  if  I would  act  as  representative  of  that  society  at  the  World’s 
Congress  of  Homoeopaths. 

Where  shall  I begin  and  what  shall  I say  ? I arrived  in  New 
York  the  other  day.  I simply  rushed  through  the  city,  and  went 
on  hurriedly  by  the  great  Pennsylvania  Railroad.  Everthing  was 
new  to  me  ; the  four  line  track,  the  stupendous  engines,  the  marvel- 
lous railway  cars,  with  all  their  well  furnished  appointments.  These 
things  arrested  my  attention.  I went  on  and  paused  and  took  full 
breath  at  Washington.  What  did  I see  there?  Such  a city  as  I 
have  seen  nowhere  else.  I have  been  north  and  south  and  east  and 
finally  I have  come  west,  and  the  west  eclipses  all. 


28 


world’s  homoeopathic  congress. 


Last  year  it  was  my  pleasure  to  go  to  the  summit  of  a continent, 
the  North  Cape,  and  there  we  were  photographed  by  the  light  of  the 
midnight  sun.  On  arriving  in  America  what  has  struck  me  most 
of  all,  next  to  the  marvellous  inventive  genius  displayed  on  every 
hand,  is  the  cordial  reception  accorded  to  me.  I have  felt  quite  at 
home.  In  Washington  one  of  the  government  officials  placed  him- 
self at  our  disposal  and  acted  as  our  guide  to  your  wonderful  Ar- 
lington, and  there  spread  out  before  us  in  panoramic  beauty,  lay 
your  glorious  capitol,  with  its  beautiful  obelisk  in  full  view. 

When  I arrived  in  this  city  the  same  welcome,  the  same  kind- 
ness was  extended  to  me  as  there,  but  I think  I must  say  that  I 
would  rather  live  in  Washington  than  in  Chicago.  I have  been  to 
the  top  of  your  Masonic  Temple.  It  was  a marvellous  sight,  but 
every  man  that  could  show  a brick  funnel  seemed  to  vie  with  his 
neighbor  to  make  the  greatest  smoke.  If  you  ever  have  any  clear 
days  here,  which  way  does  the  wind  blow  on  those  days?  I have 
no  doubt  I will  get  an  answer  to  all  these  questions  a little  later. 

Then  your  fair  White  City  came  in  view,  with  all  its  glorious  assem- 
blage of  domes  and  minarets.  But,  ladies  and  gentlemen,  nothing  has 
impressed  me  so  much  as  this  assemblage.  We  are  here  to-night  to 
honor  the  genius  of  Samuel  Hahnemann.  I say  his  genius.  When 
one  goes  out  yonder  they  see  there  marvels  of  the  inventive  faculty 
of  man,  but  do  not  think  of  Hahnemann  as  an  inventive  genius  so 
much  as  a discoverer ; and  it  seems  to  me  that  the  discoveries  of 
scientific  men  vie  with  the  inventive  faculty  in  man.  Of  all  the  dis- 
coveries potent  for  good,  of  all  our  philanthropic  institutions  is  there 
one;  yea  I think  I may  throw  down  the  gauntlet  and  challenge 
every  man  and  woman  here  to  mention  one  discovery  which  can  be 
put  on  a par  with  the  marvellous  discovery  of  Samuel  Hahnemann. 

One  word  in  conclusion.  On  my  return,  of  all  that  I shall  have 
seen  and  heard,  that  which  I shall  wish  most  to  convey  to  my  col- 
leagues will  be  the  kind  and  cordial  reception  which  has  been 
accorded  to  me  all  along  the  line.  I have  yet  much  to  see  before  I 
return. 

The  Chairman  then  introduced  to  the  meeting  Dr.  C.  Bojanus,  of 
Samara,  Russia,  who  addressed  the  Congress  in  his  native  language, 
a translation  of  which  is  here  presented. 


ADDRESSES. 


29 


Address  of  Dr.  Carl  Bo  j anus. 

My  honored  brethren  will  permit  me  to  call,  in  a few  words,  their 
attention  to  the  following  subject,  which  may  prove  useful  to  the 
welfare  of  humanity.  Whilst  working  at  my  answers  to  the  ques- 
tions which  had  been  sent  to  me  by  the  Committee  of  the  World’s 
Congress  Auxiliary  on  Medico- Climatology,  I involuntarily  remem- 
bered what  I had  written  myself  about  meteorological  stations  in 
my  work,  Homoeopathic  Therapeutics  Applied  to  Operative  Surgery , 
published  in  Stuttgardt  in  1880.  The  question  to  be  answered  in 
the  programme  of  the  Climatological  Bureau  was  as  follows : 
“ What  more  can  the  weather  bureaus  do  to  aid  climatologists  and 
disseminate  climatological  knowledge  ? ” My  answer  has  been  given 
in  the  article  sent  to  Dr.  Duncan.  What  was  it,  then,  which  put 
me  in  mind  of  what  I had  written  fourteen  years  ago  about  a work 
of  the  late  Dr.  F.  X.  Horn,  of  Munich,  entitled  About  the  Produc- 
tion of  Diseases  Through  Magnetic , Electric , and  Atmospheric  Influ- 
ences,  a work  which  had  been  read  by  me  with  great  interest  in 
1863?  A most  superficial  look  into  the  book  will  show  at  once  its 
worth  and  its  importance.  I happened  to  hear  that  this  was  not  the 
only  work  of  Dr.  Horn  upon  the  subject.  I tried  to  get  the  rest  of 
his  writings,  but  was  informed  that  these  works  were  all  out  of  sale. 
I succeeded  in  getting,  at  an  antiquarian’s  store,  the  first  mentioned 
work  of  Dr.  Horn,  and  I had  the  pleasure  of  giving  it  to  Dr.  Dun- 
can. During  my  last  stay  in  Wiesbaden,  this  spring,  I became 
acquainted  with  Dr.  Erwein,  of  Mainz,  a Homoeopathic  physician, 
who  had  studied  and  graduated  in  the  College  of  Philadelphia  some 
years  ago.  He  happened  to  have  in  his  library  the  works  of  Dr. 
Horn,  which  I had  tried  to  get  in  vain.  They  consist  of  three 
pamphlets : 

1.  “ The  Cholera  is  an  Intoxication  of  Cyanic  Acid,  Ozone  and 
Todosmon  Miasma,  Proved  by  Dr.  F.  X.  Horn,  Munich,  1874.” 

2.  “ About  the  Causes  Which  Call  Forth  an  Individual  Disposi- 
tion to  Gain  the  Cholera,  with  Proofs  Founded  upon  Magnetic  and 
Electric  Conditions.” 

3.  “ The  Earth  a Magnetic  Pendulum.  Proofs  of  the  Causes  of 
Cholera.  Diminution  of  the  Earth  Magnetism  a Second  Important 
Agent  for  the  Development  of  Cholera.  Munich,  1874.” 

It  seems  to  me  that  just  at  the  present  moment  it  would  be  impor- 
tant to  save  from  oblivion  the  works  of  Dr.  Horn,  and  verify  the 


30 


world’s  homoeopathic  congress. 


experiments  and  observations  upon  which  he  bases  his  opinion,  that 
the  constitution  of  the  air  and  weather  are  the  principal  agents  in 
the  appearance  of  cholera.  This  is  the  reason  which  has  induced 
me  to  propose  this  subject  to  the  attention  of  the  honored  assembly  of 
the  North  American  Institute  of  Homoeopathy,  with  the  request  of 
having  these  pamphlets  translated  into  English  and  published.  I 
have  just  heard  that  some  parts  of  Dr.  Horn’s  works  have  already 
been  made  known  to  the  public  by  the  late  Dr.  Constantine  Hering. 
The  last  news  in  yesterday’s  papers,  that  the  cholera  is  beginning  to 
reappear  in  Europe,  renders  the  moment  still  more  appropriate  for 
the  study  of  these  works,  which  may  prove  useful  to  the  promotion 
of  health  and  security. 

I will  transmit  these  pamphlets  to  my  honored  colleague,  Dr.  Wes- 
selhoeft,  of  Boston,  and  will  ask  him  to  look  over  these  pamphlets 
and  communicate  his  opinion  to  the  Institute.  They  have  been  lent 
to  me  by  Dr.  Erwein,  with  the  condition  of  their  being  returned 
to  him. 

Address  of  Dr.  P.  C.  Majumdar. 

Dr.  P.  C.  Majumdar,  of  Calcutta,  India,  was  introduced,  and  ad- 
dressed the  meeting  as  follows : 

Mr.  President , Ladies  and  Gentlemen : The  honor  you  have  done 
me  is  done  to  a country  once  civilized  and  intelligent,  but  we  have 
nothing  now  to  say  about  India.  We  have  the  country  left,  but  not 
the  former  grandeur  and  magnificence.  Our  people  never  travel  to 
foreign  lands,  and  when  I left  Calcutta  I was  not  acquainted  at  all 
with  the  lives  and  the  manners  of  civilized  people  in  different  parts 
of  the  world.  One  thing  that  brought  me  here  is  the  system  of  medi- 
cine introduced  by  the  immortal  Samuel  Hahnemann,  and  I think 
the  honor  that  you  have  done  me  in  selecting  me  as  the  representa- 
tive of  India  is  through  the  instrumentality  of  that  great  man, 
the  discoverer  and  the  reformer  of  the  medical  science  of  the  present 
day. 

We  cannot  boast  of  many  Homoeopathic  practitioners  in  our  coun- 
try. I can  count  them  on  my  fingers’  ends.  There  are  only  a few 
who  are  practicing  in  some  of  the  big  cities  of  India.  We  have  only 
about  a dozen  in  the  city  of  Calcutta,  and  about  another  dozen  dis- 
tributed throughout  the  whole  of  so  vast  a country  and  so  vast  a 
population.  In  fact,  you  may  say  that  it  is  like  one  drop  in  the 


ADDRESSES. 


31 


ocean.  But  we  have  our  ancient  medical  literature  and  we  have  our 
ancient  medical  system  to  be  invoked  in  my  country  at  the  present 
day.  Though  the  Homoeopathic  system  of  medicine  has  been  intro- 
duced in  India,  still  they  cannot  destroy  the  whole  of  the  physicians 
who  practice  onr  system  of  medicine  before  the  advent  of  the  Euro- 
peans in  that  country,  and  that  is  the  reason  that  we  had  a very  good 
medical  profession  in  ancient  times. 

We  are  told  that  one  of  the  gods  is  the  promulgator  of  medical 
science  in  the  world,  and  he  took  some  poisonous  substance  into  his 
body  and  made  it  a beautiful  medicine.  That  is  to  say,  he  was  not 
killed  by  that  poison,  but  he  became  immortal,  and  he  made  that 
substance,  which  is  the  deadliest  poison,  one  of  the  best  medicines  in 
the  world.  This,  to  my  mind,  shows  the  truth  of  what  Hahnemann 
has  said,  that  the  deadliest  poisons  may  be  the  best  medicine  if  we 
can  know  how  to  prepare  them  and  how  to  use  them  as  medicinal 
substances.  Arsenic,  for  instance,  is  one  of  the  best  medicines  in 
Homoeopathy,  but  it  is  one  of  the  deadliest  poisons  that  we 
know  of. 

Very  recently  we  began  to  teach  Homoeopathy  in  India.  We 
have  a school  of  medicine,  and  we  have  also  established  a Homoeo- 
pathic hospital  only  last  year. 

I have  no  material  facts  to  give  you  as  to  the  brilliant  prospects 
of  Homoeopathy  in  India,  but  I wish  to  say  that  what  we  practice 
in  India  is  pure  Homoeopathy  ; that  is,  such  as  Hahnemann  taught, 
the  purest  in  the  world. 

I am  pained  and  grieved  to  see  in  some  of  the  countries  in  Europe 
and  here  that  there  is  a mixture  of  Homoeopathy  with  Allopathy  ; 
but  that  thing  cannot  happen  in  our  country.  If  we  go  to  practice 
a little  bit  of  Allopathy,  we  are  discredited  that  we  do  not  know 
anything  about  Homoeopathy.  The  people  have  great  belief  in  the 
system  of  Homoeopathy,  so  when  they  require  their  treatment  to 
be  Homoeopathic,  they  want  pure  and  true  Hahnemann  from  begin- 
ning to  end. 

We  have  very  few  books  on  Homoeopathy  in  India;  that  is  to 
say,  very  few  books  written  by  my  countrymen  there  in  English  or 
in  foreign  languages.  We  have  recently  done  something  about  this 
literature  of  Homoeopathy  in  India  by  publishing  a few  books  in 
our  own  language,  and  in  this  way  we  are  trying  to  popularize  Hom- 
oeopathy among  the  vast  population  of  India,  and  I think  some  dav 


32 


world’s  homoeopathic  congress. 


we  will  be  able  to  say  that  we  have  done  much  for  the  cause  of 
Homoeopathy  in  that  vast  country. 

I thank  you  for  your  kindness  and  attention. 

The  Chairman  : I have  to  announce’  the  following  cablegram 
just  received : 

“Dr.  J.  S.  Mitchell,  Chairman  World’s  Congress  of  Homoeopa- 
thy : Greeting. — Theodore  Kafka,  Carlsbad,  Germany.” 

Also  from  Dr.  Alexander  Villers,  of  Dresden,  Germany: 

“ Regrets  that  I cannot  be  present  at  your  meeting.  I send  best 
wishes  for  Congress  and  Homoeopathy.” 

It  is  sometimes  interesting  to  see  ourselves  as  others  see  us,  and  I 
call  upon  our  chaplain,  Rev.  T.  G.  Milsted,  to  address  us. 

Address  of  Rev.  T.  G.  Milsted,  D.D. 

Mr.  Chairman , Ladies  and  Gentlemen , and  Visiting  Physicians  of 
the  Homoeopathic  Congress:  There  will  be  many  subjects  discussed  in 
meetings  held  in  this  building  during  this  week,  but  I choose  as 
my  subject  for  to-night  what  I think  is  the  most  interesting  of  all, 
namely,  the  doctors  themselves.  I have  nothing  to  say  this  evening 
about  the  medicine  part  of  this  meeting.  I am  going  to  say  a few 
words  about  the  man  part.  The  man  part,  I hold,  is  more  impor- 
tant than  the  medicine  part,  for  it  is  the  man  that  can  take  the 
poison,  to  which  our  brother  from  India  referred,  and  make  it  into 
medicine.  You  will  hear  this  week  about  wonderful  operations  that 
can  be  performed  and  have  been  performed.  How  were  they  possi- 
ble? Through  the  man  that  did  them  ? 

Now,  in  my  profession,  theology,  the  pill  is  everything.  The  pills 
are  all  made  up  for  us,  and  all  the  minister  has  to  do  is  to  give 
them  ; and  it  is  heresy  in  my  profession  to  attribute  too  much  to  the 
man.  Everything  must  go  to  the  theological  pill.  But  I know 
that  that  is  not  heresy  in  the  medical  profession,  where  honor,  when 
it  is  due  to  the  man,  is  gladly  rendered.  A diploma  cannot  make 
a good  physician.  The  physician,  far  from  borrowing  his  honor  from 
the  diploma,  lends  it  what  it  has.  A bright  child  said  that  she  could 
tell  true  jewels  from  false  from  the  kind  of  people  that  wore  them  ; 
and  so  the  diploma  can  be  seen  to  be  true  or  false  according  to  the 
person  that  owns  it,  according  to  the  name  that  is  on  it. 

A great  French  artist,  when  looking  on  a gathering  of  rather  li- 
centious art  students,  said  there  were  not  half  a dozen  in  all  the 


ADDRESSES. 


33 


great  assembly  that  would  amount  to  anything,  because,  with  all 
their  technical  skill,  with  their  trained  artistic  ability,  they  had  not 
the  one  great  requisite  for  excellence  in  their  profession,  namely, 
character;  that  underneath  all  technical  skill,  underneath  all  smart- 
ness and  ability,  there  was  the  deep  substratum  of  life,  character, 
out  of  which  all  good  things  proceed  ; and  that  great  scientific 
man,  Huxley,  has  said,  and  Herbert  Spencer  has  quoted  with  ap- 
proval the  saying,  “ that  the  great  discoveries  in  the  scientific  world 
have  proceeded  not  so  much  from  men  of  intellectual  acumen  as 
from  men  of  deep  religiousness  of  nature,  from  men  of  deep 
character.”  And  so  in  the  medical  profession  there  must  be  such 
substratum  of  deep  character  for  excellence. 

A newspaper  editor  once  said  to  a minister  who  had  had  a good  deaf 
of  advertising,  “Mr.  Smith,  the  newspapers  made  you.”  “Ah,  in- 
deed,” responded  the  minister,  “ make  another.” 

How  great  is  the  power  of  the  press  ! The  newspapers  can  make- 
and  unmake  a great  deal,  but  I very  much  doubt,  Mr.  Chairman* 
whether  even  the  newspapers  can  make  a first-class  physician. 

Great  and  good  has  been  the  character  of  the  medical  profession. 
The  doctors,  as  a general  thing,  have  been  true  to  the  great  respon- 
sibilities placed  in  their  hands.  They  have  been  faithful  in  the  is- 
sues of  life  and  death.  They  have  kept  the  sacred  trusts  reposed 
upon  them.  In  the  literature  of  the  Christian  centuries  the  name 
by  which  the  man  of  Nazareth,  Jesus  Christ,  is  oftenest  called 
next  to  that  of  Good  Shepherd,  is  the  Good  Physician,  and  that 
shows  the  regard  which  Christendom  has  for  the  physician.  The 
physician  is  the  friend  of  humanity.  He  is  continually  banishing 
suffering  and  disease.  He  is  discovering  the  demons  that  men  have 
feared  in  their  own  ailments  and  then  in  banishing  those  demons. 
The  physician  is  finding  out  the  laws  of  health  and  then  giving 
their  blessing  unto  men  ; is  finding  out  the  laws  and  the  forces  of 
nature  and  applying  them.  Often,  in  the  time  of  war,  we  are  told 
that  more  men  die  in  the  hospital  through  the  invisible  foe  than 
from  the  bullets  on  the  field  of  battle ; and  if  more  are  dying  in  the 
hospital  in  the  time  of  war,  how  great  we  see  is  the  harvest  of  death 
in  the  time  of  peace;  and  yet  it  is  the  doctors  who  are  fighting  for  us 
this  invisible  form  of  disease.  The  doctors  are  also  philanthropists. 
They  are  more  than  the  mere  friends  of  man — they  are  lovers  of 
men.  They  are  self-sacrificing  where  human  interests  are  concerned.. 

3 


34 


world’s  homoeopathic  congress. 


It  was  said  by  an  old  Latin  poet : “ Whatever  is  related  to  man 
is  not  foreign  to  me.”  Such  is  the  substance  of  it,  and  it  is  said 
that  in  old  Rome  the  plaudits  used  to  ring  whenever  that  sentiment 
was  uttered  in  the  theatre.  Those  words  of  that  old  Latin  poet 
have  been  adopted  as  the  motto  of  one  of  the  colleges  here  repre- 
sented and  not  in  Chicago. 

Now,  of  course,  all  the  good  we  have  to  say  of  the  doctors  belongs 
to  the  ladies  as  well  as  to  the  gentlemen.  Indeed,  if  the  women  in 
the  medical  profession  have  the  same  experience  that  some  of  the 
men  have  had,  the  men  will  have  to  look  out  for  their  laurels.  There 
is  a woman  preacher  in  our  town  who  is  very  much  beloved  by  her 
people,  and  they  wouldn’t  think  of  exchanging  her  for  any  man.  It 
so  happened  that  on  one  Sunday  when  she  was  out  of  her  pulpit 
another  woman  preacher  preached  for  her;  but  this  visiting  preacher 
was  of  a rather  coarse  and  masculine  nature,  and  when  she  had  got 
through  the  people  turned  up  their  noses  and  said,  “ We  don’t  want 
any  more  of  her ; she  isn’t  much  better  than  a man.” 

Now,  with  all  due  respect  to  the  ladies  and  with  all  good  wishes 
for  their  success,  may  that  fate  be  spared  you  gentlemen. 

There  is  a connection  more  or  less  plain  between  the  profession  of 
medicine  and  that  of  theology.  A great  many  people  have  gloomy 
views  in  general,  and  I think  that  springs  from  bodily  ailments.  A 
great  many  people  think  they  are  experiencing  religion  when  they 
only  have  an  attack  of  the  dyspepsia.  There  is  one  church  which 
in  its  Sunday  service  repeats  every  Sunday,  u Good  Lord,  deliver 
us.”  I think  it  would  be  a very  good  thing  if  they  should  say,  and 
if  it  could  be  done,  “ Good  Lord,  reliver  us.”  Then,  I think  their 
health  would  be  very  much  better. 

In  order  that  the  doctors  may  always  hold  the  high  place  in  the 
future  that  they  have  in  the  past,  progress  is  necessary.  This  is  an 
age  of  progress  which  is  just  as  possible  in  medicine  as  in  nearly 
every  other  walk  of  life;  and  the  physician  must  be  a broad  man  of 
wide  culture  and  knowing  many  things.  He  must  ever  be  going 
onward.  He  must  not  be  afraid  of  new  discoveries  as  a great  many 
physicians  were  afraid  of  the  new  discovery  of  Hahnemann.  He 
must  not  be  like  the  hunter  who  turned  back  when  he  struck  the 
trail  of  the  bear,  because  it  was  too  fresh.  A great  many  people 
turn  back  just  where  they  ought  to  go  on  and  achieve  success.  I 
heard  of  an  old  professor  who  was  very  successful  when  he  started 


ADDRESSES. 


35 


out,  but  forty  years  afterwards  his  lecture-room  was  deserted,  and  he 
couldn’t  understand  it,  because  his  lectures  he  said,  were  just  the 
same  as  they  had  been  before. 

The  medical  profession  has  had  its  full  share  of  those  who  have 
advanced,  from  the  time  of  Harvey  down  through  Hahnemann,  to 
many  within  our  own  day,  and  the  mere  fact  that  you  physicians  are 
gathered  together  here  from  all  parts  of  the  civilized  world  shows 
how  much  you  desire  progress. 

Now  I wish  to  say  to  all  you  who  have  come  from  distances  that 
we  want  you  to  stay  with  us  a long  time,  we  want  to  get  acquainted 
with  you  and  want  you  to  get  acquainted  with  us,  and  I have  no 
doubt  that  when  our  brother  from  across  the  water  is  acquainted 
with  us  he  will  much  rather  to  live  here  than  in  Washington. 

The  Chairman,  Dr.  J.  S.  Mitchell,  then  delivered  his  inaugural 
address,  as  follows : 

Inaugural  Address  of  J.  S.  Mitchell,  M.D. 

Ladies  and  Gentlemen : When  the  proposition  to  hold  a World’s 
Congress  of  Homoeopathic  Physicians  and  Surgeons  was  first  made 
by  the  World’s  Congress  Auxiliary,  it  was  felt  by  the  Committee 
addressed  to  be  a duty  which  it  owed  the  profession,  to  see  that 
proper  arrangements  were  made  for  the  holding  of  such  a Congress. 
The  plan  included  the  selection  of  an  advisory  council,  consisting  of 
representative  men  in  our  school,  of  all  lands.  Correspondence  with 
these  demonstrated  that  the  project  met  with  cordial  endorsement 
on  the  part  of  all.  When  at  the  meeting  of  the  American  Institute 
at  Washington,  D.  C.,  in  June,  1892,  it  was  decided  to  hold  the 
next  session  in  connection  with  the  World’s  Congress,  its  success 
was  assured. 

It  was  hoped  that  the  attractions  of  the  great  Exposition  together 
with  those  of  the  Congress  would  bring  no  inconsiderable  number  of 
our  distinguished  foreign  confreres.  It  has  been  learned  that  com- 
paratively few  can  be  with  us  in  person,  but  the  responses  to  the  re- 
quests of  the  committee  for  reports  and  scientific  papers,  have  been 
hearty  and  extensive.  Official  and  personal  letters  in  large  num- 
bers have  been  received,  which  will  be  submitted  at  a later  period 
to  the  Convention  by  the  Secretary.  We  are  grateful  to  those  who 
have  honored  us  with  their  presence  and  extend  a hearty  welcome  on 
the  part  of  all  connected  with  the  Congress. 


36 


world’s  homoeopathic  congress. 


We  call  attention  specially  to  an  interesting  historic  parallel : At 
the  time  of  the  Convention  in  1876,  the  venerable  widow  of  the 
illustrious  founder  of  our  school,  then  residing  in  Paris,  sent  to  the 
Homoeopaths  of  the  world,  with  her  greeting,  a bronze  bust  of  Hahne- 
mann, cast  from  the  marble  one  by  David  d’Anger  which  was 
affirmed  to  be  a perfect  likeness  of  that  distinguished  man.  To- 
night we  have  upon  this  platform  a model  for  an  heroic  statue  of 
Hahnemann,  to  be  erected  at  Washington,  D.  C.,  as  soon  as  the 
necessary  funds  can  be  obtained,  sent  also  from  Paris,  the  scene  of 
Hahnemann’s  latest  triumphs. 

The  400th  anniversary  of  the  discovery  of  a new  continent  is 
being  fittingly  commemorated  by  many  occasions,  but  among  the 
most  notable  are  those  connected  with  the  World’s  Congress  Aux- 
iliary. Long  after  the  grand  and  imposing  architecture  of  the 
“ White  City  ” has  faded  from  memory,  long  after  the  beautiful,  the 
costly,  the  useful  and  attractive  exhibits  it  enshrines  have  been  for- 
gotten, the  records  of  these  gatherings  of  prominent  men  and  women 
of  all  climes  and  shades  of  belief  will  endure.  In  the  tomes  that 
will  be  left  in  every  public  library  in  the  civilized  world  will  be 
inscribed  the  best  thought  of  the  ablest  minds  in  all  departments  of 
human  activity. 

It  was  a fine  conception  to  bring  together  so  many  representative 
men  and  women  at  a time  when  the  highest  products  of  art  are 
being  exhibited.  No  occasion  could  be  more  fitting  and  none  more 
likely  to  effect  desirable  results.  There  is  no  standard  by  which  we 
can  measure  the  work  of  such  a convention  as  the  one  we  inaugurate 
to-night.  Its  programme  outlining  the  week’s  labors,  by  no  means 
tells  the  whole  story.  Its  general  meetings,  at  which  addresses  on 
topics  of  wide  interest  will  be  presented  and  calmly  discussed,  its 
sections  in  which  papers  on  special  subjects  will  be  read  and  de- 
bated with  a completeness  that  no  other  method  offers,  its-  committee 
meetings  at  which  our  most  trained  minds  will  quickly  draw  those 
conclusions  which  are- fraught  with  the  best  interests  of  the  cause — 
these  indeed  are  the  main  features.  But  we  must  realize  that  there 
is  always  in  gatherings  of  men  and  women  of  such  large  propor- 
tions as  we-  now  see,  far  more  than  can  be  estimated  by  actual  re- 
sults. The  casual  remarks,  the  unspoken  thoughts,  the  emulative 
spirit  aroused,  the  constant  interchange  of  views  during  interims, 
and  that  mental  attrition  which,  though  it  gives  immediately  no 


ADDRESSES. 


37 


scintillation,  yet  at  some  time  may  electrify  the  world — aggregate  in 
the  end  a train  of  forces  from  which,  later,  a universe  gets  the  reflex. 

Most  of  the  congresses  that  are  to  be  held  can  boast  of  records  ex- 
tending through  a long  series  of  years.  Centuries  sometimes  count 
for  but  little  in  human  thought.  Medicine  is  as  old  as  man.  Charon 
taught  his  pupils  in  the  recesses  of  a Thessalian  grotto.  To-day 
every  civilized  land  has  its  medical  colleges,  and  some  of  them  are 
palaces  of  science.  The  school  of  medicine  which  is  represented  here 
to-night  has  only  eighty-three  years  of  existence.  During  this  brief 
period  it  has  a history  whose  page  is  more  attractive  than  any  other 
in  the  development  of  medicine;  whether  we  take  the  personal 
career  of  its  illustrious  founder,  the  records  of  the  labors  of  his  dis- 
ciples— often  conducted  under  disadvantages  and  trials  that  would 
have  appalled  the  stoutest  hearts — or  the  results  that  have  accrued 
to  humanity  in  many  lands  through  his  teachings. 

The  reform  in  medical  practice  inaugurated  by  Hahnemann,  and 
which  his  followers  have  so  successfully  carried  out  to  a fruition 
acknowledged  even  by  the  testimony  of  opponents,  constitutes  one  of 
the  world’s  epochs.  Time  is  wanting,  nor  is  the  occasion  opportune, 
for  an  adeqifate  rhumb  of  Hahnemann’s  work  or  an  enunciation  of 
his  principal  tenets.  But  we  may  be  pardoned  for  a glance  at  the 
record  of  our  school ; for  an  attempt  to  show  the  position  it  to-day 
occupies  in  the  world  of  medicine  and  for  a brief  reference  to  its 
destiny. 

The  first  complete  promulgation  of  Homoeopathy  by  the  Organon , 
which  has  been  termed  the  Bible  of  Medicine,  was  in  the  year  1810. 
Hahnemann,  after  his  conception  of  its  main  truth,  had  devoted  a 
number  of  years  to  long  and  patient  study.  His  scientific  spirit  was 
sublime.  He  did  not  promulgate  his  law  of  cure  until  it  had  been 
tested  by  experiment  and  deduction  to  such  an  extent  that  his  ad- 
mirers have  always  been  amazed  at  his  research. 

During  fifteen  years  he  proved  on  his  own  person  more  than  sixty 
drugs,  collated  all  the  data  concerning  them,  and  then  presented  his 
views  deduced  from  this  long  experience,  tersely,  logically  and  in  har- 
mony with  true  scientific  methods.  Sir  John  Forbes,  the  acknowl- 
edged head  of  the  English  profession  of  medicine,  who  had  no  faith 
in  Homoeopathy,  had  sufficient  frankness  to  say  in  1846,  three  years 
after  the  death  of  Hahnemann  : 

“ No  candid  observer  of  his  actions,  or  candid  reader  of  his  writ- 


38 


world’s  homoeopathic  congress. 


ings  can  hesitate  to  admit  for  a moment  that  he  was  a very  extra- 
ordinary man — one  whose  name  will  descend  to  posterity  as  the 
exclusive  excogitator  and  founder  of  an  original  system  of  medicine, 
as  ingenious  as  many  that  preceded  it,  and  destined  probably  to  be 
the  remote  if  not  the  immediate  cause  of  more  fundamental  changes 
in  the  practice  of  the  healing  art  than  have  resulted  from  any  pro- 
mulgated since  the  days  of  Galen  himself ; he  was  undoubt- 

edly a man  of  genius  and  a scholar;  a man  of  indefatigable  industry 
and  of  dauntless  energy.” 

But  all  his  contemporaries  were  not  thus  unprejudiced.  The 
persecution  of  Hahnemann  is  one  of  those  records  of  human  experi- 
ence we  would  gladly  blot  from  the  page  of  history.  It  would  be 
sad  indeed  to  contemplate  the  life  of  a great  reformer,  even  as  late 
in  the  world’s  history  as  Hahnemann’s  day,  did  we  not  know  that 
such  noble  souls  are  helped  through  their  almost  crushing  trials  by 
divine  aid.  The  unpopularity,  the  danger,  the  ostracism  endured  is 
patiently,  bravely,  and  almost  cheerfully  borne  until  the  end,  because 
such  men  are  endowed  with  an  heroic  spirit  that  knows  not  depres- 
sion. The  world  has  seen  many  heroes,  but  none  so  worthy  of  the 
immortality  now  assured,  as  that  grand  old  man  of  medfeine,  Samuel 
Hahnemann. 

The  early  progress  of  Homoeopathy  was  slow.  Like  all  great 
reforms  it  had  to  encounter  opposition,  ridicule,  and  derision.  Its 
inherent  strength  enabled  it  to  survive  all  these,  and  its  growth  was 
steady  during  the  first  years  of  its  existence.  A great  reform  is  like 
a sea.  It  may  be  calm  at  any  time,  but  at  others  its  force  is  irre- 
sistible. A successful  reform  must  recognize  the  evils  of  its  day  with 
perfect  clearness,  and  seek  their  remedy  with  determination.  It 
must  stimulate  thought  and  action  upon  the  part  of  intelligent  sup- 
porters. It  must  appeal  to  reason  and  invoke  the  aid  of  logic.  Our 
reform  in  medicine  has  fulfilled  all  these  conditions. 

It  is  a marvel  when  we  remember  the  short  period  the  world  has 
had  before  it  this  idea,  that  it  now  has  its  thousands  of  adherents, 
its  long  list  of  associations  that  requires  page  after  page  of  the  Ameri- 
can Institute  proceedings  to  enumerate  and  its  millions  of  believers. 
Even  journalism  claims  to  have  been  in  existence  since  the  days  of 
Christ,  although  printing  was  not  discovered  until  1456.  All  the 
great  reforms  of  the  day  will  point  through  their  advocates  to  periods 
dating  from  one  to  many  centuries.  We  cannot  even  celebrate  a 


ADDRESSES. 


39 


Centennial,  and  yet  we  are  prepared  to  demonstrate  that,  measured 
by  the  amount  of  work  accomplished,  the  benefit  the  world  has 
received  from  Homoeopathy  is  incomparable.  It  has  not  alone  been 
directly  effected.  Like  all  great  reforms  it  permeates  in  more  direc- 
tions than  are  manifest  except  by  critical  study.  There  is  a reflex 
influence  that  extends  to  all  classes  of  mankind.  The  modifications  of 
existing  parties  which  a new  sect  of  any  importance  soon  influences, 
is  one  of  its  most  pronounced  features,  and  one  which  oftentimes  is 
not  given  due  credit.  No  great  idea  was  ever  held  by  its  adherents 
alone.  The  unconscious  influence  of  Homoeopathy  pervades  many 
medical  minds  that  would  scorn  to  give  it  right  expression.  The 
silent  thoughts  of  the  people  are  woven  into  the  mighty  web  of  their 
existence. 

Since  its  firm  establishment  in  America  its  progress  has  been  in 
an  ever  increasing  ratio. 

In  1876  the  first  World’s  Convention  was  held  in  Philadelphia  at 
the  time  of  the  Centennial  Exposition.  In  his  inaugural  address, 
the  President  stated  that  there  were  then  5000  physicians  in  the 
United  States.  Less  than  two  decades  after,  at  this  assembling,  we  are 
able  to  assert  that  there  are  12,000  in  this  country.  This  makes  an 
army  whose  presence  is  not  to  be  despised.  In  many  other  countries 
the  growth  of  Homoeopathy  has  been  remarkable,  but  it  should  be 
noted  that  in  this  land  where  freedom  of  thought  and  political  action 
is  most  pronounced,  its  adherents  are  most  numerous.  It  sometimes 
looks  as  though  this  country  would  profoundly  influence  the  spread 
of  Homoeopathy  throughout  the  world.  Even  now  the  isles  of  the 
seas  contain  our  physicians  educated  in  this  country.  The  papers  to 
be  read  at  this  Congress  from  Australia  and  the  Sandwich  Islands 
are  by  graduates  of  American  colleges.  We  do  not  undervalue  the 
labors  of  our  colleagues  in  other  lands  than  our  own,  but  the  exist- 
ence of  our  twenty  colleges  gives  us  a mighty  power. 

The  steady  gain  in  our  ranks,  the  increase  in  the  number  of  our 
colleges,  hospitals,  dispensaries  and  journals,  has  done  much  to  bat- 
ter down  the  opposition  formerly  urged  against  us  and  to  establish 
for  Homoeopathy  a position  equal  to  that  so  long  enjoyed  by  the 
dominant  school. 

We  are  recognized  by  the  Government  of  a great  nation  in  the 
various  departments  of  this  great  Exposition.  We  have  Homoe- 
opathic headquarters  on  the  Exposition  grounds  upon  land  assigned 


40 


world’s  homceopathic  congress. 


us  by  the  Directory,  which  we  dedicated  with  appropriate  exercises 
to-day.  We  have  a collective  exhibit  of  our  colleges  and  hospitals 
in  the  Government  building,  a special  college  exhibit  in  the  Depart- 
ment of  Liberal  Arts;  in  the  Woman’s  building  an  exhibit  from 
the  London  Homceopathic  Hospital,  of  the  work  of  trained  nurses, 
and  a hospital  under  the  charge  of  medical  women  of  our  faith  ; 
and  last,  the  recognition  of  our  school  by  the  World’s  Congress 
Auxiliary. 

When,  however,  we  enumerate  the  whole  list  of  our  adherents, 
when  we  have  fully  announced  our  present  status  everywhere,  we 
can  truly  say  Homoeopathy  is  not  then  completely  demonstrated. 
There  is  something  majestic  in  the  steady  flow  of  a mighty  river,  but 
grander  still  is  the  unconscious  influence  it  unceasingly  exerts  upon 
the  ocean  into  which  it  pours  its  mighty  waters.  Steadily,  almost 
imperceptibly,  Homoeopathy  has  forced  its  way  into  all  forms  of 
medical  belief — it  has  modified  the  practice  of  the  Old  School,  com- 
pelled it  to  make  its  drug  form  more  minute  and  palatable,  and  even 
to  admit,  in  a guarded  way,  its  cardinal  truths. 

It  ought  to  be  stated  in  every  such  assemblage  as  this,  in  simple 
justice  to  the  illustrious  founder  of  our  school,  that  he  did  not  de- 
nounce medical  science  except  as  it  related  to  his  own  teachings,  and 
that  he  did  not  believe  after  his  works  were  published,  that  the  evo- 
lution of  medicine  would  cease. 

Homoeopathy  has  stood  the  severest  of  all  tests ; that  of  time. 
Other  medical  faiths  have  usually  perished  with  their  founders. 
Herbert  Spencer  says : “ The  failure  of  Cromwell  permanently  to 
establish  a new  social  condition,  and  the  rapid  revival  of  suppressed 
institutions  and  practices  after  his  death,  show  how  powerless  is  a 
monarch  to  change  the  type  of  the  society  he  governs.” 

Yet  we  see,  fifty  years  after  his  death,  the  illustrious  promulga- 
tor of  this  great  medical  reform  still  profoundly  affecting  the  whole 
medical  body  politic,  and  accomplishing  what  a powerful  ruler  en- 
dowed with  an  iron  will  and  sovereign  ability  could  not. 

It  is  characteristic  of  genius  that  it  possesses  fulness.  There  is 
something  wonderful  in  the  works  of  the  great  men  who  have  doub- 
ted the  world  of  thought.  The  wisdom  of  Shakespeare  shines  just  as 
clearly  as  it  did  when  first  enunciated.  The  lapse  of  time  does  not  in 
the  least  dim  its  lustre.  Milton’s  great  epic  is  not  yet  excelled.  The 
discoveries  of  Laennec  in  auscultatiou  have  received  comparatively 


ADDRESSES. 


41 


few  additions  since  his  day.  Hahnemann’s  reformation  of  medicine 
has  had  more  influence  upon  practice  in  all  schools  than  the  combined 
results  of  the  labors  of  all  other  discoverers  in  medicine.  Who  can 
predict,  in  the  light  of  the  wondrous  growth  of  our  cause  since  its 
first  promulgation,  what  a few  more  decades  will  accomplish  ? Time 
adds  steadily  to  its  laurels,  to  its  influence  and  to  its  dissemination. 

Homoeopathy  has  passed  the  stage  of  discussion,  of  controversy,  of 
argument;  it  is  now  a firmly  established  science.  Do  not  confound 
it  with  arts  and  judge  it  by  their  standard  of  progress.  It  is  a long 
period  since  the  Centennial  in  Art,  but  in  Science  scarcely  a day. 
Centuries  of  use  of  such  familiar  drugs  as  quinia  and  morphia  de- 
velop the  fact  that  our  opponents  still  differ  as  to  their  application. 

Hahnemann’s  inspiring  spirit  still  rests  upon  his  followers.  Con- 
sider the  work  spent  upon  our  Materia  Medica.  Science  possesses 
few  greater  instances  of  human  industry  and  research.  Allen’s 
Encyclopaedia  and  the  Cyclopaedia  of  Drug  Pathogenesis  will  long 
remain  as  the  monuments  of  those  who  created  them.  The  thought- 
ful of  our  faith  realize  the  imperfections  that  still  exist,  but  so  far 
from  bringing  any  discouragement,  they  are  incentives  to  further 
work.  Science  is  always  fresh  ; in  whatever  paths  you  travel  it,  it 
leads  to  new  facts  and  thoughts.  Therein  is  one  of  its  charms  to  its 
devotees.  There  are  always  “ new  worlds  to  conquer.” 

It  is  proof  that  our  science  is  not  perfect,  that  we  are  here  to-night 
in  grand  convention  assembled,  to  testify  to  this  fact  and  to  take 
measures  for  its  further  development.  Those  who  grow  impatient 
and  think  our  pace  too  slow  should  meditate  on  the  rules  that  gov- 
ern progress  in  all  departments  of  human  thought.  Instead  of  being 
behind  in  the  march  of  civilization,  we  are  continually  at  the  fore. 
No  charge  that  it  is  a laggard  can  be  truthfully  directed  against 
Homoeopathy.  It  has  grown  from  a little  band  of  students  of 
therapeutics  to  a great  school  of  medicine.  In  our  deliberations  this 
week  we  shall  convene  in  nine  sections,  embracing  all  the  main  divis- 
ions of  medical  science  and  art ; and  complete  as  is  this  list,  it  would 
have  been  longer  but  for  the  fact  that  another  Congress  which  em- 
braces climatology,  meets  this  week  under  the  chairmanship  of  a 
member  of  our  school,  and  still  later  in  the  season,  one  on  Public 
Health.  At  our  first  World’s  Congress  in  1876,  few  papers  on  sur- 
gery were  presented.  But  they  were  of  high  order  and  indicated 
that  our  School  was  progressive.  We  shall  now,  in  the  different 


42 


world’s  homoeopathic  congress. 


sections  have  nearly  the  whole  range  of  surgery  covered.  In  the 
specialties  in  medicine  we  had  little  representation  in  1876.  To- 
day we  have  as  skilled  men  in  them  all  as  may  be  found  in  any 
school ; and  the  creation  of  a new  one  by  one  of  our  number,  chal- 
lenges the  profound  attention  of  medical  minds. 

Jorg,  the  German  professor,  in  1825  sought  to  controvert  Homoe- 
opathy by  secret  experiments  with  his  pupils;  However,  as  will 
always  be  the  case  when  a judicial  scientific  investigation  is  made, 
he  only  served  to  establish  it  on  a firmer  basis.  Coming  years,  it  is 
now  clear,  will  bring — not  only  on  our  part,  but  that  of  our  oppo- 
nents— the  application  of  every  new  test  to  the  demonstration  of  its 
law  and  corollaries  that  modern  science  and  the  evolution  of  medi- 
cine will  originate.  But  its  believers  stand  in  no  fear.  Whatever 
modifications  may  be  effected,  we  rest  with  sublime  confidence  in  the 
view  that  its  methods  will,  in  the  main,  be,  eventually,  universally 
adopted.  This  is  not  simply  a hope;  it  is  a conclusion  based  upon 
premises  that  careful  consideration  will,  we  feel  sure,  deem  valid. 
In  the  possession  of  the  elements  of  every  successful  reform,  in  its 
firmer  establishment  after  the  death  of  its  founder,  in  its  marvellous 
growth,  in  the  intelligence  of  the  clientelage  its  practitioners  secure, 
in  its  consonance  with  the  rigid  requirements  of  science,  lie  the  deep 
foundations  of  our  convictions. 

And  there  is  an  immense  amount  of  work  still  to  be  done.  Ma- 
caulay sums  up  the  vicissitudes  that  attend  the  building  up  of  a new 
science  when  he  says : 

“ The  improvement  of  a science  is  gradual  and  slow.  Ages  are 
spent  in  collecting  the  material,  ages  more  in  separating  and  assign- 
ing them,  and  even  when  a system  has  been  formed  there  is  still 
something  to  add,  alter  or  reject.  Every  generation  enjoys  the  use 
of  the  vast  hoard  bequeathed  it  by  antiquity,  and  transmits  that 
hoard,  augmented  by  fresh  acquisitions,  to  future  ages.” 

The  development  of  any  science  being  necessarily  slow,  that  of 
medicine  presents  almost  insuperable  obstacles.  It  is  based  on  the 
collation  of  an  immense  amount  of  data.  These  refer  not  only  to 
a most  complex  organization,  but  one  constantly  under  varying  con- 
ditions; hence  deductions  from  them  must  necessarily  be  varied  and 
uncertain.  Yet,  in  spite  of  this,  while  subject  in  the  main  to  these 
impediments,  Homoeopathy  has  developed  fast  in  the  number  of 
years  it  has  been  in  existence.  This  is  due  to  the  fact  that  it  has 


ADDRESSES. 


43 


steadily  been  ruled  by  law.  Empiricism  has  not  governed  its 
progress. 

As  one  illustration  of  the  labor  before  us,  we  may  instance  that 
recent  advances  in  medical  science  involve  a new  outlining  of  Hom- 
oeopathic provings ; it  will,  doubtless,  be  shown  fully  by  the  papers 
and  debates  during  this  week,  that  we  shall  now  have  to  bring  our 
distinctive  work  in  relation  to  all  new  planes  of  thought  and  action. 
So  vast  is  this  undertaking  that  it  will  require  separate  colleges,  with 
complete  laboratories,  for  its  successful  culmination. 

Particularly  is  Homoeopathy  in  closer  touch  with  that  growing 
spirit  in  the  profession — to  give  a larger  attention  to  the  unques- 
tioned source  of  a prominent  part  of  all  disease— the  mind.  It  is 
on  this  very  ground  that  Homoeopathy  has  won  some  of  its  proudest 
laurels.  The  success  of  our  school  in  the  State  Insane  Asylums  at 
Middletown,  N.  Y. ; at  Westboro,  Mass.;  at  Ionia,  Mich.;  at  Fer- 
gus Falls,  Minn.,  has  induced  California  to  lately  place  one  in  charge 
of  a Homoeopathic  physician,  and  we  trust  will  soon  secure  from  the 
legislature  of  the  State  of  Illinois  another.  Not  matter,  but  mind, 
is  to-day  the  world’s  new  balance-wheel.  Our  School  will  have 
to  devote  its  energies  further  in  this  department  which  promises 
such  brilliant  advances  in  our  treatment  of  disease. 

The  Homoeopath  of  to-day  is  far  different  from  the  believer  of 
seventy-five  years  ago.  He  has  kept  pace  with  the  development  of 
medicine,  he  has  added  to  his  armamentaria  every  other  effective 
method  of  cure,  no  door  is  shut  to  him,  he  recognizes  the  value  of 
physiological  therapeutics,  and  that  they  are  governed  by  principles 
that  are  often  strictly  scientific.  No  one  can  claim  to  be  a physician 
in  its  widest  sense  unless  he  is  of  liberal  mind  and  accepts  the  whole 
of  medical  truth. 

But  we  are  obliged  to  cling  with  tenacity  to  our  organization,  both 
to  maintain  our  existence  and  to  extend  our  views  among  people  of 
every  land.  Our  position  as  a sect  was  forced  upon  us  by  oppo- 
nents. We  are  only  battling  for  the  enthronement  of  the  principles 
of  our  own  faith. 

Medical  liberty  is  as  sacred  as  political  or  religious  liberty.  Every 
encroachment  upon  it  must  be  faithfully  and  zealously  resisted  by 
those  who  are  entrusted  with  its  preservation. 

Webster  said  : “We  must  fight  the  germ  of  unjust  power.”  It  is 


44 


world’s  homoeopathic  congress. 


our  duty  to  fight  not  only  the  germ  of  medical  intolerance,  but  its 
whole  horde  of  chemical  combinations. 

The  profession  of  medicine  has  but  one  great  stigma — the  perse- 
cution of  Homoeopathy.  It  steadily  keeps  passing  retroactive  laws 
that  are  the  opprobrium  of  justice.  Like  many  other  sad  pages  of 
human  history,  most  of  this  opposition  is  based  on  misunderstand- 
ing. With  a better  conception  of  what  Homoeopathy  is  and  of  its 
aim,  it  is  probable  that  many  of  the  bars  now  separating  the  great 
schools  of  medicine  would  be  broken  down.  It  will  only  take  a few 
more  World’s  Congresses  before  this  blot  upon  the  fair  escutcheon 
of  a noble  calling  is  forever  wiped  out.  In  all  other  directions  the 
admiration  and  respect  of  the  people  of  every  land  go  out  to  the 
medical  profession.  It  labors  with  an  unselfish  devotion  to  human 
interests  to  which  the  world  furnishes  few  parallels.  It  lays  down 
its  life  on  the  altar  of  duty.  In  the  face  of  an  epidemic  from  which 
even  trained  soldiers  flee,  it  calmly  and  faithfully  stands  at  its  post. 
It  shrinks  from  no  risk  which  any  exigency  it  may  encounter  neces- 
sitates. It  sacrifices  comfort,  social  life  and  recreation  when  human 
life  is  at  stake. 

It  brings  light  into  all  homes  with  its  benign  influence  for  every- 
thing good,  for  everything  hopeful,  for  everything  that  can  afford 
succor  in  time  of  distress.  It  is  the  comfort  of  the  weary,  the  hope 
of  the  misanthrope,  the  deliverer  of  the  sick  and  the  rescuer  from 
death.  Will  such  a profession  always  manifest  intolerance?  We 
answer:  No.  Do  you  think  me  sanguine?  Only  last  week,  during 
a brief  interview — and  this  incident  so  recently  taking  place  con- 
firms some  points  already  made  in  this  address — a prominent  mem- 
ber of  the  Woman’s  Congress,  the  wife  of  an  Old-School  physician, 
in  a three  minutes’  speech,  delivered  one  of  the  most  eloquent,  though 
terse  panegyrics  on  Homoeopathy,  from  the  standpoint  of  a non-be- 
liever, ever  made.  It  would  have  graced  this  platform.  It  was 
from  the  lips  of  an  earnest,  noble  woman,  whose  name  is  known  in 
every  household  where  the  sweetest  of  all  things,  charity,  is  cul- 
tivated. 

We  see  the  Hindoo,  so  widely  differing  from  us  in  religion,  in 
manners,  in  customs  and  in  dress,  yet  in  that  character  alone  in 
which  no  one  thinks  it  an  affront  to  be  considered — as  a man — our 
peer.  Upon  this  same  platform,  will  soon  sit  the  representatives  of 


ADDRESSES. 


45 


all  religions,  discussing  on  common  grounds  its  cardinal  truths. 
With  the  leveling  of  caste,  the  battering  down  of  deep-rooted  pre- 
judices, the  development  of  the  brotherhood  of  man,  which  such 
congresses  will  secure,  it  is  fair  to  assume  that  eventually  we  shall 
have  our  school  of  medicine  recognized  by  the  whole  profession.  He 
is  a shallow  student,  and  a man  of  narrow  mind,  who  sees  only  in 
his  little  circle  all  there  is  of  truth.  Even  the  blind  groping  of  the 
savage  heart  is  to  be  noted  and  directed;  for,  many  times  in  its 
yearnings,  there  are  hopes  that  we,  who  are  so  much  more  favored, 
might  have  fulfilled. 

Hahnemann  was  a full  century  in  advance  of  his  time.  Had 
Homoeopathy  been  sprung  upon  the  medical  profession  of  to-day, 
it  would  have  eagerly  seized  it  and  investigated  it  with  a calm,  judi- 
cial spirit  never  yet  manifested.  Bergeon’s  method,  Koch’s  lymph, 
Brown-Sequard’s  elixir,  and  Organopathy,  have  had  only  brief  and 
humiliating  careers.  In  view  of  these,  are  we  not  justified  in  de- 
manding from  our  confreres  of  other  schools  a more  critical,  impartial 
investigation  of  Homoeopathy  ? 

With  effulgent  light,  in  contrast  to  such  uncertain  methods,  stands 
Homoeopathy,  the  science  of  Therapeutics.  Hence  its  raison  d’etre. 
The  shafts  of  ridicule  have  not  annulled  its  claims;  the  persecutions 
of  former  years  only  made  more  numerous  its  adherents;  ostracism 
and  proscriptive  laws  still  more  closely  bind  its  followers,  and  weld 
them  into  so  compact  and  determined  a band  that  it  is  irresistible ; 
for,  however  lacking  in  numbers  it  may  be,  the  strongest  force  that 
moulds  this  world  is  a party  of  men  with  a righteous  cause — a cause 
whose  alpha  and  omega  is  truth. 

We  care  not,  as  Homoeopaths,  what  rigid  scientific  investigation 
may  lop  off— for  much  that  is  called  Homoeopathy  has  little  relation 
to  its  main  truth.  We  stand  serene  in  the  face  of  any  test  that  may 
be  applied,  in  the  light  of  the  experience  of  the  master  and  his 
thousands  of  followers  who  have,  all  these  years,  patiently  delved 
in  the  mine  whose  golden  depths  he  first  laid  open.  The  iconoclasm 
of  the  nineteenth  century,  which  so  ruthlessly  tears  down  one  after 
another  of  our  cherished  idols,  has  thus  far  only  served  to  place 
Homoeopathy  on  more  solid  ground. 

It  stands  comparison  with  the  more  intricate  development  in  other 
departments.  Music  has  grown  much  more  complicated;  it  has 
taught  us  to  resolve  discords  into  harmony,  it  has  evolved  higher 


46 


world’s  homoeopathic  congress. 


coloring.  Everything  tends  to  be  more  subtle.  Hence,  we  must 
have  more  artists  in  medicine  ; men  who  can  grasp  fine  points.  We 
do  not  always  get  perfection,  even  in  artists.  They  sometimes  treat 
us  to  a faulty  pose.  We  need  not  only  artists,  but  artists  of  genius. 
Hahnemann  was  the  first  and  greatest  artist  medicine  has  yet  seen. 
He  recognized  the  eternal  fineness  of  everything  human.  In  his 
abstraction  from  the  crude  and  coarse,  he  was  far  in  advance  of  his 
age;  hence,  medicine  must  yet  come  to  him  for  inspiration. 

There  are  some  of  the  profession  who  are  much  distressed  because 
we  are  not  agreed  on  all  points.  It  is  true,  that  wherever  there  is 
a difference  it  is  likely  to  widen,  but  the  different  views  which  men 
hold  often  serve  to  make  them  more  interesting,  providing  they 
manifest  a tolerant  spirit  toward  the  opinions  of  others.  Those 
who  look  for  perfection  will  be  continually  doomed  to  disappoint- 
ment. There  is  no  perfection  except  in  an  opening  of  new  vistas. 
The  higher  the  power  of  the  microscope,  the  greater  its  revelations. 
The  larger  and  finer  the  lens  of  the  telescope,  the  more  worlds  it 
reveals. 

Homoeopathy  stands  pre-eminently  fitted  to  adapt  itself  to  the 
finer  adjustments  that  are  coming  in  all  directions.  It  will  blend 
with  all  valuable  developments  that  the  medicine  of  the  future 
evolves,  for  its  basis  is  truth. 

“Marble  and  recording  brass  decay, 

And  like  the  graver’s  memory,  pass  away. 

The  works  of  man  inherit,  as  is  just, 

Their  author’s  frailty,  and  return  to  dust. 

But  truth  divine  forever  stands  secure; 

Its  head  is  guarded  as  its  base  is  sure. 

Fixed  in  the  rolling  flood  of  endless  years 
The  pillar  of  the  eternal  plan  appears, 

The  raging  storm  and  dashing  wave  defies, 

Built  by  that  architect  who  built  the  skies.” 

The  Congress  then  adjourned  until  10  o’clock  on  Tuesday  morn- 
ing, May  30th. 


ADDRESSES. 


47 


SECOND  DAY’S  SESSION. 

Tuesday,  May  30,  1893. 

The  Congress  reassembled  at  10  o’clock. 

Dr.  I.  T.  Talbot,  of  Boston,  Mass.,  said:  Members  of  the  In- 
ternational Homoeopathic  Congress  of  Physicians  and  Surgeons,  I 
am  requested,  as  the  honorary  President  of  this  body,  to  introduce 
to  you,  as  the  presiding  officer  of  this  Congress,  one  to  whom  we  are 
indebted  for  the  inception  of  the  Congress  and  to  whose  labors  we 
owe  the  successful  manner  in  which  it  has  been  brought  to  this 
time — Dr.  J.  S.  Mitchell,  of  Chicago. 

Dr.  J.  S.  Mitchell  : Ladies  and  Gentlemen : When  the  propo- 
sition for  a World’s  Congress  was  first  made  to  the  local  committee 
by  President  Bonney  of  the  World’s  Congress  Auxiliary  it  was  de- 
cided that  it  would  be  wTise  for  the  Homoeopathic  profession  of  the 
world  to  avail  itself  of  the  invitation.  The  local  committee  imme- 
diately went  to  work  and  at  the  meeting  of  the  American  Institute 
at  Washington  it  was  decided  by  a committee  appointed  by  the  In- 
stitute, together  with  its  Executive  Committee,  and  by  the  Commit- 
tee of  the  Auxiliary  Council,  that  a committee  consisting  of  the 
Chairman  and  Vice-Chairman  of  the  two  congresses — men  and 
women — and  the  President  and  Vice-President  of  the  American 
Institute  should  constitute  a Committee  to  appoint  distinguished 
members  of  the  profession  to  prepare  addresses  and  to  take  charge 
of  the  different  sections.  This  committee,  after  many  meetings,  set- 
tled upon  the  arrangement  which  you  will  find  in  the  programmes 
before  you.  The  committee  of  the  American  Institute  and  the  Exe- 
cutive Committee,  together  with  the  Committees  of  the  Congress, 
have  labored  during  the  year  and  a half  that  have  elapsed  since  the 
first  inception  of  the  Congress.  Some  thirty  thousand  circulars  have 
been  sent  throughout  the  world  announcing  the  details  of  the  Con- 
gress. The  World’s  Congress  Auxiliary  sent  to  the  ministers  of  our 
country  in  all  lands  official  notification  of  the  manner  in  which  the 
work  was  to  be  conducted,  with  a request  that  such  notifications  be 
sent  to  all  physicians  of  the  Homoeopathic  faith  who  could  be  reached 
in  those  countries.  In  addition,  the  Committee  on  Foreign  Corre- 
spondence, consisting  of  the  Chairman  and  the  Secretary,  have  sent 
to  all  Homoeopathic  physicians  throughout  the  world  embraced  in 


48 


world’s  homceopathic  congress. 

Dr.  Villers’s  Directory,  copies  of  the  circulars  and  also  official  and 
personal  letters,  stating  the  objects  and  aims  of  the  Congress  and  re- 
questing their  co-operation.  Many  reports  have  been  received  from 
these.  They  have  been  very  cordial  and  have  expressed  great  hope 
that  the  Congress  would  be  a success,  and  that  its  influence  upon 
Homoeopathy  will  be  marked  for  all  time. 

It  was  moved  and  carried  that  the  Rules  of  Order  of  Business,  as 
given  in  the  circular  already  issued,  with  the  substitution  of  10.30 
for  10  a.m.  as  the  hour  of  daily  meeting  be  adopted  as  the  order  of 
business  for  this  Congress. 

The  Chairman:  The  next  business  on  the  programme  is  an 
address  by  Dr.  William  Tod  Helmuth,  of  New  York  City.  Dr. 
Helmuth  is  unavoidably  detained  and  I will  call  upon  Dr.  A.  S. 
Couch  to  read  his  address. 


SURGERY  IN  THE  HOMOEOPATHIC  SCHOOL. 


49 


ADDRESS. 

SURGERY  IN  THE  HOMCEOPATHIC  SCHOOL . 

By  William  Tod  Helmuth,  M.D.,  New  York,  N.  Y. 


It  is  time  that  the  early  history  of  surgery  as  connected  with  the 
Homoeopathic  School  of  Medicine,  be  placed  upon  *record.  In  an- 
other decade  it  is  probable  that  the  few  desultory  records  of  it  which 
belong  to  the  first  period  of  Homoeopathy  in  this  country  will  be 
lost.  There  can  be  no  more  fitting  time,  nor  more  appropriate  occa- 
sion for  this  than  our  Columbian  year,  a year  that  will  rear  an 
everlasting  monument  upon  the  pathway  of  the  history  of  medicine, 
and  especially  upon  the  history  of  Homoeopathy,  throughout  the 
world. 

It  would  be  out  of  place  even  if  it  were  possible,  to  attempt  to 
produce  in  an  address  of  this  character,  a detailed  account  of  the 
surgery  and  surgeons  of  our  school,  as  it  stands  in  the  United 
States  to-day,  or  has  stood  for  the  last  quarter  of  a century.  It 
would  be  a work  of  supererogation.  Our  medical  colleges  flour^ 
ish  all  over  this  broad  land,  each  teaching  a full  curriculum,, 
thus  necessarily  embracing  instruction  in  surgical  science.  These 
institutions  have  their  records,  their  published  reports,  their 
archives  and  their  alumni  to  give  the  once- neglected  branch 
her  proper  niche  in  the  temple  of  AEsculapius.  Our  medical  jour- 
nals and  the  published  transactions  of  our  societies  furnish  ample 
proof  of  the  steadily  growing  interest  in  every  department  of  sur- 
gery, and  exhibit  the  undeniable  ability  of  our  surgeons.  Such 
facts  and  such  men  need  no  mention  here.  The  humble  endeavor  of 
this  paper  shall  be:  First,  to  rescue  from  oblivion  some  facts  that 
belong  to  our  surgery  up  to  the  year  1870,  which,  perhaps,  are  not 
very  well  known,  and  thus,  by  giving  them  place  in  the  Transac- 
tions of  this  Congress,  to  ensure  their  safety  for  future  generations 
and  as  a basis  for  a more  extended  history ; and,  second,  to  speak  of 
surgery  as  a factor — and  a powerful  one — for  the  extension  of  Horn- 


50 


world’s  homoeopathic  congress. 


oeopathy,  and  as  a means  for  elevating  it  in  the  estimation  of  the 
community  at  large. 

After  some  careful  study  of  the  subject,  I think  I may  be  able  to 
show,  strange  as  it  may  appear,  and  meagre  as  are  the  sources  from 
which  information  can  be  obtained,  that  certain  of  the  great  opera- 
tions of  the  last  ten  or  fifteen  years,  which  have  so  astonished  both 
the  profession  and  the  public — with  the  details  of  which  the  medi- 
cal periodicals  have  teemed.,  and  the  results  of  which  have  been  so 
brilliant,  have  been  discounted  by  the  earlier  Homoeopathists  with- 
out antisepsis,  and  some  of  them,  perhaps  without  anaesthesia.  I 
have  no  doubt,  however,  when  I have  recorded  these  cases,  that  a 
smile  of  incredulity,  or  a sneer  of  unbelief,  or  a sniff  of  ridicule,  or  a 
wholesale  denial  of  facts,  one  or  all  of  them  will  fall  from  the  Old- 
School  man  who  dares  peruse  our  Transactions  ; but  I place  the 
facts  upon  record,  because  the  time  will  come  when  with  the  shout 
will  reverberate  u palman  que  meruit  ferat.” 

When  in  1825,  Dr.  H.  B.  Gram  brought  Homoeopathy  to  the 
notice  of  the  profession,  those  gentlemen  who  first  began  to  study 
and  practice  according  to  its  precepts  were  all  medical  men ; and 
such  surgery  as  came  under  their  notice  they  eagerly  turned  over  to 
any  one  who  would  take  it.  In  New  England,  during  the  quarter 
of  a century  which  elapsed  between  the  landing  of  Gram  and  1850, 
in  which  year  1 began  to  take  cognizance  of  the  field,  Dr.  Fuller 
(Homoeopathist)  occasionally  performed  surgical  operations  for  his 
friends  and  Dr.  Winslow  Lewis  and  Dr.  George  F.  Gay,  both  skill- 
ful and  liberal  men — though  belonging  to  the  Old  School — would 
render  such  surgical  service  as  requested  by  the  Homoeopathists. 

In  New  York,  among  the  Old-School  men  who  would  hold  sur- 
gical consultations  with  the  Homoeopathists  were  Dr.  David  Hos- 
sack  and  Dr.  Carnochan — honor  to  their  liberality  of  spirit.  There 
is  the  name  of  one,  however,  whom  I must  mention  here,  who., 
seeing  the  ostracism  to  which  the  Homoeopathists  were  subjected, 
and  the  difficulty  in  securing  consultations  in  surgical  or  medical 
practice,  suggested  that  the  Homoeopathists  should  create  specialists 
among  themselves,  and  thus  be  better  qualified  for  consultation  with 
each  other.  I allude  to  Dr.  John  A.  McVickar.  Dr.  McVickar 
was  born  in  1812,  was  graduated  from  the  College  of  Physicians 
and  Surgeons  of  New  York  in  1833,  and  was  appointed  to  the  chair 
of  Clinical  Midwifery  in  the  University  of  the  City  of  New  York 


SURGERY  IN  THE  HOMOEOPATHIC  SCHOOL. 


51 


in  1839.  The  next  year  he  embraced  Homoeopathy,  and  was  (such 
was  the  spirit  of  the  times),  shut  out  immediately  from  all  the  ave- 
nues of  medical  advancement,  and  the  New  York  Academy  of 
Medicine  closed  its  doors  upon  him.  He  chose  surgery  as  his 
specialty,  re-matriculated  at  his  Alma  Mater,  to  perfect  himself  in 
anatomy  and  was  of  great  assistance  to  his  brother  practitioners. 
He  was  a careful  and  skillful  operator,  and  a warm  personal  friend 
of  my  own  when  I first  arrived  in  New  York. 

In  Philadelphia  where  the  strife  was  more  concentrated  and 
severe,  perhaps  on  account  of  Hering’s  growing  popularity  and  suc- 
cess, the  only  Old-School  surgeon  who  would  consult  with  the  Ho- 
moeopathists  was  Dr.  Paul  Beck  Goddard,  a brilliant  and  successful 
surgeon,  who  allowed  to  every  man  the  rights  he  claimed  to  himself 
and  hesitated  not  to  consult  with  the  then  “ despised  sect  ” for 
which  he  received  the  maledictions  of  his  Allopathic  friends,  who 
threatened  to  expel  him  from  their  societies  and  close  the  doors  of 
their  institutions  upon  him.  I was  but  a boy  then,  and  remember 
my  pride  when,  just  beginning  to  study  medicine,  the  assistance  that 
this  liberal-minded  man  gave  me  in  studying  the  surgical  anatomy 
of  Stone,  through  the  medium  of  Dupuytren’s  posthumous  plates. 
Indeed,  I may  say  it  was  through  these  investigations  and  the  dis- 
sections that  followed  them  that  I determined  to  devote  my  life  to 
surgery,  a branch  of  science  which,  I grew  to  be  painfully  aware,  was 
very  much  neglected  by  the  Homeeopathists.  Ten  years  after  the 
arrival  of  Dr.  Gram  and  on  Hahnemann’s  birthday — viz.  : April 
10th  in  the  year  1835,  the  North  American  Academy  of  the  Homoe- 
opathic Healing  Art  was  founded  at  Allentown,  Pa.  In  its  first 
circular*  in  Article  XXIX.  among  the  list  of  studies  which  are 
considered  indispensable  for  the  complete  education  of  the  physi- 
cian, the  word  “ Chirurgini  ” occurs ; and  that  is  the  only  mention 
made  of  surgery  in  the  entire  pamphlet.  Having  learned  that  Dr. 
William  Wesselhoeft  was  the  incumbent  of  that  chair  I proceeded 
to  make  the  necessary  inquiries  of  one  of  his  distinguished  relativist 
and  find  that  he  was  graduated  by  the  University  of  Jena,  in  1820, 
came  to  America  in  1824,  settled  in  Pennsylvania  and  began  to 

* First  circular  of  the  North  American  Academy  of  the  Homoeopathic  Healing 
Art,  Phila.,  1835,  p.  24. 

f Private  letters  of  Dr.  Conrad  Wesselhoeft,  Boston,  Mass. 


52 


world’s  homoeopathic  congress. 


practice  Homoeopathy  in  1828.  Dr.  Wesselhoeft  had  a penchant  for 
surgery ; and  especially  was  he  skillful  in  the  management  of  frac- 
tures and  dislocations.  He  was  said  to  be  pre-eminently  semper 
paratus,  and  many  are  the  traditious  records  of  his  skill  that  to-day 
float  round  the  country  where  he  resided.  I have  also  learned  from 
Dr.  John  Detwiller  of  Eastern  Pennsylvania  that  his  father,  Dr. 
Henrich  Detwiller*  who  was  also  connected  with  the  Allentown 
Academy,  performed  many  serious  and  capital  operations  in  his 
vicinity.  Dr.  Detwiller  came  to  America  in  1817,  and  has  the 
honor  to  be  the  first  physician  to  prescribe  a dose  of  Homoeopathic 
medicine  in  the  State  of  Pennsylvania.  His  son,  Dr.  John  Detwil- 
ler, with  whom  the  author  has  a warm  personal  friendship,  is  the 
lithotomist  of  his  district,,  and  his  collection  of  vesical  calculi  is 
unique  in  its  variety. 

It  gives  me  pleasure  to  place  on  record,  in  this  connection,  one  of 
the  remarkable  surgical  procedures  performed  by  one  of  our  own 
school,  and  which  perhaps  is  not  widely  known,  and  one  which,  as 
far  as  I know,  has  not  yet  been  equalled  anywhere.  The  operator 
was  Dr.  John  Ellis,  now  in  advanced  age  and  retired  from  practice, 
but  very  well  known  to  the  older  Homoeopathists  for  his  zealous 
devotion  to  their  cause  when  the  strife  raged  fiercest.  In  these  days 
of  anaesthesia  and  antisepsis,  with  the  use  of  animal  ligatures  and 
the  better  environment  of  the  patient,  many  brilliant  results  have 
been  secured  in  the  ligation  of  arteries  but,  so  far  as  I know,  and 
so  far  as  I can  learn  from  considerable  research,  this  double  ligation 
of  the  common  carotid  below  the  omohyoid  (the  interval  between 
the  placing  of  the  ligatures  being  only  four  and  one-half  days  with 
recovery — and  those  last  two  words  are  important)  has  not  been 
equalled  in  the  world  as  yet.  In  the  Gross  tablef  of  thirty-six  cases 
of  “ ligation  of  both  carotids  ” I find  Mott’s  case  “ interval  of  fifteen 
minutes,  patient  died.”  Murdoch’s  case,.  “ interval  of  three  days, 
patient  died.”  Lewis’s  case  of  “ five  days,  patient  died.”  The  first 
ligation  was  performed  on  October  21,  1844,  at  Grand  Rapids,  Mich. 
The  patient,  aged  21,  was  engaged  in  setting  a trap  in  the  woods, 
and  was  mistaken  for  a bear  as  he  was  stooping  and  received  the 
contents  of  a rifle.  The  ball  struck  him  on  the  left  side  above  the 


* Private  correspondence  from  Dr.  John  Detwiller,  Easton*  Pa. 
f Gross's  System  of  Surgery,  vol..  i.,  p.  7,84. 


SURGERY  IN  THE  HOMOEOPATHIC  SCHOOL. 


53 


spine  of  the  scapula,  passing  out  after  making  a flesh  wound  of  2J 
inches,  and  entering  the  neck  at  the  centre  and  posterior  edge  of 
the  sterno-cleido  mastoid,  passing  up  through  the  centre  of  the 
tongue,  and  out  of  it  to  the  right  of  the  medial  line,  knocking  out 
several  teeth  and  emerging  through  the  upper  lip.  The  wounds 
were  properly  dressed,  but  on  the  night  of  the  seventh  day,  quite  a 
severe  haemorrhage  occurred  from  the  tongue,  which  was  arrested  by 
compression.  The  next  night,  another  severe  bleeding  took  place, 
and  Dr.  Ellis  tied  the  left  carotid  below  the  omohyoid.  On  the 
eleventh  day  another  severe  bleeding  followed  which  was  arrested 
temporarily,  by  pressure,  but  the  next  day  a second  haemorrhage  of 
such  severe  character  followed,  that  it  became  necessary  to  ligate  the 
right  common  carotid. 

The  patient  recovered,  the  ligature  from  the  left  vessel  coming 
away  on  the  seventeenth  day,  that  from  the  right  on  the  fourteenth 
day.*  This  is  one  of  the  cases  I here  offer  for  the  consideration  of 
all  surgeons  in  all  schools ; and  would  say  that  perhaps  it  was  the 
treatment  adopted  afterward  by  the  doctor,  that  assisted  in  relieving 
the  congestion  thatfollowed,  and  thus  rendered  the  remarkable  opera- 
tion a success. 

About  four  years  after  this  surgical  achievement  the  Homoeo- 
pathic Medical  College  of  Pennsylvania  was  founded,  viz.,  1848,  and 
its  first  Professor  of  Surgery  was  Francis  Sims,  M.D.,  a graduate  of 
the  University  of  Pennsylvania.  Dr.  Sims  was  a good  lecturer,  and 
did  whatever  operations  came  to  him,  which  I must  say  were  very 
few, — for  in  those  days  the  people  were  not  disposed  to  trust  any  one 
with  a knife,  who  believed  in  the  globulistic  quackery.  During  my 
three  years’  studentship  in  the  old  institution,  I think  there  were  but 
four  operations  performed  before  the  class,  and  none  of  these  could  be 
classed  among  the  capital  ones  of  surgery.  Dr.  Sims  was  followed 
by  Dr.  Jacob  Beakley,  who  afterwards  held  the  Chair  of  Surgery  in 
the  New  York  Homoeopathic  Medical  College. 

On  January  30,  1852,  Dr.  B.  L.  Hill,  Professor  of  Obstetrics  in 
the  Homoeopathic  College  of  Cleveland,  Ohio,  issued  a circular  to 
all  Homoeopathic  physicians,  asking  their  assistance  in  the  prepara- 
tion of  a forthcoming  work  on  surgery.  Those  who  contributed 
articles  on  surgical  subjects  were  Drs.  Neidhard  and  Kitchen,  of 


* New  York  Journal  of  Medicine  and  the  Collateral  Sciences , September,  1845,  vol. 
v.,  No.  XII.,  p.  187  ; also  Velpeau’s  Operative  Surgery , vol.  ii.,  p.  377. 


54 


world’s  homoeopathic  congress. 


Philadelphia,  Dr.  Shipman,  of  Chicago,  Dr.  Powell,  Lexington,  Ky., 
Drs.  Teft  and  Beckwith,  Norwalk,  Conn.,  Dr.  S.  M.  Cate,  Augusta, 
Me.,  Drs.  Babcock  and  Foote,  Galesburg,  111.,  Dr.  Rogers,  Farm- 
ington, 111.,  Dr.  Sharpe,  England,  Dr.  Rosa,  Painesville,  Ohio,  Dr. 
A.  Bauer,  Dr.  W.  Owens  and  Dr.  Park,  of  Connecticut.  This 
book  did  not  appear,  however,  until  1855,  about  two  months  after 
the  publication  of  my  own  work,  and  the  complete  title  is  as  follows, 
The  Homoeopathic  Practice  of  Surgery , together  with  Operative  Sur- 
gery, illustrated  by  two  hundred  and  forty  engravings.  By  B.  L. 
Hill,  M.D.,  Professor  of  Obstetrics  and  Diseases  of  Females,  and 
late  Professor  of  Surgery  in  the  Western  Homoeopathic  College,  and 
James  G.  Hunt,  M.D.,  Professor  of  Surgery  in  the  Western  Homoe- 
opathic College,  Cleveland,  Ohio.  J.  B.  Cobb  & Co.  1855. 

The  second  part  of  this  work,  viz.,  the  operative  portion  of  it,  was 
taken  from  the  Lectures  on  American  Eclectic  Surgery , published 
several  years  before.  This  book  comprises  653  pages.  It  never 
passed  to  a second  edition.  My  own  work  bearing  title  of  Surgery 
and  Its  Adaptation  to  Homoeopathic  Practice , by  Wm.  T.  Helmuth, 
M.D.,  illustrated  with  numerous  engravings  on  wood.  Philadel- 
phia: Moss  & Brother.  1855.  Comprises  652  pages.  And  I am 
happy  to  say,  through  the  kindness  of  my  friends,  it  is  still  in  exist- 
ence, having  gradually  passed  to  its  fifth  edition.  In  1851  Dr.  B. 
L.  Hill,  on  several  occasions,  successfully  performed  lithotomy  and 
other  operations.  In  those  days  the  opposition  of  Allopath ists  to 
everything  Homoeopathic,  handicapped  those  of  our  own  school  who 
attempted  surgical  performances.  If  an  error  should  chance  to  be 
committed,  or  an  operation  prove  a failure,  or  the  patient  succumbed, 
such  results  were  given  as  additional  grounds  to  prove  the  incompe- 
tency of  the  Homoeopath  ists,  and  as  another  reason  why  they  should 
be  swept  from  the  face  of  the  earth.  Suits  for  malpractice  were  in- 
stituted upon  slight  deformities  after  fractures,  and  every  impedi- 
ment placed  in  the  way  of  our  school  advancing  in  surgical  practice. 
Dr.  S.  R.  Beckwith,  who  in  1853  amputated  at  the  hip-joint  and  in 
1854  removed  successfully  a large  ovarian  tumor  (quite  an  exploit 
in  those  days)  had,  on  one  occasion  amputated  the  thigh  of  a patient 
of  Dr.  Wheeler,  a venerable,  dignified  old  gentleman,  a brother-in- 
law  of  Gen.  Wool.  The  second  day  after  the  operation  Dr.  Wheeler 
was  visiting  his  patient  at  the  Weddell  House  in  Cleveland,  when 
Prof.  Ackley  (Old  School)  entered  the  room,  and  ordered  Dr.  Wheeler 


SURGERY  IN  THE  HOMCEOPATHIC  SCHOOL. 


55 


to  leave  it,  stating  that  “ It  was  damnable  enough  for  little-pill  doctors 
to  be  allowed  to  practice  medicine,  but  they  should  not  practice  sur- 
gery.” Upon  Dr.  Wheeler  refusing  to  obey  the  peremptory  and 
unreasonable  demand,  Prof.  Ackley  seized  him  by  the  hair  and 
dragged  him  into  the  hall.  The  affair  ended  by  Dr.  Ackley  being 
placed  under  four  thousand  dollars  bond  to  keep  the  peace,  and  by 
Dr.  Wheeler  ever  thereafter  combing  his  hair  over  a bald  spot  on 
the  side  of  his  head.  * 

Dr.  Beckwith  was  for  a long  time  Professor  of  Surgery  in  the 
Western  Homoeopathic  College,  and  did  much  in  that  day  to  extend 
Homoeopathic  surgery  in  the  West. 

In  1855  Dr.  I.  T.  Talbot  performed,  if  not  the  first,  among  the 
first,  successful  tracheotomy  in  this  country.  By  the  term  successful 
is  here  understood,  not  that  the  opening  of  the  trachea  and  insertion 
of  the  tube  were  accomplished,  but  that  the  patient  recovered  f I 
draw  attention  to  this  success,  as  another  to  show  how  surgery 
flourished  “ under  the  rose,”  and  to  record  the  facts  that  here  and 
there,  important  operations  were  done  and  remained  unheralded,  but 
like  the  truth  when  crushed  to  earth  has  risen  again  to  testify  to  the 
abilities  of  men  who  loved  Hahnemann  and  Homoeopathy. 

I need  say  no  more  of  Dr.  Talbot’s  position  and  teaching  since 
those  early  times.  It  is  a matter  of  record.  The  man  stands  before 
you  to-day  covered  with  honor. 

I have  already  recorded  two  surgical  triumphs  : Let  me  proceed 
to  a third.  The  surgical  world,  within  the  last  ten  years,  has  been 
deeply  interested  in  the  advancements  made  in  abdominal  surgery ; 
or,  I should  more  properly  say,  intestinal  surgery.  The  wonders 
that  have  been  accomplished  by  intestinal  anastomosis;  the  ingenuity 
exhibited  in  the  invention  of  sutures,  plates  of  animal  and  vegetable 
substances,  the  methods  of  sewing,  etc.,  are  esteemed  among  the 
“ most  advanced  of  the  advancements  ” that  belong  to  modern  sur- 
gery. The  records  of  these  cases  in  the  medical  periodicals  are  so 
remarkable  that  the  doctors  are  surprised  and  the  laity  astounded  by 
them.  Let  me  now  recount  to  you  the  record  of  a case,  in  which 
four  feet  and  ten  inches  of  the  intestines  were  resected, — an  intestinal 
anastomosis  skillfully  made,  with  complete  recovery,  with  the  extra- 
ordinary addition  that  the  patient  underwent  all  the  dangerous 

* MS.  furnished  the  author  by  Dr.  S.  R.  Beckwith, 
f Personal  letter  of  Dr.  I.  T.  Talbot  to  author. 


56 


world’s  homoeopathic  congress. 


symptoms  of  strangulation  of  the  intestine,  by  two  serious  operations, 
being  four  months  pregnant,  went  on  to  full  term  and  was  delivered 
of  a healthy  child.  The  operator  was  no  other  than  Dr.  George  D. 
Beebe,  to  whom  also  I lectured  on  anatomy  in  the  Homoeopathic 
Medical  College  of  Pennsylvania,  and  who  was  a college  chum  of 
the  late  lamented  Dr.  George  A.  Hall.  At  the  time  this  remarkable 
operation  was  done,  nearly  a quarter  of  a century  ago,  I was  editing 
the  Western  Homceopcithie  Observer  in  St.  Louis,  and  as  many 
comments  were  made  upon  it  in  both  the  secular  and  medical  press, 
I wrote  personally  to  Dr.  Beebe  for  a brief  description  of  the  case. 
Here  it  is.  He  says  : 

“ I hasten  to  accept  your  friendly  invitation  to  communicate  the 
notes  of  an  operation  for  hernia  recently  referred  to  in  the  public 
press,  and  as  the  pages  of  your  valuable  journal  are  always  full  of 
useful  material  I will  be  brief. 

“On  July  10th  I was  called  to  see  Mrs.  J.  B.  Childs,  of  Lee  Centre, 
111.,  who  was  temporarily  in  our  city  for  a visit,  and  while  at  the 
house  of  a friend  was  taken  with  most  violent  pain  in  an  umbilical 
hernia,  from  which  she  had  suffered  since  the  birth  of  a child,  seven 
years  previously.  On  reaching  the  patient’s  bedside,  I found  a large 
tumor  at  the  umbilicus,  the  thin  integumental  coverings  of  which 
were  greatly  discolored,  and  were  on  the  point  of  yielding  to  the 
pressure  of  a considerable  quantity  of  fluid  therein  contained.  The 
patient  had  vomited  for  two  or  three  days,  and  during  the  twelve 
hours  preceding  my  visit  the  vomiting  had  been  stercoraceous,  with 
frequent  hiccough.  The  skin  and  pulse  did  not  show  any  marked 
peritoneal  inflammation,  but  there  seemed  no  apology  for  further 
delay  in  ascertaining  the  condition  of  the  hernial  mass.  A careful 
incision  of  the  integuments  liberated  a quantity  of  dark,  bloody 
serum,  and  this  escaping  revealed  a mass  of  gangrenous  intestine. 
With  a grooved  director  the  hernial  sac  was  freely  laid  open,  when 
I was  startled  to  find  so  much  of  the  intestine  involved  and  the 
entire  mass  not  only  black  with  discoloration,  but  at  pointsyielding  and 
emitting  faecal  matter.  The  situation  was  novel  and  without  pre- 
cedent, but  a moment’s  reflection  satisfied  me  that  the  patient’s 
chances  for  life  lay  in  removing  the  devitalized  tissue,  and  pursuing 
such  further  steps  as  would  subject  her  to  the  least  hazard  possible 
under  the  circumstances.  With  the  assistance  of  two  or  three  of  my 
medical  colleagues,  whom  I could  hastily  summon  to  my  aid,  I 


SURGERY  IN  THE  HOMCEOPATHfC  SCHOOL. 


57 


traced  the  gut  to  the  hernial  ring  and,  finding  sound  tissues  there, 
divided  it,  and  passing  a strong  suture,  secured  the  sound  extremity 
to  the  margin  of  the  incision.  Then,  with  a pair  of  scissors,  I cut 
the  intestine  away  from  the  mesentery  throughout  its  extent  until 
sound  intestine  was  found  at  the  opposite  side.  Here  it  was  again 
divided,  and  the  sound  extremity  secured  like  the  former.  The 
mesenteric  vessels,  which  were  very  numerous,  as  may  be  inferred, 
were  closed  by  torsion  and  by  ice  until  all  haemorrhage  had  ceased. 
This  was  the  most  protracted  part  of  the  operation,  but  when  ac- 
complished the  hernia  knife  was  brought  to  bear  on  the  ring,  and 
this  was  freely  enlarged.  Making  sure  that  the  bleeding  did  not 
recur  on  the  removal  of  the  pressure  maintained  by  the  ring,  the 
parts  were  now  returned  within  the  abdomen,  leaving  the  two  divided 
ends  of  the  intestine  protruding  from  the  abdomen  and  lying  side  by 
side,  where  they  were  secured  to  the  integumental  margin  in  such  a 
manner  as  to  form  an  artificial  anus.  The  day  following  the  opera- 
tion the  pulse  rose  to  a hundred  and  twenty,  and  there  was  some  dis- 
position to  singultus,  but  the  cathartics,  which  had  been  freely  ad- 
ministered by  my  predecessor  in  the  case,  were  being  poured  out 
freely  at  the  artificial  anus,  and  in  two  days  the  irritation  had  begun 
to  subside,  and  from  that  time  the  digestive  functions  became  toler- 
ably well  established.  An  examination  of  the  intestine  removed 
proved  it  to  be  of  the  jejunum,  and  to  measure  four  feet  ten  inches. 
As  soon  as  I could  feel  some  assurance  of  the  patient  surviving  the 
first  operation,  I began  to  prepare  for  the  second,  viz.,  the  cure  of 
the  artificial  anus.  There  was  not  wanting  those  in  the  profession 
who  wisely  shook  their  heads  and  thought  this  operation  should 
have  been  deferred  for  several  months  to  enable  the  patient  to  gain 
strength,  etc.,  and  influences  were  brought  to  bear  upon  the  patient 
to  that  end  ; but  the  patient  seemed  willing  to  rest  her  case  in  my 
hands,  and  so  soon  as  my  instrument  maker  could  prepare  the  in- 
strument from  drawings  I furnished  him,  I was  ready  to  proceed. 
A few  days’  delay  was  asked  by  the  patient’s  husband  on  account  of 
business,  and  then,  on  July  31st,  a clamp  was  introduced,  the  blades 
of  which  were  oval,  three-fourths  of  an  inch  wide,  and  one  and  one- 
fourth  inches  long,  and  fenestrated,  leaving  serrated  jaws  one-eighth 
of  an  inch  wide.  One  blade  was  passed  into  each  end  of  the  intes- 
tine until  fully  within  the  abdomen.  Great  care  was  exercised  that 
only  the  intervening  walls  of  these  intestines  should  be  embraced  by 


58  world’s  homceopathic  congress. 

the  clamp,  and  the  blades  were  then  approximated  by  a set  screw  in 
the  handles  until  slight  pain  was  occasioned.  Instructions  were 
given  that  if  nausea  and  vomiting  occurred  the  clamp  should  be 
loosened,  otherwise  it  should  be  very  gradually  tightened  during  the 
next  two  days.  On  the  third  day,  the  presumption  being  that  adhe- 
sive inflammation  had  united  the  two  intestines,  firm  pressure  was 
applied  by  the  clamp  that  the  parts  embraced  might  be  caused  to 
slough,  and  a free  incision  was  made  from  one  intestine  to  the  other 
through  the  fenestral  opening  in  the  clamp.  On  the  fourth  day  the 
clamp  was  gradually  loosened  and  removed,  and  from  that  time  the 
foecal  matter  passed  freely  into  the  lower  bowels  and  regular  evacu- 
ations occurred  by  the  rectum.  A digital  exploration  revealed  the 
smooth,  rounded  edges  of  the  opening  made  by  the  clamp,  and  it 
now  only  remained  to  close  the  integumental  opening,  which  was 
done  by  deeply  set  quill  sutures  on  the  8th  day  of  August,  and  the 
patient  departed  for  her  home  in  the  central  part  of  the  State,  leav- 
ing my  cabinet  enriched  by  a pathological  specimen  which  is  as 
highly  valued  as  it  is  rare.  It  is  no  less  amazing  than  gratifying  to 
witness  the  happy  effects  of  Homoeopathic  remedies  in  controlling 
the  constitutional  disturbances  consequent  upon  grave  surgical  oper- 
ations, and  seldom  have  these  been  more  happy  in  my  hands  than  in 
the  present  case,  where  Aconite  and  Arsenicum  played  so  important 
a part  in  controlling  peritonitis  and  enteritis. — Yours,  truly  (signed), 
G.  D.  Beebe.” 

This  remarkable  operation,  the  ingenuity  of  making  the  anasto- 
mosis and  its  results,  which  were  published  in  the  New  England  Medi- 
cal Gazette  and  the  United  States  Medical  and  Surgical  Journal, 
aroused  the  sententious  spirit  of  many  Old-School  periodicals,  and 
the  Boston  Medical  and  Surgical  Journal*  in  a sneering  editorial, 
stated  : “ We  are  informed  the  patient  died  four  days  after  the  oper- 
ation. Whether  the  heart  was  or  was  not  flabby  or  fatty,  we  have 
not  heard.”  I merely  insert  this  opinion  of  the  Boston  Medical  and 
Surgical  Journal , not  because  it  is  of  the  slightest  importance,  but 
that  we  of  to-day  may  understand  the  bigotry  of  the  Old  School 
twenty-five  or  thirty  years  ago.f 

I may  mention  here  that  Dr.  Beebe  was  appointed  brigade  sur- 
geon by  President  Lincoln,  and  was  on  duty  under  Gen.  Halleck 


* March  17,  1870. 

f Western  Homoeopathic  Observer,  vol.  vii.,  p.  162. 


SURGERY  IN  THE  HOMCEOPATHIC  SCHOOL. 


59 


and  Gen.  Grant,  and  was  enthusiastic  in  his  idea  of  the  outdoor 
treatment  of  the  wounded.  Speaking  of  the  War  of  the  Rebellion 
brings  to  my  mind  the  name  of  another  of  our  surgeons  who  was 
very  prominent  during  those  times  of  bloodshed  and  disruption, 
no  doubt  the  most  distinguished  of  our  military  surgeons.  I mean 
Dr.  E.  C.  Franklin,  who  was  born  in  1822,  became  a private  pupil 
of  Dr.  Valentine  Mott,  and  was  graduated  from  the  medical  depart- 
ment of  the  University  of  New  York  in  1846.  During  his  Allo- 
pathic career  he  was  made  deputy  health  officer  of  California,  and 
was  given  charge  of  the  Marine  Hospital  at  San  Francisco.  In 
1857  he  began  the  practice  of  Homoeopathy,  and  in  1860  came  to 
St.  Louis,  where  I was  his  fellow- laborer  for  many  years.  It  was 
through  my  own  instrumentality  that  he  was  made  Demonstrator  of 
anatomy  in  the  Homoeopathic  Medical  College  of  Missouri.  Dr. 
Franklin’s  career  in  the  army  was  remarkable.  At  the  breaking  out 
of  the  war  he  was  appointed  surgeon  to  the  Fifth  Regiment  of  Missouri 
Volunteers,  and  shortly  after  was  made  surgeon-in-chief  to  the  first 
regularly  organized  military  hospital  west  of  the  Mississippi  River. 
He  soon  was  created  brigade  surgeon,  and  organized  the  United 
States  General  Hospital  at  Mound  City,  111.  After  the  reorganiza- 
tion of  the  Homoeopathic  Medical  College  of  Missouri,  in  1872,  he 
received  the  appointment  to  the  Chair  of  Surgery  in  that  institu- 
tion. Finally  he  was  called  to  the  Professorship  of  Surgery  in  the 
Homoeopathic  Department  of  the  University  of  Michigan,  but  he 
returned  to  St.  Louis  before  his  death.  Dr.  Franklin  was  an  author 
of  the  Science  and  Art  of  Surgery , which  embraced  two  editions,  the 
first  published  in  1867,  the  second  in  1873.  Dr.  Franklin  and 
myself  were  rivals  in  the  surgical  field  at  St.  Louis,  Mo.,  and  many 
a dispute  we  have  had ; but  looking  back,  at  this  late  date,  to  the 
contentions  and  discussions  of  those  days,  they  seem  so  small,  so 
little  and  so  insignificant  that  they  sink  out  of  sight,  and  serve  only 
as  lessons  to  teach  us  how,  in  our  selfish  egotism,  we  are  apt  to  mag- 
nify trifles  connected  with  our  own  dear  selves,  which  time  soon 
effaces,  leaving  only  the  absolute  wonder  that  such  minutiae  could 
in  any  manner  weigh  against  the  truer  and  better  and  more  enduring 
efforts  of  our  life’s  work.  During  this  period  our  much-lamented 
Liebold  was  also  surgeon,  and  performed  many  linear  resections  and 
amputations,  which  are  duly  recorded  in  the  Medical  and  Surgical 
History  of  the  War  of  the  Rebellion.  During  this  period  there  was 


60 


world’s  homoeopathic  congress. 


in  the  navy  of  the  United  States  a man  who  did  good  service.  This 
was  Dr.  L.  H.  Willard,  now  one  of  the  surgical  staff  of  the  won- 
derful Homoeopathic  Medical  and  Surgical  Hospital  of  Pittsburgh. 
He  entered  the  navy,  and  did  good  service  in  1865,  was  active  in 
his  duties  on  board  both  the  Ottawa  and  the  Mohawk,  and  was 
captured  by  the  rebels.  He  edited  the  surgical  department  of  my 
periodical  up  to  1870,  when  it  was  discontinued. 

Dr.  H.  F.  Biggar,  of  Cleveland,  in  1866,  devised  the  Penostead 
flap  in  amputations  and  reamputations,  and  of  this  he  says:  “This 
operation,  while  original  with  myself,  may  have  been  adopted  by 
others  previous  to  1866.”* 

Before  I pass  to  the  second  division  of  my  subject  I desire  to 
place  upon  record  a case  of  brain  surgery.  I do  this  because,  since 
cerebral  localization  has  become  such  an  interesting  topic,  the  sur- 
gery of  the  brain  has  made  such  rapid  strides  that  few  are  aware 
that,  without  this  knowledge,  one  of  our  own  men  in  the  West  was 
successful  in  removing  a neoplasm  from  behind  the  orbit  before 
1870.  This  case  was  operated  upon  by  Dr.  N.  Schneider  at  the 
hospital  and  before  the  class  of  the  Homoeopathic  Medical  College 
at  Cleveland,  Ohio,  and  has  never  been  recorded.  Dr.  Schneider 
thus  writes  :f  “ I entered  within  the  cranial  cavity,  removing  what 
was  probably  angioma.  It  pressed  upon  the  brain  in  such  a manner 
and  direction  as  to  produce  functional  disturbances  of  sight  and 
hearing  on  the  right  side,  together  with  severe  neuralgic  pains  and 
spasms  of  the  muscles,  terminating  in  epilepsy.  I will  not  detail 
the  symptoms  leading  to  the  diagnosis,  but  they  were  sufficient  to 
induce  the  belief  that  there  was  a growth  behind  the  right  eye. 
I entered  the  cranium  through  the  orbit,  and  found  a tumor  the 
size  of  a hickory-nut  and  attached  to  the  dura.  After  a bloody 
and  exhaustive  operation  I took  it  away.  The  patient  recovered 
from  the  operation  rapidly.  By  the  tenth  day  he  was  sitting  up; 
in  two  weeks  he  was  walking  about,  and  in  six  weeks  was  about 
the  streets,  free  from  pain  and  gaining  strength  steadily.  About 
the  1st  of  April,  upon  getting  up  at  night,  he  stumbled  and  fell, 
striking  the  occiput  against  the  lock  of  the  door,  which  produced, 
first,  concussion,  then  meningitis,  which  was  followed  by  death. 
Although  the  end  was  fatal,  I never  attributed  it  to  the  operation, 


* Personal  letter  from  Dr.  Biggar. 
f Personal  letter  from  Dr.  Schneider. 


SURGERY  IN  THE  HOMCEOPATHIC  SCHOOL. 


61 


and  have  always  looked  upon  the  case  as  a success.”  Such,  then,  is 
another  record  of  skill,  which  it  gives  me  pleasure  to  record  in  its 
proper  place  to-day. 

In  mentioning  these  items  in  regard  to  the  early  surgery  of  our 
school,  necessarily  many  omissions  have  been  made.  I have  endeav- 
ored to  give  an  outline  of  facts  up  to  about  1870,  twenty-three 
years  ago.  Since  then,  as  I have  already  mentioned,  our  surgeons7 
names  and  our  surgeons7  work  are  matters  of  history.  Were  I to 
begin  from  that  date,  the  distinguished  President  of  the  Institute, 
Dr.  J.  II.  McClelland,  whose  labors  as  a surgeon  and  a health  officer 
are  known  both  in  this  country  and  Europe,  would  head  the  list, 
and  be  followed  by  a list  of  names  of  which  this  Institute  is  proud. 

I desire  now  to  inquire  how  came  about  the  proverb,  “ There  is  no 
surgery  in  the  Homoeopathic  School.77  In  those  earlier  times,  even 
within  my  own  recollection,  the  professors  of  the  Homoeopathic  faith 
abjured  surgery  and  thus  unwittingly  laid  the  foundation  for  that 
opprobrium,  the  shadow  of  which  continues  in  many  sections  of  the 
country  to-day.  “ No  surgery ; no  surgeons  among  the  Homoeo- 
pathists.”  This  was  a logical  sequence  and  should  not  be  found  fault 
with.  The  majority, — in  fact,  I may  say  all  the  men  who  first 
espoused  the  cause  of  Hahnemann  were  Old-School  physicians  (not 
surgeons,  mark  you).  They  were  graduates  of  Allopathic  colleges 
and  had  espoused  the  practice  of  medicine  as  their  department.  They 
had  no  especial  taste  (perhaps  even  a distaste)  for  surgery  in  the  Old 
School.  Why  should  they  be  expected  to  adopt  it  in  the  new? 
When  the  beneficent  light  of  a specific  law  of  cure  began  to  illumi- 
nate the  dark  places  of  older  and  more  uncertain  methods,  is  it  a 
wonder  that  these  thoughtful  men  became  more  and  more  impressed 
with  its  reliability  in  the  treatment  of  disease?  Is  it  a wonder  that 
they  met  together  by  day  and  by  night,  whenever  opportunity 
offered,  to  exchange  experiences,  to  verify  symptoms,  to  declare 
clinical  results,  to  prove  new  medicines,  to  discuss  potencies,  and  all 
other  subjects  relative  to  Homoeopathy  ? Is  it  a wonder  when  they 
were  ostracised  by  the  Old  School,  forsaken  by  their  former  friends, 
denied  the  rights  of  medical  societies,  refused  consultations  with  those 
graduated  in  the  same  university  and  were  branded  as  knaves,  and 
quacks  and  fools,  that  they  more  closely  bound  themselves  together 
and  worked  with  redoubled  energy  to  prove  the  truth  of  that  law, 
for  the  adoption  of  which  they  were  content  to  bear  such  miserable 


62 


world's  homoeopathic  congress. 


persecution?  What  did  such  men,  with  minds  so  involved,  care  for 
the  setting  of  a broken  bone  or  the  extirpation  of  a growing  tumor  ? 
What  was  the  mechanical  treatment  of  any  accident,  or  the  perform- 
ance of  any  surgical  operation  compared  with  the  verification  of  a law 
destined  to  revolutionize  therapeutics.  4t  Procul  est  profani”  was 
their  cry.  Surgery  at  this  timp,  as  they  understood  it,  was  a secon- 
dary consideration.  The  outside,  or  collateral  branches  of  medical 
science,  the  disciples  of  Hahnemann  regarded  with  a cynicism  which 
would  be  ludicrous  in  these  days.  It  was  the  Materia  Medica  Pura 
they  studied  ; it  was  Homoeopathic  therapeutics  pure  and  simple 
that  they  honored ; it  was  the  recognition  and  propagation  of  the 
law  of  cure  for  which  they  fought.  Well  is  it  for  us  to-day  that  these 
zealous  and  courageous  men  did  so  devote  their  lives  to  the  establish- 
ment of  truth.  They  placed  the  star  of  Homoeopathy  on  high  and 
it  lights  this  century  to-day.  The  enlightened  professional  men  and 
women  of  all  schools  acknowledge  “ Similia  Similibus  Curantur  ” 
as  a law  of  cure;  and  the  crude  medication  of  fifty  years  ago  has 
given  place  to  a new  posology.  But'**  mark  you  now  what  follows.” 
As  the  years  passed  swiftly  by  and  Homoeopathy  became  more  widely 
disseminated,  and  the  pioneers  were  “ passing  to  the  other  side”  a 
serious  question  arose : What  was  to  be  done  for  those  who  desired 

to  study  medicine  and  who  believed  in  the  Homoeopathic  law?  No 
Allopathic  college  would  receive  such  men,  no  Homoeopathic  pre- 
ceptorship  would  be  recognized  ; no  .compromise  would  be  allowed. 
But  one  course  remained,  viz.,  the  establishment  of  Homoeopathic 
colleges.  The  believers  in  the  system  in  those  days  were  all  educa- 
ted men,  graduated  in  acceptable  universities  at  home  and  abroad. 
They  loved  knowledge  as  well  as  they  loved  truth.  They  believed 
in  thorough  medical  training  and  so  it  came  to  pass  that  when  the 
first  colleges  were  established,  surgery  was  an  important  branch  of 
medical  science ; necessarily  it  was  embraced  in  the  curriculum  of 
study.  I have  watched  its  growth,  watched  it  with  a jealous  eye  for 
over  forty  years,  and  while  I see  around  me  in  all  the  great  cities, 
men  brilliant  and  enthusiastic  who  are  working  with  all  their  energy 
toward  the  establishment  of  surgical  science,  it  seems  to  me  that 
sometimes  the  shadow  of  the  old  opprobium  hovers  over  us  still.  I 
feel  that  the  great  professors  of  Homoeopathy  in  their  excess  of  zeal 
for  Hahnemann’s  law  exhibit  a careless  disregard  of  surgery  as  a pow- 
erful auxiliary  in  securing  honor,  position  and  place  for  Homoeo- 


SURGERY  IN  THE  HOMOEOPATH IC  SCHOOL. 


63 


pathy,  which  is  to  me  surprising.  The  surgery  of  to-day  stands  pre- 
eminently foremost  among  the  sciences  and  arts,  which  with  all  their 
magnificence  adorn  the  latter  end  of  this  nineteenth  century.  It 
absorbs  the  science  of  asepsis,  which  holds  in  its  hands  the  theory  of 
germs.  It  embraces  in  its  intelligent  practice  the  microscopic 
appearances  of  every  tissue,  normal,  abnormal  or  extraneous,  in  the 
human  body.  It  brings  within  its  sphere  of  usefulness,  many  of  the 
instruments  of  precision  ; the  newer  chemistry  is  its  hand-maiden, 
and  bacteriology  its  invaluable  assistant;  and  (speaking  now  from 
a purely  artistic  standpoint)  it  is  my  opinion  that  the  world  cannot 
show  in  any  department  of  art,  any  more  unrivaled  workmanship  than 
that  exhibited  by  the  surgeons,  and  especially  the  American  surgeons 
of  to-day.  The  question  regarding  artistic  and  ideal  surgery  is  not 
“ What  can  it  do  ? ” but  “ What  can  it  not  do?  ” The  world  re- 
spects it,  legislative  bodies  appreciate  its  worth  to  the  communities 
they  govern,  and  the  people  applaud  it  as  the  most  progressive  of  all 
the  collateral  branches  of  medical  science  ; and  I make  the  assertion 
here,  that  after  a tolerably  wide  experience,  until  the  value  of  sur 
gery  as  a means  of  the  propagation  of  the  interests  of  our  own  school 
is  fully  acknowledged  by  our  own  men , we  can  never  obtain  equal 
governmental  and  civil  appointments  with  the  Old  School.  Private 
practice  may  increase,  but  public  recognition  will  remain  in  abeyance. 
I state  further  that  it  is  only  since  our  own  surgery  has  been  in  a 
measure  acknowledged,  that  a few  public  hospitals  have  been  open  to 
us.  Great  institutions  will  never  be  entrusted  to  our  care.,  until  those 
controlling  them  are  satisfied  that  injuries  can  be  cared  for  and  all 
operations  properly  performed.  The  Homoeopath ists  will  never  re- 
ceive appointments  in  the  army  and  navy  until  sufficient  proficiency 
in  surgery  is  acknowledged.  It  is  to  these  facts  that  I desire  to  call 
the  attention  of  this  Congress.  There  is  something  more  to  be 
studied  in  the  Homoeopathic  School  than  Materia  Medica  and  Thera- 
peutics. There  are  other  branches  of  medical  science  to  be  consid- 
ered by  our  great  national  and  state  organizations,  for  Homoeopathy 
can  be  carried  into  everything;  into  Surgery,  into  Obstetrics,  into 
Paedology  ; and  the  surgeon  who  amputates  a limb,  and  prescribes 
homoeopathieally  for  the  pain,  or  sets  a fracture  and  prescribes  Calc, 
phosphor,  to  assist  in  the  formation  of  callus,  or  administers  Silicea 
for  a felon,  or  Hamamelis  for  haemorrhage,  or  Conium  for  cancer, 
must  hold  at  least  as  high  a rank  among  upholders  of  the  system  of 


64  world’s  homoeopathic  congress. 

Hahnemann  as  the  symptomatologist,  the  Materia  Medica  man  or 
the  therapeutist. 

This  appeal  I now  make  to  those  of  my  school  whose  feelings  and 
inclinations  prompt  them  to  investigate  only  those  branches  of  medi- 
cal science  with  which  Homoeopathy  is  most  closely  allied,  viz., 
Materia  Medica  and  Therapeutics.  I beg  them  to  consider  the  im- 
portance of  surgery,  properly  taught  and  properly  practiced,  as  a 
factor  in  the  wider  dissemination  of  Homoeopathy.  You  must  par- 
don this  apparent  importunity  on  my  part,  gentlemen.  It  is  not 
that  I desire  to  be  litigious  that  I mention  these  matters  here,  but 
the  generation  to  which  I belong  has  topped  the  hill  and  it  is  facing 
the  decline.  As  time  speeds  onward,  never  stopping,  never  waiting, 
I see  my  oldest  friends  in  the  service  of  surgery  have  well-nigh  gone 
the  way  of  all  mortality.  Even  since  the  appointment  of  this  lec- 
tureship, one  of  the  foremost  of  our  surgeons,*  and  one  whom  I have 
known  and  loved  since  I was  a boy,  to  whom  I lectured  (although 
almost  his  own  age),  one  who  stood  foremost  in  the  ranks,  a man  of 
sound  judgment,  a fearless  operator,  and  a generous  friend,  and  on 
whose  diploma  my  signature  is  written,  has  passed  into  the  light  of 
God’s  day;  and,  as  I recognize  these  things,  the  gladness  of  victory, 
the  impatience  of  achievement,  the  fierceness  of  strife,  are  not  what 
they  once  were  ; and  I say  this  to  you,  with  the  increasing  light  of 
experience  and  observation,  that  a full  knowledge  of  the  collateral 
sciences,  among  which  surgery  stands  pre-eminently  foremost  at  this 
day,  is  the  only  stepping-stone  to  the  successful  recognition  of  the 
Homoeopathic  school,  the  bulwark  wherewith  to  protect  it  “ from  all 
assaults  of  the  enemy,”  the  tutelary  gods  to  shield  it  from  disgrace, 
the  potent  power  wherewith  to  place  it  on  equal  footing  with  the 
older  and  traditional  school.  In  other  words,  we  want  more  eru- 
dition in  the  collateral  sciences  (in  which  surgery  stands  pre-emi- 
nent), and  less  thrasonical  talk  concerning  Homoeopathic  cures, 
which,  indeed,  if  we  will  let  them  alone,  will  talk  for  themselves. 
We  want  more  general  and  specific  knowledge,  and  we  want,  how 
we  want ! the  wisdom  to  know  how  to  use  it. 

“ Knowledge  and  wisdom,  far  from  being  one, 

Have  ofttimes  no  connection.  Knowledge  dwells 
In  heads  replete  with  thoughts  of  other  men, 

Wisdom  in  minds  attentive  to  their  own. 

Knowledge  is  but  a rude  and  shapeless  mass, 


* Dr.  George  A.  Hall. 


SURGERY  IN'  THE  HOMOEOPATHIC  SCHOOL. 


65 


The  mere  material  with  which  wisdom  builds, 

Till  formed  and  squared  and  fitted  in  its  place, 

Doth  but  encumber  him  it  seems  t’enrieh. 

Knowledge  is  proud  that  it  has  learned  so  much, 

Wisdom  is  humble  that  it  knows  no  more.” 

Discussion. 

The  Chairman  : I will  call  upon  Dr.  I.  T.  Talbot,  of  Boston,  to 
discuss  this  paper  of  Dr.  Helmuth’s. 

Dr.  Talbot  : Mr.  President , Ladies  and  Gentlemen : I feel  my- 
self utterly  inadequate  to  say  anything  which  can  add  to  the  value 
of  this  address.  It  is  a resume  of  the  progress  of  our  School  in  this 
one  subject.  I may,  perhaps,  give  one  or  two  points  which  have  not 
been  included  in  this  paper  ; and  first,  let  me  speak  of  the  first  chair- 
man— for  such  he  was  called  at  the  time — of  the  American  Institute 
of  Homceopathy.  I refer  to  Dr.  Flagg,  of  Boston — a Homoeopath 
who  was  so  well  acquainted  with  the  subject,  and  who  loved  it  to  the 
last  day  of  his  life,  and  had  such  implicit  confidence  in  it.  He  stood 
at  that  time  the  very  first  one  to  raise  to  a science  and  an  art  the- 
whole  subject  of  dentistry.  He  was,  at  the  time,  a progressive,  lead- 
ing man,  and  did  much  for  it,  and  yet  he  was  the  first  chairman  of 
the  American  Institute  of  Homoeopathy. 

The  consideration  of  the  position  of  surgery  during  the  early  years 
of  the  American  Institute,  which  was  organized  less  than  twenty 
years  after  the  entrance  of  Gramm  into  this  country,  found  a large 
number  of  Homoeopathic  physicians  who,  in  their  earnestness  for 
what  Homoeopathy  was  to  do — in  their  great  belief  in  the  efficacy  of 
the  globule — felt  that  surgery  was  a thing  of  the  past;  that  it  would 
be  no  longer  needed;  and  it  threw*  a chill  upon  those  who  felt  that 
surgery  was  yet  to  be  cultivated  among  Homoeopathic  physicians. 
There  was  still  another  point.  When  Homoeopathy  began  to  achieve 
its  first  popularity,  there  unfortunately  came  a class  of  men  who  took 
the  box  and  book,  and  felt  that  knowledge  and  science  were  entirely 
unnecessary  in  Homoeopathic  prescribing,  and  they  did’nt  dare  to  use 
the  knife;  they  had  no  knowledge  of  surgery,  and  therefore  decried 
all  surgical  procedures.  Now,  it  was  at  this  time  that  the  first  Ho- 
moeopathic college  was  established,  in  Phi  lade!  phia,  as  Dr.  Helmuth 
has  told  us;  and  there  were  no  men,  in  the  twenty- three  years  that 
had  followed  the  introduction  of  Homoeopathy,  competent,  as  Dr. 
Helmuth  afterwards  became,  to  be  its  instructor;  and  he  has  well 
said,  that  in  the  three  years  that  he  was  there,  but  three  or  four 
operations  were  performed.  I was  a class-mate  of  Dr.  Helmuth, 
and  we  at  that  time  deprecated  the  condition  of  affairs  in  the  school 
as  related  to  surgery.  We  felt  the  necessity  of  it;  we  urged  upon 
the  Faculty  at  Philadelphia  to  erect  a hospital,  that  surgery  might 

5 


66 


world’s  homoeopathic  congress. 


be  properly  taught  and  practiced  ; but  it  took  a good  many  years 
for  that  to  be  done.  And  thanks  to  the  efforts  that  have  since  fol- 
lowed in  Philadelphia,  in  that  college  where  we  and  they  saw  in  a 
year  but  a single  surgical  operation,  and  that  a slight  one,  we  have 
now  a hospital  which  is  a credit  to  our  school  and  an  honor  to  that 
institution.  We  have  one  of  the  best  hospitals  in  the  United  States, 
where  the  operations  are  not  by  ones  and  twos,  by  dozens  and  scores 
even,  but  by  hundreds — the  most  severe  and  difficult  operations,  with 
the  most  brilliant  success.  The  same  is  true  in  all  the  Homoeopathic 
colleges  of  the  United  States. 

It  is  for  us,  ladies  and  gentlemen,  as  a body  of  physicians  with 
a belief  in  Homoeopathy,  that  it  shall  advance  in  medical  sci- 
ence— it  is  for  us  to  set  our  standard  to  the  very  highest  point  at- 
tainable. It  is,  that  surgery  shall  be  taught  and  practiced  in  the 
very  best  manner.  It  is,  that  all  the  sciences  which  go  to  make  up 
the  great  advancing  science  of  medicine,  and  all  the  knowledge 
which  goes  to  make  the  physician,  shall  be  taught  in  all  our  col- 
leges in  the  best  and  most  thorough  manner.  It  is  for  you,  ladies 
and  gentlemen,  it  is  for  you,  physicians  of  this  country,  holding  to 
this  belief,  to  put  your  hands  to  the  work  and  your  shoulders. to  the 
wheel,  to  help  these  colleges  in  their  efforts  for  the  advancement 
of  surgery,  and  of  all  the  sciences  that  underlie  the  successful  prac- 
tice of  the  noble  art  of  Medicine. 

The  Chairman  : I will  now  call  upon  J.  H.  McClelland,  M.D., 
of  Pittsburgh,  Pa.,  for  further  discussion. 

Dr.  McClelland,  President  of  the  American  Institute  of  Homoe- 
opathy : Mr.  Chairman  and  Members  of  the  Congress:  As  remarked 
by  my  distinguished  friend,  Dr.  Talbot,  I don’t  see  what  I can  add 
to  what  has  been  said  by  Dr.  Helmuth.  He,  you  know,  is  om  parti- 
ceps  princeps.  He  is  first,  and  deserves  to  be.  I really  had  not 
thought  of  speaking  about  this  address  of  Dr.  Helmuth’s  because 
I had  but  heard  it ; had  no  copy  of  it  and,  of  course,  knew  nothing 
at  all  of  its  contents  until  I heard  it  read  this  morning.  I was,  I 
believe,  to  discuss  a paper  that  was  to  be  presented  by  Dr.  Helmuth 
in  the  Surgical  Section.  I will  add  a word,  however,  in  the  same 
line  as  that  taken  by  Dr.  Talbot,  and  that  is,  that  though  the  sur- 
gery of  early  Homoeopathy  was  very  small  indeed,  I think  we  may 
justly  say  that  the  surgery  of  to  day  in  the  Homoeopathic  School 
compares  with  that  of  any  school  or  of  any  class.  We  have  with 
us  here  men  who  have  added  lustre  to  surgical  science,  who  have 
done  credit  to  the  Homoeopathic  School ; and  they  are  not  here  and 
there  merely,  as  single  workers  in  this  important  field,  but  you  find 
them  in  every  city  and  almost  every  hamlet  of  this  great  country, 
and  the  number  is  increasing.  You  find  a surgeon  here  and  a sur- 
geon  thereon  every  hand,  and  they  are  doing  excellent  work.  Now 
to  say  that  the  results  are  very  much  assisted  and  bettered  by  the 


SURGERY  IN  THE  HOMOEOPATHIC  SCHOOL. 


67 


therapeutic  element  of  the  case,  I think,  goes  without  saying. 
There  is  no  doubt  that  the  Homoeopathic  surgeon  receives  very 
great  assistance  from  Homoeopathic  therapeutics.  I believe  that  is 
the  experience  of  every  one. 

As  a bit  of  personal  knowledge  I would  say  that  I very  well 
remember  the  beginning  of  small  things  in  our  own  city.  It  is,  I 
think,  some  twenty-five  years  ago  that  the  first  capital  operation 
was  performed  in  the  Homoeopathic  hospital  of  Pittsburgh,  then  in 
its  first  year.  I had  the  honor  of  doing  that  capital  operation,  and 
it  was  counted  in  those  days  among  us  as  a great  one.  It  was  the 
amputation  of  a leg.  Well,  of  course  the  amputation  of  a leg 
ought  to  be  done  right,  at  any  time,  but  that,  you  know,  is  a very 
simple  affair  now,  and  goes  among  the  minor  operations.  As  com- 
pared with  that,  our  hospital  now  of  200  beds,  which  this  last  year 
has  received  $60,000  from  the  legislature  for  maintenance,  is  doing 
very  much  larger  work.  I think  we  have  in  the  neighborhood  of 
some  two  or  three  hundred  capital  operations  in  a year.  Only  this 
last  year,  for  instance,  we  included,  among  others,  three  double  am- 
putations and  subjects  that  were  very  badly  shocked  and  injured  as 
well,  and  they  all  recovered.  We  had  in  one  week  three  vaginal 
hysterectomies,  which  all  recovered,  and  a fourth  was  added  which 
recovered.  We  added  one  to  the  operation  of  Ctesarian  section 
wherein  the  mother  and  child  both  lived  ; and  so  I might  go  on  to 
compare  the  day  of  small  things  with  our  standing  to-day,  and  the 
experience  I give  in  our  own  institution  is  repeated  here  and  there 
all  over  this  great  country.  I will  be  very  glad  indeed  if  we  can 
hear  from  such  veteran  surgeons  as  Hr.  Ludlam,  who  has  added 
great  lustre  to  our  school  in  the  line  of  surgery  ; and  there  are 
others  who,  I think,  could  address  you  to  much  bettter  advantage 
than  I. 

The  Chairman  : The  subject  is  now  open  for  general  discussion. 
Those  who  speak  are  limited  to  five  minutes. 

R.  Ludlam,  M.D.,  of  Chicago  : Mr.  Chairman,  Ladies  and  Gen- 
tlemen: I don’t  know  what  I can  say  in  five  minutes  that  would 
entertain  you,  but  I may  venture  to  give  my  approval  of  what  has 
been  said  in  the  address  and  in  the  discussion  thus  far.  This  is  one 
of  the  times  I long  have  sought  and  mourned  because  I found  it  not. 
I have  felt  for  many  years  that  the  surgical  branch  of  our  work  did 
not  receive  a due  share  of  attention  at  the  hands  of  physicians  of 
the  Homoeopathic  School,  and  that  this  specialty  needs  more  con- 
sideration in  the  organization  of  our  colleges  and  in  our  work.  This 
subject  has  received  great  emphasis  to-day.  I believe  it  will  do  us 
great  good.  We  need  to  be  armed  at  all  points  in  the  practice  of 
our  profession,  and  to  have  gone  the  whole  round  of  the  medical 
compass.  I cannot  perceive  how  perfect  knowledge  of  one  branch 
of  the  healing  art  shall  make  us  weak  and  worthless  and  willowy 


68 


world’s  homoeopathic  congress. 


in  another.  I never  could  conceive  why  a man  who  was  a good 
surgeon  in  our  school  should  be  any  the  less  a good  Homoeopathic 
physician.  A man — it  has  been  proved  of  late  years — may  be  a 
sound  physician — a Homoeopath — and  yet  not  be  a fool  at  the  same 
time.  He  may  be,  I think,  a good  surgeon  and  a good  Homooopa- 
thist,  a good  obstetrician  and  a good  gynaecologist.  The  long  and 
short  of  it  is,  my  prophecy  I believe  is  coming  true,  and  if  I shall 
live,  as  Moses  did,  to  see  the  promised  land,  I shall  be  delighted.  I 
spoke  of  Moses  yesterday ; Moses  is  an  old  friend  of  mine.  He 
made  some  mistakes,  I am  told,  but  he  was  a good  fellow.  This  is 
my  point:  We  are  cultivating  specialties  now  and  it  always  seems 
as  if  they  were  fads.  They  are  not  fads  necessarily.  If  we  keep 
on  with  the  development  of  specialties  that  are  germane  to  medi- 
cine, bye  and  bye  the  fashion  will  change;  bye  and  bye  the  Old 
School  will  come  to  our  camp  to  learn  therapeutics  as  a specialty. 
They  have  almost  abandoned  the  study  of  therapeutics.  They  give 
anything  now-days  in  the  most  off-hand  way.  They  are  doing  ab- 
solutely nothing  with  therapeutics.  Wait  a bit  until  these  special- 
ties have  been  developed  to  their  utmost  and  somebody  has  got  to 
take  hold  of  therapeutics  and  develop  that  as  a specialty,  and  then 
they  will  come  to  somebody  who  knows  something  about  it  to  start 
with. 

The  Chairman  : The  next  business  in  order  will  be  the  paper 
by  Richard  Hughes,  M.D.,  of  Brighton,  England,  and  in  his  ab- 
sence it  will  be  read  by  O.  S.  Runnels,  M.D.,  of  Indianapolis.  We 
have  with  us  E.  Vernon,  M.D.,  of  Toronto,  President  of  the  Ca- 
nadian Institute,  at  Hamilton,  who  I will  ask  to  take  the  chair 
during  the  reading  of  Dr.  Hughes’s  paper. 


THE  FURTHER  IMPROVEMENT  OF  OUR  MATERIA  MEDICA.  69 


ADDRESS. 

THE  FURTHER  IMPROVEMENT  OF  OUR  MATERIA 

MEDICA. 

By  Richard  Hughes,  M . D. , Brighton.,  England. 


I have  been  asked  to  speak  to  you  on  this  occasion  regarding  the 
“ Further  Improvement  of  our  Materia  Medica.”  The  term  “ fur- 
ther” implies  that  some  improvement  has  already  taken  place,  from 
which,  as  a resting-point  we  may  note  progress  and  survey  the 
ground  yet  beyond  us.  The  reference  is  obviously  to  the  Cyclo- 
paedia of  Drug  Pathogenesy , and  upon  this  I would  say  a few  words 
at  the  outset. 

The  work  in  question  consists — as  you  know — of  a collection  of 
the  provings  of  drugs  not  contained  in  Hahnemann’s  own  volumes, 
with  a selection  from  cases  of  poisoning  by  them  and  of  experi- 
ments made  with  them  upon  the  lower  animals.  These  provings, 
poisonings  and  experiments  have  been  carefully  translated  or  tran- 
scribed from  their  originals,  and  are  presented  in  the  primary  nar- 
ratives w7herever  these  are  given.  The  provings  themselves  are  a 
selection,  made  upon  rules  approved  by  the  two  National  Societies 
of  America  and  England,  and  so  framed  as  to  exclude — as  far  as  it 
is  possible — all  dubious  matter.  We  thus  have,  in  the  four  volumes 
of  the  Cyclopaedia , pathogeneses  of  as  many  hundred  medicines,*  as 
trustworthy  as  careful  choice  can  insure,  and  as  correct  as  knowl- 
edge and  painstaking  care  can  make  them,  with  the  additional  ad- 
vantage that,  wherever  practicable,  they  are  presented  in  an  intelli- 
gible and  interesting  form. 

The  result  gained  by  the  completion  of  this  work  is  that  the  la- 
mentations over  the  unsatisfactory  state  of  our  Materia  Medica, 
which  for  the  last  forty  or  more  years  have  been  heard  from  all  parts 
of  the  Homoeopathic  world,  may  now  sink  to  silence,  or  rather  be 


* The  exact  number  is  413. 


70 


world’s  homceopathic  congress. 


exchanged  for  gratulation.  They  were  well  warranted  when  Jalir’s 
Manual , in  its  various  forms,  was  our  sole  collection  of  pathogenesy. 
Symptomatology  was  there  presented  in  a form  most  incredible,  un- 
intelligible and  repulsive,  without  ground  for  its  statements  or  clue 
to  its  mazes:  it  was,  as  it  has  been  called,  “nonsense  made  difficult.” 
Nor  were  the  groans  evoked  by  it  altogether  assuaged  by  the 
appearance  of  the  Encyclopedia  of  Dr.  Allen,  great  advance  though 
this  was.  Our  scattered  provings  were  there,  indeed,  brought  to- 
gether and  referred  to  their  authors,  besides  being  much  enriched 
from  general  medical  literature ; but  they  remained  unsifted,  and 
were  all  broken  up  into  the  categories  of  the  Hahnemannian  schema. 
Our  Materia  Medica,  even  in  “ Allen,”  continued  to  be  dubious  and 
unattractive.  Now  it  is  neither.  The  student  can  read  the  narra- 
tives of  proving,  poisoning  and  experiment  contained  in  the  Cyclo- 
pedia of  Drug  Pathogenesy  with  as  much  confidence  and  as  lively 
interest  as  if  they  were  cases  of  idiopathic  disease;  and  the  practi- 
tioner can,  with  firm  reliance,  utilize  them  in  his  practice.  If  doubt- 
ful matter  still  remains,  as  where,  with  little  or  no  information  as  to 
their  origin,  we  merely  have  a list  of  symptoms,  the  statements  made 
as  to  their  character,  and  (generally)  the  inferior  type  in  which  they 
are  presented,  will  suffice  to  warn  off  from  possible  quicksands  or 
quagmires. 

But  I must  not  leave  the  Cyclopedia  without  a word  as  to  the 
pathogeneses  given  us  by  Hahnemann  himself,  to  which  it  contents 
itself  with  referring,  evidently  implying  that  they  also  should  be 
possessed  by  the  reader.  Those  of  the  Chronic  Diseases , indeed,  are 
still  a sealed  book  to  most  from  the  lack  of  an  adequate  and  accessi- 
ble version.  The  Materia  Medica  Pura,  however,  has  been  now  re- 
translated for  us  by  the  competent  hand  of  Dr.  Dudgeon,  and  can 
be  obtained  by  any  one.  There  may  be  read  the  results  of  the  master’s 
primal  essays  at  drug-proving,  with  his  own  illuminative  introduc- 
tions and  notes.  The  symptoms  are  arranged  in  schema-form,  in- 
deed, and  there  is  little  information  as  to  how  they  were  elicited  ; 
but  the  latter  deficiency  is  supplied  from  other  sources,  and  many  of 
the  individual  symptoms  are  themselves  groups  which  have  associa- 
tion and  sequence.  When  I speak  of  our  Materia  Medica  as  we 
English-speaking  nations  have  it,  it  must  be  understood  that  I in- 
clude these  two  volumes  of  Hahnemann’s  as  well  as  the  four  of  the 
Cyclopedia  which  supplement  them. 


THE  FURTHER  IMPROVEMENT  OF  OUR  MATERIA  MEDICA.  71 


And  now,  from  the  standpoint  of  what  has  been  gained,  let  us  in- 
quire what  remains  to  be  done  towards  the  improvement  of  this 
Materia  Medica  of  ours.  Let  us  clear  the  way  by  seeing  what 
should  not  be  done. 

The  first  thing  to  be  deprecated  is  the  view  that  the  narratives  of 
the  Cyclopaedia  constitute  so  much  “raw  material”  only,  and  must 
be  worked  up  into  a schematic  symptom  list  before  they  can  be  made 
available  for  practice.  Why  should  this  be?  For  readiness  of  ref- 
erence, it  is  replied  : when  we  want  to  know  what  spinal  symptoms 
Cicuta  induces,  we  can  turn  to  them  at  once  in  Allen,  but  in  the 
Cyclopaedia  we  have  to  hunt  them  through  a number  of  records.  My 
answer  is,  that  this  need  should  be  provided  for  by  an  index,  as  it  is 
in  other  books.  We  do  not,  in  these,  cut  up  the  text  into  categories 
that  individual  items  may  be  the  better  discovered  ; nor  should  we 
do  so  here.  Hahnemann  unfortunately  took  this  course  with  his 
own  provings;  and  nothing,  I think,  has  done  more  to  rob  him  of 
his  honor  in  the  profession  at  large,  to  hinder  conversion  to  Homoe- 
opathy, and  to  drive  practitioners  of  the  system  into  empiricism, 
than  the  distortion  which  has  resulted.  I maintain  further  that 
symptoms  placed  singly,  divorced  from  their  sequence  and  concomi- 
tants, often  convey  a false  idea  as  to  the  pathogenetic  action  of  drugs  : 
so  that  the  schema  is  not  only  unnecessary  but  misleading.*  The 
abandonment  of  this  mode  of  presenting  our  Materia  Medica  is  one 
of  the  most  important  features  of  the  Cyclopaedia  ; and  it  would  be 
no  “ further  improvement  ” if  we  were  to  build  again  that  which 
we  had  destroyed. 

It  is  under  the  influence  of  these  considerations  that  I do  not  feel 
as  sympathetic  as  otherwise  I should  be  towards  another  plan  for 
reconstructing  our  Materia  Medica — that  advocated  from  Boston  by 
Drs.  Wesselhoeft  and  Sutherland,  and  taken  up  (with  some  modifi- 
cations) by  the  Baltimore  Investigation  Club.  It  is  mainly  a trying 
of  the  symptoms  of  our  pathogeneses  by  the  test  of  their  recurrence 
in  more  than  one  subject  of  the  drug’s  influence — only  those  which 
stand  the  ordeal  being  retained.  I am  not  quite  sure  about  the 
soundness  of  the  method  ; there  must  be  some  flaw  in  a mode  of  pro- 
ceeding which  leads  to  the  rejection  of  Cactus  as  inert,  and  to  the 

* These  theses  are  defended  in  detail  in  a paper  on  “ The  Presentation  of  the 
Materia  Medica,”  read  by  me  at  the  International  Homoeopathic  Congress  of  1886, 
and  published  in  its  Transactions,  p.  121. 


72 


world’s  homceopathic  congress. 


reduction  of  the  symptom-list  of  Gelsemium  (upon  one  proposed 
method)  to  four  items  only.*  The  principle,  however,  is  excellent ; 
it  is  that  upon  which  I am  to  a large  extent  acting  in  making  the 
index  to  the  Cyclopaedia.  I am  referring  only  to  such  apparent 
effects  of  drugs  as  “ by  the  force  of  their  occurrence  or  the  con- 
stancy of  their  recurrence  witness  to  organic  connection  with  their 
assumed  causes.”f  But  suppose  I were  to  write  down  these  symp- 
toms as  I indexed  them,  and,  casting  them  into  the  categories  of  a 
schema,  were  to  publish  them  as  the  tried  residuum  of  our  sympto- 
matology. Genuine  they  might  be;  but  a Materia  Medica  so  con- 
stituted would  retain  all  the  remaining  faults  of  those  of  old;  it 
would  be  as  unintelligible,  as  repellent,  as  misleading  as  these 
were. 

One  of  our  journals,  in  noticing  the  Cyclopaedia,  says  that  “ it  to- 
tally ignores  a host  of  old  Homoeopathic  landmarks.”  By  this  is 
probably  meant  the  “ clinical  symptoms”  which  swell  the  bulk  of 
so  many  of  our  Materia  Medicas — meaning  by  this  term  morbid 
states  which  have  (not  appeared,  but)  d/sappeared  while  their  sub- 
jects were  taking  certain  medicines.  Hahnemann  made  some, 
though  sparing,  use  of  such  symptoms  only,  however,  when  they 
occurred  in  provers  of  drugs, J and  always  noting  that  they  were 
Heilwirkungen.  Jahr  introduced  them  more  freely,  0 indicated  their 
character  by  affixing  a small  circle  (o)  to  each.  So  far  little  harm, 
if  little  good,  was  done.  More  recently,  however,  the  practice  has 
grown  up  of  mixing  pathogenetic  and  clinical  symptoms,  together 
with  guesses,  therapeutic  suggestions,  and  hypothetical  inferences,  in 
one  indiscriminate  mass,  and  calling  this  conglomerate  the  Homoeo- 
pathic Materia  Medica.  Men  imagine  that  they  are  applying  the 
law  of  similars  when  they  work  with  such  books,  whereas  they  are 
very  often  practicing  the  merest  empiricism. 

I do  not  wish,  on  the  present  occasion,  to  go  further  into  detail  on 
this  subject.  I have  often  expressed  myself  upon  it  and  always 
feelingly  ; for  I deplore  the  procedure  in  question  as  one  of  the 


* See  New  England  Medical  Gazette  for  December,  1888,  and  North  Amer.  Journ. 
of  Horn,  for  June,  1889. 

f See  “The  Index  to  the  Cyclopaedia  ” in  the  Monthly  Horn.  Review  for  Novem- 
ber, 1890. 

t The  symptom-list  of  Iodium  in  the  Chronic  Diseases  is  the  sole  exception  to 
this  statement. 


THE  FURTHER  IMPROVEMENT  OF  OUR  MATERIA  MEDICA.  73 


greatest  calamities  that  has  ever  befallen  us.  My  sole  reason,  how- 
ever, for  mentioning  it  now  is  to  support  the  opposition  I would 
make  to  any  vitiation  of  our  symptomatology  with  matter  of  a clini- 
cal kind.  It  is  not  that  I undervalue  the  usus  in  morbis  or  despise 
therapeutic  suggestions;  but  I would  have  these  kept  separate  from 
the  pure  pathogenesy.  They  may  appear  in  prefaces  and  notes,  as 
in  Hahnemann’s  publications;  or  they  may  occupy  a separate  vol- 
ume, as  must  be  in  our  case.  There  they  find  scope  for  abundant 
usefulness;  but  mixed  up  with  the  results  of  provings  and  poison- 
ings they  are  confusing,  illusory,  and  destructive  of  all  scientific 
thought  and  practice. 

Not  therefore  by  schematizing,  by  reducing  in  number,  or  by 
blending  with  clinical  materials,  the  drug-effects  on  the  healthy  we 
have  brought  together,  do  I conceive  that  the  Materia  Medica  of 
Homoeopathy  will  receive  further  improvement.  In  fact,  I am  of 
the  same  mind  now  as  I was  in  1879,  when  reviewing  attempts  at 
reconstruction  by  Drs.  Jousset  and  Espanet.*  I deprecated  any  at- 
tempt to  substitute  such  studies  of  drugs  for  our  existing  symptoma- 
tology. “ Let  this,”  I wrote,  “ stand  as  it  is,f  and  let  our  work 
upon  it  be  something  like  that  of  theologians  upon  their  sacred 
books.  As  with  them,  let  our  best  endeavors  be  made  to  enrich,  to 
purify,  and  to  illuminate  the  text.  Then  let  those  competent  for  the 
task  give  us  commentaries  upon  it,  elucidating  its  language.  Let  the 
teachers  of  Materia  Medica  in  our  schools  publish  from  time  to  time 
their  systematic  lectures,  embodying  (as  these  must  do)  all  the  side- 
lights which  from  toxicology,  from  the  physiological  laboratory,  and 
from  therapeutic  experience  they  can  bring  to  bear  upon  its  study. 
These  will  answer  to  treatises  on  doctrinal  and  practical  theology; 
and  then,  for  the  sermons  which  expound  and  apply  particular 
texts,  let  us  have  clinical  records  showing  the  bearing  of  patho- 
genetic symptoms  upon  the  phenomena  of  disease.  In  this  way, 
while  we ’shall  lose  no  grain  of  fact  which  can  be  made  available  in 
the  comparison  of  drug-action  with  morbid  conditions,  there  will  be 
supplied  to  every  student  of  the  Materia  Medica  a general  knowl- 
edge of  its  constituents,  of  their  sphere  and  kind  of  action,  of  their 


* See  British  Journal  of  Homoeopathy , xxxvii.,  257. 

f Of  course,  neither  there  nor  here  am  I minimizing  the  need  of  fresh  provings. 
But  on  this  score  I spoke  so  fully  at  the  International  Homoeopathic  Congress  of 
1891,  that  it  is  needless  to  repeat  myself  on  the  present  occasion. 


74 


world’s  homoeopathic  congress. 


characteristic  features  and  ascertained  effectiveness,  which  shall  send 
him  forth  fully  equipped  for  using  them  in  the  treatment  of  disease. 
There  is  thus  abundance  of  work  for  all  who  desire  to  labor  in  the 
field  of  Materia  Medica,  and  the  more  there  is  done  of  the  kind  the 
better  for  the  future  practitioners  of  our  method.” 

Now  that,  in  the  Cyclopedia,  the  text  of  our  Materia  Medica  has 
been  enriched,  purified  and  illuminated,  I the  more  earnestly  urge 
its  being  left  alone,  and  no  attempt  being  made  to  substitute  for  it 
the  result  of  any  extractive  or  other  process.  The  rest  of  the  work 
suggested  remains  open  ; as  it  is  adequately  performed,  the  further 
improvement  desiderated  will  accrue.  I would  especially  call  for 
commentaries,  elucidative  and  exegetical ; and  would  suggest  that 
those  most  competent  for  such  a task  are  the  specialists  of  our  school 
— the  neurologists,  the  oculists,  the  aurists,  the  gynaecologists.  To 
the  study  by  such  men  of  the  symptomatology  of  disease,  aided  by 
post-mortem  examination  and  experiments  on  animals,  we  owe  the 
great  advances  in  pathology  which  have  marked  the  last  sixty  years. 
May  not  similar  investigation,  when  directed  to  pharmacology, 
achieve  like  results?  The  phenomena  of  drug-disease  have  also 
their  meaning,  and  lend  themselves  to  patient  interpretation.  They 
are  not  themselves  to  be  forgotten,  and  the  phrase  which  explains 
them  substituted,  any  more  than  the  clinical  features  of  idiopathic 
disease  are  to  be  merged  in  its  nosological  name.  But  the  explana- 
tion illumines  them,  makes  them  coherent,  intelligible,  memorable; 
they  become  part  of  our  mental  furniture,  and  are  not  mere  strings 
of  symptoms  to  be  learned  by  heart.  A series  of  studies,  by  experts 
in  each  department,  of  the  neurotic  phenomena  of  the  oxalic  and 
picric  acids,  of  Agaricus,  Bisulphide  of  carbon,  Hypericum,  Lathy- 
rus,  Osmium,  Phosphorus,  Physostigma,  Secale,  Zinc. ; of  the  eye- 
symptoms  of  Ammoniacum,  Aurum,  Digitalis,  Euphrasia,  Macrotin, 
Naphthaline,  Ruta,  Santonine  and  Spigelia;  the  tinnitus  of  Quinine, 
the  Salicylica,  Coca  and  Chenopodium  ; and  the  pelvic  disorder  oc- 
casioned by  Ferrum,  Lilium,  Murex,  Sabina  and  Xanthoxylum— 
a series  of  such  studies,  I say,  would  enrich  the  very  life-blood  of 
our  practice,  and  make  us  all  better  fitted  to  deal  with  the  morbid 
states  that  come  daily  before  us. 

Discussion. 

The  Chairman  : Before  the  discussion  of  this  paper  I would 
like  to  announce  that  the  section  of  surgery  will  meet  in  this  room 


THE  FURTHER  IMPROVEMENT  OF  OUR  MATERTA  MEDICA.  75 


at  3 o’clock  this  afternoon  under  the  charge  of  Dr.  John  E.  James, 
temporary  chairman.  I would  also  give  notice  on  behalf  of  the 
World’s  Congress  Auxiliary  that  it  desires  all  members  in  attendance 
upon  the  Congress  to  register  in  the  basement  at  the  official  registry. 
This  is  distinct,  ladies  and  gentlemen,  from  your  registration  in 
Room  2 under  the  auspices  of  the  Congress  and  the  American  Insti- 
tute of  Homoeopathy. 

The  discussion  on  Dr.  Hughes’s  paper  will  be  opened  by  Dr.  J. 
P.  Dake,  of  Nashville,  Tennessee. 

Dr.  Dake:  Ladies  and  Gentlemen:  It  seems  hardly  necessary 
for  me  to  say  anything  upon  this  paper  of  Dr.  Hughes.  Dr.  Hughes 
and  I have  been  associated  in  work  for  several  years  and  we  quite 
agree  in  our  views.  However,  there  are  some  points  in  which  I 
must  place  a little  dissent  from  the  address.  While  I agree  with 
him  fully  that  the  proper  publication  of  all  provings  should  be  in 
the  narrative  form  just  as  the  symptoms  have  occurred  from  the  first 
day  or  the  first  hour  until  the  last;  still,  for  the  convenience  of  the 
profession  and  the  busy  practitioner,  I hold  that  it  is  necessary  to 
have  some  sort  of  minor  arrangement  or,  as  Dr.  Hughes  calls  it, 
extractive  work  applied.  I must  confess  that  my  use  of  the  Materia 
Medica,  as  we  have  had  it  in  its  schematic  form,  has  been  useful  to 
me,  and  I may  not  agree  as  yet  to  cast  it  aside.  Of  course,  the 
cutting  up  of  symptoms  by  an  arrangement,  as  we  have  had  from 
Hahnemann  down,  does  separate  them  and  take  them  out  of  their 
connection,  but  the  physician,  while  using  the  schematic  form  to  find 
what  he  is  after,  ought,  in  my  judgment,  to  refer  constantly  to  the 
original  record,  and  particularly  when  he  has  a case  that  requires 
much  study  of  remedies.  There  you  have  it  in  those  connections, 
and  we  must  look  upon  the  effects  of  drugs  as  drug  diseases.  Bel- 
ladonna produces  a Belladonna  disease,  and  we  ought  to  take  it  in 
its  entirety  as  we  do  a case  for  which  we  are  prescribing. 

I cannot  entirely  agree,  therefore,  with  Dr.  Hughes  in  what  he 
says  in  regard  to  the  work  in  Boston  by  Drs.  Wesselhoeft  and  Suther- 
land, and  in  what  he  says  with  regard  to  the  work  being  done  in 
Baltimore  by  the  Investigation  Club. 

I have  had  in  years  past  a little  controversy  with  some  of  my 
English  friends  in  regard  to  this  matter.  I hold  that  when  the 
symptomatology  of  a drug  is  properly  taken  and  properly  studied  that 
it  is  possible,  by  a study  of  those  records,  to  know  something  of  what 
are  the  characteristic  symptoms  of  the  drug.  I hold  that  there  is 
no  other  way  safely  to  determine  what  are  the  characteristic  symp- 
toms of  a drug.  To  depend  upon  clinical  experience  will  not  do. 
We  have  been  misled  often  by  such  attempts.  I once  made  this 
point,  in  answer  to  some  of  my  English  friends,  that  while  we  may 
have  a map  of  the  United  States  in  detail,  giving  every  river  and 
every  county  line,  and  the  location  of  every  city,  and  perhaps  of 


76 


world’s  homoeopathic  congress. 


every  village,  still  it  should  be  possible  to  give  an  outline  map  of 
the  United  States  that  will  not  be  misleading,  even  if  it  does  not  give 
us  all  the  information  that  we  may  desire. 

For  that  reason  I hold  that  it  is  possible,  when  provings  are 
rightly  made  and  rightly  recorded,  to  have  an  abstract  of  Materia 
Medica  that  will  comprise  the  characteristic  or  more  prominent  and 
persistent  symptoms  of  each  drug. 

I will  not  detain  you,  but  wish  to  make  this  remark,  that  the 
future  improvement  of  the  Materia  Medica  depends  not  so  much 
upon  the  arrangement  of  the  material  we  now  have  as  upon  the  pro- 
duction of  better  material.  The  provings  should  be  made  with  all 
the  care,  and  recorded  with  all  the  care,  that  you  may  see  in  any  other 
department  of  science.  This  is  a matter  of  experiment.  Experi- 
ments ought  to  be  performed  with  every  precaution  that  is  possible, 
against  illusion,  against  error  and  corruption. 

It  is  a fact,  that  I may  have  occasion  to  mention  again  before  we 
get  through  with  our  Congress,  that  provings  have  been  made  here 
and  there  and  everywhere  by  busy  physicians,  by  people  who  are 
full  of  theoretical  ideas  and  of  pathological  notions,  that  make  their 
appearance  in  their  provings.  Provings  have  been  made  by  per- 
sons who  are  not  even  acquainted  with  anatomy,  so  as  to  be  able  to 
locate  their  symptoms  in  attempting  to  describe  them.  These  are 
faults  which  must  be  remedied,  and  to  do  that  we  will  have  to  have 
this  matter  conducted  by  persons  competent  to  supervise  it,  by  provers 
who  are  in  the  right  conditions  to  have  the  effects  of  the  drug  re- 
flected properly,  and  to  have  all  the  symptoms  recorded  in  a plain 
and  proper  manner. 

The  Chairman  : The  paper  by  Dr.  Hughes  will  be  further  dis- 
cussed by  Dr.  T.  F.  Allen,  of  New  York  City. 

Dr.  Allen  said  : Ladies  and  Gentlemen : I have  listened  with  the 
greatest  interest  to  the  reading  of  Dr.  Hughes’s  paper,  but  confess 
my  disappointment  that  in  it  he  alludes  to  the  Cyclopsedia  of  Drug 
Pathogenesyf  or  the  improved  Materia  Medica,  standing  as  it  is,  as 
the  sacred  books  of  the  Bible. 

At  the  meeting  in  Deer  Park  I,  a minority  of  one,  protested 
against  the  doctrine  and  the  principles  upon  which  this  new  Materia 
Medica  was  based.  I have  not  since  that  time  changed  my  opinion  ; 
and  the  Materia  Medica  as  incorporated  in  the  Cyclopsedia  of  Drug 
Pathogenesy  cannot  stand,  in  my  opinion,  as  the  sacred  books  of  the 
Bible.  I do  not  now,  and  never  have,  believed  in  the  method  of 
arrangement  as  practical  and  adapted  to  the  wants  and  necessities  of 
the  homoeopathic  physician.  In  that  respect  I differ  from  Dr. 
Hughes  when  he  says  that  he  regrets  that  Hahnemann  saw  fit  to  put 
his  Materia  Medica  into  the  schematic  form,  and  perhaps  that,  there- 
fore, Homoeopathy  suffered.  I believe,  as  an  humble  follower  of 
Hahnemann,  that  he  did  the  best  thing  for  Homoeopathy,  and  that 


THE  FURTHER  IMPROVEMENT  OF  OUR  MATERIA  MEDICA.  77 


if  he  had  not  put  his  Materia  Medica  into  this  schematic  form  it 
would  have  almost  died  in  its  birth. 

I differ  now,  have  always  and  must  always  differ,  from  Dr.  . 
Hughes  on  this  point.  I cannot  conscientiously  do  otherwise  as  a 
teacher  and  practitioner  of  Homoeopathy.  The  narrative  form 
is  extremely  valuable  for  study.  The  narrative  form  of  the  Cy- 
clopaedia is  a book  I prize  most  highly.  It  is  on  the  front  shelf  of 
my  desk.  I consult  it  constantly,  but  in  prescribing  for  my  patients 
I use  the  Schema,  not  the  Narrative  form.  In  studying  for  the 
preparation  of  lectures,  for  the  working  out  of  the  points,  the  char- 
acteristic features  of  the  action,  and  study  of  the,  if  I might  almost 
coin  a word,  the  Pathognomenia  of  the  drug,  I use  the  Cyclopaedia  ; 
but  Hahnemann  wanted  to  make  it  practical,  and  that  is,  I think, 
what  the  Homoeopathic  profession  of  to-day  needs.  So  Dr.  Hughes’s 
paper  goes  on  principally  at  first  to  speak  of  the  arrangement  of  the 
Cyclopaedia. 

Next  he  states  that,  in  his  opinion,  the  improvement  of  the  Ma- 
teria Medica  will  come  not  from  the  improvement  of  the  Materia 
Medica,  mind  you,  as  he  says,  but  from  exigencies.  That  we  must 
have  lectures  upon  it;  it  must  be  eliminated;  we  must  have  talks 
and  sermons  upon  this  Materia  Medica.  But  that  is  not  an  im- 
provement in  the  Materia  Medica  itself,  and,  therefore,  I wish  to 
submit  a few  words  on  the  subject-matter  of  Dr.  Hughes’s  address, 
rather  than  on  the  address  itself. 

The  improvement  of  the  Materia  Medica  has  taken  hold  of  the 
minds,  I am  happy  to  see,  of  many  of  the  younger  men  as  well  as 
the  older  men  in  the  profession,  and  Materia  Medica  clubs  have 
been  formed  in  various  parts  of  our  country;  the  Boston  Club,  the 
Baltimore  Club,  the  New  York  Materia  Medica  Club,  all  having 
for  their  object  the  study  and  improvement  of  the  Materia  Medica. 

Dr.  Dake  has  very  properly,  and  in  accordance  with  my  own 
opinion,  sounded  the  keynote  of  his  approval  of  the  course  adopted 
by  the  Boston  and  Baltimore  Clubs  in  conceiving  the  Materia 
Medica.  I entered  heartily  into  that  work,  and  I believe  it  to  be 
true,  as  Dr.  Dake  has  just  said  to  you,  that  the  characteristic  symp- 
toms of  our  Materia  Medica  will  be  found  in  the  provings.  • Yes, 
but  only  when  the  provings  of  a drug  shall  have  been  completed,  as 
he  himself  modified  his  statement.  There  is  not  more  than  one  or 
two  drugs,  perhaps,  in  the  whole  Materia  Medica  which  have  been 
completely  proved.  I would,  perhaps,  mention  Lycopodium  as  one 
approximately  complete.  Most  all  of  the  drugs  of  our  Materia 
Medica  are  extremely  incomplete,  and  on  this  ground  I base  my  ob- 
jection to  the  improvement  of  the  Cyclopaedia , because  it  threw  out 
isolated  provings. 

Now,  many  of  the  most  valuable  symptoms  to  me  for  my  use  in 
practice  have  been  derived  from  my  study  of  isolated  cases  of  poi- 


78 


world’s  homoeopathic  congress. 


soning  or  isolated  provings.  A single  proving,  a single  case  of  poi- 
soning has  given  me  most  valuable  indications.  Symptoms  for  use 
at  the  bedside  which  I consider  characteristic,  and  which  I rely  upon 
and  must  continue  to  rely  upon.  Those  provings  have  not  been 
duplicated.  These  observations,  indeed,  have  not  been  dupli- 
cated. I cannot  use  the  Materia  Medica  which  leaves  them  out, 
and  consequently  my  manuscript  Materia  Medica  is  a large  and 
constantly  accumulating  one.  I rely  upon  it.  How,  then,  are  we 
to  know,  except  by  symptoms,  what  to  do  with  this  enormous  mass  of 
Materia  Medica?  The  making  of  a Materia  Medica  is  really  in  its 
infancy;  this  proving  of  drugs  is  just  commenced.  As  I said  at 
the  meeting  at  Atlantic  City,  we  are  laying  the  foundation,  the 
ground-work  for  centuries  of  labor  in  proving  drugs.  It  seems  an 
almost  infinite  work,  but  until  our  proving  is  complete,  so  that  we 
can  prove  a drug  in  every  part  of  the  body,  upon  every  symptom, 
susceptible  to  its  drug  action,  our  work  will  not  be  complete  and  our 
Boston  and  Baltimore  Clubs  cannot  group  their  symptoms.  My 
own  limited  experience  in  proving  teaches  me  that  different  condi- 
tions develop  different  symptoms.  It  is  only  when  we  have  large 
masses  of  provers,  over  and  over  again,  that  we  get  the  whole  proof 
of  the  drug  upon  every  part  of  the  body  susceptible  to  this  drug 
action.  It  must  necessarily  be  so;  we  cannot  complete  this  work; 
it  is  in  its  infancy. 

I want  to  say  to  you,  and  should  have  spoken  of  it  sooner,  that, 
in  my  opinion,  the  improvement  of  the  Materia  Medica  must  come 
about  through  its  application  at  the  bedside.  Improvement  in 
methods  of  provings?  Yes.  Improvement  in  the  interpretation  of 
symptoms  ? Yes. 

When  an  observation  comes  to  my  hand,  an  isolated  observation 
of  the  effect  of  a drug,  and  I test  it,  and  the  test  is  repeated  at  the 
bedside,  it  fixes  its  value  in  my  estimation  and  must  do  so  in  yours. 
We  cannot  yet  dispense,  I will  say,  with  clinical  symptoms — I do 
not  believe  in  them  ; but  we  cannot  dispense  with  our  experience 
obtained  from  the  application  of  drug  symptoms  at  the  bedside.  We 
all  of  us  come  to  rely  upon  them.  We  all  of  us  see  more  or  less, 
perhaps,  doubtful  symptoms.  We  cannot  depend  entirely  upon  the 
book,  because  I may  say  that  no  drug  is  yet  completely  understood, 
and  we  do  not  know  what  may  be  developed  in  the  future.  The 
value  of  what  has  been  verified  repeatedly  at  the  bedside  cannot  be 
overestimated.  If  a single  observation  of  a single  individual  serves 
me  well  every  time,  I will  hold  to  it  as  a good  symptom,  and  my 
cure  is  Homoeopathic.  So  I think  the  course  taken  in  the  New 
York  Materia  Medica  Club  (of  which,  I am  sorry  to  say,  I am  a 
very  poor  member,  having  never  attended  a meeting)  meets  with  my 
hearty  approval.  Their  course  is  able  to  test  the  symptomatology 
of  our  Materia  Medica;  it  is  practiced  at  the  bedside,  in  the  dispen- 


THE  FURTHER  IMPROVEMENT  OF  OUR  MATERIA  MEDICA.  79 


sary,  in  private  practice,  and  week  to  week  coming  with  “this 
symptom  and  that  symptom  cannot  be  verified  at  th.e  bedside;  bat 
this  symptom  is  always  verified  at  the  bedside.”  We  make  notes- 
of'  these;  we  underline  them  in  our  books;  we  rely  upon  them  be- 
cause they  have  been  repeatedly  found  to  serve  us  well.  Our  im- 
provement in  Materia  Medica  lies  largely,  it  seems  to  me,  in  the 
clinical  application  of  it. 

There  is  much  more  to  say,  but  I will  not  detain  you  longer. 

Conrad  Wesselhoeft,  M.D.,  of  Boston,  Mass. : I shall  only 
detain  you  a few  moments.  I want  to  make  a few  brief  allusions 
to  Dr.  Hughes  in  reference  to  myself.  He  has  honored  me  by  ref- 
erence to  my  elimination  or  exclusion  of  Cactus,  referring  to  the 
method  which  I have  employed  in  coming  to  that  conclusion.  Per- 
haps I may  be  wrong,  but  what  I want  to  discuss  is  the  method  by 
which  it  was  done.  He  says  there  were  flaws  in  the  method,  or 
else  Cactus  would  not  have  been  excluded.  Likely  there  were  flaws 
in  the  method.  The  method  was  simply  that  alluded  to  by  Dr. 
Lane,  Dr.  Bates  and  others,  of  comparing  the  results  of  proving — 
making  a careful  comparison  of  provings.  It  is  by  comparison 
alone — a great  number  of  comparisons — that  any  true  results  in 
science  can  be  reached.  The  experiments  were  very  painstaking 
and  thorough.  The  reasons  for  which  I threw  some  doubts  upon 
the  utility  of  Cactus  was  not  only  because  comparisons  of  the  prov- 
ings gave  that  result,  but  because  I also  made  personal  provings 
upon  it  with  the  same  result.  I was  willing  to  sacrifice  my  valua- 
ble person  to  so  valuable  a medicine  and  for  the  good  of  mankind. 
Not  I alone,  but  a good  many  of  our  students  in  Boston,  have  re- 
proved Cactus  a good  many  times  and  very  thoroughly  since  Dr. 
Ravenna,  in  Naples,  first  came  out  with  his  marvellous  proving  of 
Cactus.  If  there  is  error  in  my  conclusions,  very  likely  it  is  owing 
to  the  difficulty  of  the  matter,  but  not  owing  to  the  principle  upon 
which  it  was  done.  Why  should  not  I exclude  Cactus  on  careful 
examination,  on  careful  proof,  on  careful  reproof  and  careful  com- 
parison, when  Dr.  Hughes  takes  it  upon  himself  to  deal  with  Natrum 
muriaticum  in  the  way  he  does  without  any  proving  or  reproving 
or  comparison  at  all?  He  gives  no  reasons  why;  he  has  not  made 
any  comparisons  or  provings  with  Natrum  muriaticum  as  I have 
done.  He  has  made  no  reproving.  If  Dr.  Hughes  is  justified  in 
throwing  out  a medicine  on  such  reasons  as  those,  I think  I should 
be  justified  in  throwing  some  doubts  at  least  upon  the  utility  of  the 
proving.  I have  carefully  compared  and  reproved,  and  spent  not 
only  days,  but  weeks,  in  doing  so  myself.  Now,  there  may  be  a 
great  deal  of  good  in  Cactus.  I have  in  my  possession  a two-ounce 
bottle  of  tincture  of  Cactus,  presented  to  me  by  my  old  friend  in 
Brookline,  who  obtained  it  in  Naples  from  Dr.  Ravenna.  He 
brought  this  to  me,  and  was  very  anxious  that  I should  prove  it, 


80 


WORLD  S HOMOEOPATHIC  CONGRESS. 


and  I did  so.  I went  carefully  to  work  to  make  the  provings, 
merely  to  show  that  I could  get  effects  from  it — from  twenty  to 
thirty,  forty  or  fifty  drops  of  that  very  powerful  stimulant.  Those 
of  us  who  have  proved  it  have  done  so  not  only  with  the  potencies 
— first  two,  four  and  five  tincture  graduated  doses — but  have  carried 
it  to  the  ounce,  and  got  no  other  results.  I do  not  say  that  my 
provings  are  as  good  as  Dr.  Ravenna’s.  He  gives  no  provings  at 
all.  He  states  facts,  makes  statements,  and  when  you  read  them 
you  would  suppose  a person  who  had  taken  Cactus  had  fallen  with 
an  attack  of  epilepsy,  in  which  he  rolled  and  writhed  on  the  ground. 
Others,  again,  there  are  who  think  the  person  died  of  heart  disease 
or  suffocation  or  of  violent  cough  or  tremendous  haemorrhages,  which, 
in  reading,  would  appal  even  one  accustomed  to  sights  of  horror.  I 
say,  from  the  proving  of  Cactus,  at  first  thought,  it  might  be  haem- 
orrhage, heart  disease,  epilepsy — all  these  things  they  suppose  I 
might  be  troubled  with,  but  I got  nothing  of  the  kind.  I said  to 
Dr.  Hughes:  These  are  strong  evidences  of  the  value  of  the  prov- 
ing. It  has  been  ascertained  that  Dr.  Ravenna  took  certain  quan- 
tities. Some  friends  found  among  his  papers  that  he  had  taken  the 
third  attenuation  to  get  these  symptoms.  That  was  a good  many 
years  after  Ravenna  was  dead  that  somebody  wrote  that;  but  Dr. 
Hughes  don’t  think  such  a statement  is  going  to  get  into  Materia 
Medica,  that  Dr.  Ravenna,  by  means  of  the  third  attenuation,  pro- 
duced these  results.  I do  not  believe  them;  I do  not  want  to 
impugn  anybody’s  veracity,  but  I do  not  think  they  are  correct.  I 
merely  suggest  that  Cactus,  instead  of  being  a medicine  that  would 
produce  violent  effects,  was,  on  the  other  hand,  an  innocent  potherb. 

Dr.  Hawkes:  Just  one  word  or  two  upon  this  point.  You 
would  look  in  vain  through  all  the  works  on  Materia  Medica  for 
my  name,  but  if  I cannot  claim  to  be  a writer  I can  claim  to  be  a 
reader  and  a user.  I wish  in  this  connection  and  under  this  state- 
ment to  offer  one  word  of  warning,  and  that  is  this  : That  it  may  be, 
and  is,  a very  honorable  thing  to  notice  a medicine  which  has  been 
well  tried  and  well  proven  ; but  he  incurs  a very  heavy  responsi- 
bility who  excludes  from  our  Materia  Medica  certain  medicines, 
because  they  have  not  been  so  fully  used.  There  is  one,  Muritius 
Upia  (?)  that  has  served  me  in  the  very  best  possible  way.  I have 
learned  to  use  it  from  just  one  word  repertory,  introduced  by  Drys- 
dale.  I refer  to  Allen’s  big  book,  and  that  contains  a reference  to 
Upia,  and  I followed  that  up,  but  now  that  drug  is  excluded  from 
the  Hand  Book,  which  I use,  by  the  way,  alternately  as  a hand 
book  and  an  Indian  club.  It  is  excluded  also  from  other  works, 
with  reference  to  which  we  have  heard  this  morning,  but  I wish  to 
say  a word,  the  symptom  of  a burning  in  the  left  ovary  has  proved 
to  be  of  the  very  greatest  value.  My  work,  of  which  I must  not 
speak  now,  has  some  connection  with  that  part  of  the  body.  I would 


THE  FURTHER  DEVELOPMENT  OF  OUR  MATERIA  MEDICA.  81 


not  hesitate  if  occasion  required  it  to  open  the  abdomen,  and  if  this 
were  the  proper  place  I could  bring  case  after  case  before  you  that 
had  been  condemned  for  operation,  and  where  operation — I am  not 
saying  now  whether  that  was  a virtue  or  not,  but  that  operation  has 
been  saved.  And  amongst  other  things  I would  say  that  this  drug, 
a description  of  which  you  will  find  in  any  of  these  Materia  Medicas, 
but  is  fairly  well  and  fully  spoken  of  in  the  bigger  work  of  Allen. 
I would  say  that  this  is  a direct  cause  of  evil  ; that  one  solitary  in- 
stance which  I,  as  a user  of  the  drug,  rather  than  a writer  of  Materia 
Medica,  would  speak  of  and  mention  as  a word  of  warning  to  those 
who  are  perhaps  a little  too  ready  to  cut  out  from  our  Materia 
Medica. 

F.  Parke  Lewis,  M.D.,  of  Buffalo,  New  York,  then  addressed 
the  Congress  on  the  subject  of  “The  Value  of  Specialties  in  Medi- 
cine.” 


82 


world’s  homceopathic  congress. 


ADDRESS. 

THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 

By  F.  Parke  Lewis,  M,D.,  Buffalo,  N.  Y. 


While  we  are  gathered  together  from  widely  separated  parts  of 
the  world  in  this  fair  city  where  so  much  that  is  of  interest  is  now 
centered,  I am  not  insensible  to  the  honor  you  do  me  in  pausing  even 
for  a few  moments  to  listen  to  the  thoughts  I have  to  offer  upon  the 
general  subject  of  “ Specialties  in  Medicine.”  Though  the  occasion 
is  not  one  to  warrant  us  in  entering  largely  into  details,  both  the  time 
and  subject  are  too  important  to  permit  superficial  consideration. 

Let  us  therefore,  first  inquire  briefly  how  the  thing  which  we 
now  know  as  specialization  was  evolved.  When  we  resolve  all  the 
multiform  effort  of  the  world  into  elementais,  we  find  that  the  one 
thing  in  the  world  is  life.  The  one  thing  we  are  trying  to  do  is 
live.  All  the  isms  and  ologies  are  only  a part  of  it,  or  helps  to  it. 
The  effort  of  all  who  think  and  work  truly  is  to  increase  the  value 
of  life,  not  to  make  life,  that  were  impossible,  but  to  render  life 
more  complete,  more  perfect. 

Broadly  considered,  human  life  can  be  perfect  only  when  a power 
and  faculty  is  fully  developed  in  absolute  harmony  with  every  other. 
But,  as  it  would  be  impossible  to  entrust  to  any  one  man  or  set  of 
men,  the  guidance  of  the  race  in  all  of  its  wonderful  and  bewilder- 
ing individual  capacities,  man  early  came  to  be  regarded  as  divided 
into  three  distinct  entities,  physical,  intellectual  and  moral  (or 
spiritual),  and  we  have  as  a result  three  classes  of  men  to  whom  the 
world  looks  for  its  uplifting.  To  physicians  has  been  given  the  task 
of  broadening  and  perfecting  the  physical  life  of  the  race.  To  the 
clergy  the  hardly  more  sacred  work  of  enlarging  the  moral  life  and 
perfecting  spiritual  vision,  and  to  the  great  army  of  teachers  in  every 
branch  of  science  and  art  comes  the  glorious  possibility  of  develop- 
ing the  intellect  of  man  into  something  yet  more  godlike. 

Medicine,  theology,  and  philosophy,  the  first  three  specialties. 


THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 


83 


But  so  complex  and  all  comprehending  a thing  as  intellectual  life 
could  never  be  brought  within  the  bounds  of  one  man’s  power  and 
knowledge,  and  so  the  educators  have  almost  infinitely  divided  their 
work.  Those  to  whom  the  care  of  souls  was  given  soon  discovered 
that  no  one  expression  of  belief  could  be  broad  enough  to  provide 
scope  for  the  infinitely  out-stretching,  constantly  expanding  indi- 
vidual spiritual  life,  and  theology  consequently  divided  and  sub- 
divided, and  took  to  itself  creeds. 

While  it  is  obvious  how  powerless  any  one  man  must  be  and  must 
have  been  to  cover  with  ever  so  great  industry  and  genius  the  whole 
vast  field  of  human  possibilities,  and  while  a division  of  labor  was 
and  is  imperative,  the  greatest  possible  value  can  never  be  obtained 
by  such  division  in  any  field  without  a right  understanding  on  the 
part  of  those  who  undertake  any  branch  of  work  of  the  economic 
reasons  governing  its  divisions,  and  the  great  natural  laws  under 
which  each  man  must  work  within  his  own  lines. 

The  more  deeply  we  think  and  study  into  the  things  of  nature 
and  of  life,  the  more  we  become  aware  of  a central  unity  running 
through  all  things;  a fundamental  law  with  which  all  other  laws 
must  co-operate,  with  which  all  truth  falls  in  line,  to  which  all  logic 
finally  points  as  the  needle  to  the  pole. 

We  are  closely  pressed  in  our  industrial  life  in  these  days  by 
failing  to  appreciate  or  to  apply  this  law.  The  underlying  prin- 
ciple of  unity,  in  man  as  in  nature,  implies  the  most  perfect  har- 
mony, the  fullest  co-operation,  and  at  the  same  time,  and  only  in 
consequence  of  this,  the  most  perfect  expression  of  individual  life 
and  liberty. 

As  the  plant  is  dependent  upon  the  sun  and  dew;  as  the  tree  is 
saved  from  death  by  the  bird  that  lives  upon  the  insect  which  would 
destroy  it ; as  the  tide  answers  to  the  moon  and  the  world  itself  to 
the  motion  of  the  spheres,  so  must  man  recognize  his  unity  with  man 
and  nature,  acknowledge  his  constant  mutual  interdependence,  must 
serve  and  be  served,  or  lose  his  highest  and  most  harmonious  de- 
velopment. 

The  freest  and  most  perfect  expression  of  human  power  and  life 
is  possible,  then,  not  by  more  and  more  separation,  but  by  more  and 
more  unification  ; by  a deeper  and  surer  perception  of  the  laws  of 
the  world,  and  a living  in  harmony  with  them.  This  does  not  pre- 
clude special  work.  It  does  not  deny  to  any  man  the  right  to  work 


84 


world’s  homoeopathic  congress. 


out  the  best  that  is  in  him  in  his  own  way,  to  choose  his  work  within 
very  narrow  lines  if  he  will.  But  that  he  may  attempt  something 
like  perfection  in  one  direction,  he  must  laydown  as  well  as  take  up. 
Specialization  means  concentration.  Emerson  has  somewhere  said  : 
“ You  must  elect  your  work ; you  shall  do  what  your  brain  can  and 
drop  all  the  rest.  Concentration  is  the  secret  of  strength.”  Some 
apprehension  of  this  truth,  however  dimly  conceived,  lay  at  the 
foundation  of  the  first  conscious  division  of  work  into  what  we  call 
specialties.  But  specialization  means  also  renunciation.  “ Drop  all 
the  rest,  lay  down  as  well  as  take  up.”  Leave  some  work  that  one 
might  do,  that  even  might  bring  more  generous  results  in  its  per- 
formance than  the  little  bit  that  must  be  wrought  at  with  such  un- 
flagging care  to  bring  it  to  its  fullest  beauty  and  perfection.  One 
must  leave  to  some  one  else  the  work  that  might  have  been  his  own ; 
he  must  relinquish  some  part  of  his  inheritance;  and  if  he  would 
secure  a true  value  in  his  exchange,  let  him  see  to  it  that  what  he 
gets  is  something  more  than  a mess  of  pottage.  His  work  will  be  to 
him  little  more  than  this  if  it  is  undertaken  from  motives  of  self- 
aggrandizement.  If  his  object  is  a mercenary  one,  he  will  doubt- 
less make  money,  which  means  food  and  clothes,  as  good  as,  or 
a little  better  than,  his  neighbor’s;  a little  power  and  splendor,  and 
a residuum,  after  careful  analysis,  of  dust  and  ashes. 

His  object  has  been  separation,  not  unification  ; he  has  striven 
against,  not  with,  his  brothers;  he  has  undertaken  a special  work, 
not  that  he  might  do  a little  more  perfectly  than  he  could  do  more, 
and  the  thing  that  he  has  devoted  his  life  to  be,  in  consequence,  of 
more  value  to  the  world,  but  that  by  doing  some  one  thing  better 
than  any  one  else  could  do  it,  he  might  receive  for  himself  more 
gain  and  glory.  Both  may  become  his,  the  gain  and  the  glory. 
But  cui  bono.  The  greatest  good  will,  of  a surety,  be  denied  him 
if  he  is  content  to  seize  these  apples  of  Sodom.  His  work,  I do 
not  hesitate  to  say  it,  will  fall  short  of  that  which  is  best. 

Therefore,  the  value,  that  is,  the  worth,  the  importance,  the  utility 
of  specialties,  in  medicine  as  in  anything  else,  depends  less  upon  the 
thing  specialized,  or  the  necessity  for  its  specialization,  than  upon 
the  man  who  does  it  and  the  spirit  he  works  in.  In  comparison  with 
this,  all  other  reasons  and  reasoning  are  vain. 

It  has  been  said,  and  not  without  reason,  that  narrowness  is  a re- 
sult of  specialization. 


THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 


85 


But  a broad  man,  liberally  educated,  does  not  necessarily  become 
narrow  by  devoting  his  best  energies  to  some  one  thing  that  he  feels 
he  can  develop  more  power  in  than  he  could  attain  in  any  other  di- 
rection. He  may  give  himself  up  so  completely  to  his  chosen  work 
as  to  almost  exclude  the  possibility  of  any  extended  reading,  not  to 
say  research,  in  any  other  direction.  His  time  may  become  so  ab- 
sorbed by  the  demand  upon  it  in  his  limited  field  that  he  can  rarely 
even  meet  with  those  whose  work  is  carried  on  with  larger  lines.  And 
yet,  if  he  maintains  his  true  relation  to  the  world;  if  his  mental  attitude 
be  a right  one,  I insist  that  he  need  not  become  narrow  in  the  generally 
accepted  sense  of  the  term.  There  will  be  much  that  he  cannot  know, 
that  he  must  voluntarily  relinquish  the  possibility  of  knowing,  but  he 
will  be  broadly  interested  in  it  all.  He  may  renounce  frequent  fel- 
lowship, but  if  in  his  work  and  growth  he  is  constantly  and  consci- 
entiously one  of  the  great  human  family,  connected  by  the  closest 
ties  with  every  other,  doing  his  part,  however  distinct  it  may  be, 
not  in  isolation,  not  in  the  spirit  of  separation,  but  simply  as  his  bit 
of  the  great  whole,  in  all  of  which  he  has  a personal  interest,  which 
is  all  his,  and  yet  not  his;  which,  but  for  the  perfection  of  his, 
would  be  less  perfect,  which  is  never  to  be  lost  sight  of  in  the  exclu- 
sion of  his  own, — if,  in  a word,  his  special  work,  however  absorbing 
it  may  be,  does  not  get  between  him  and  life,  he  need  not  lose  mate- 
rially, or  beyond  compensation,  by  his  adoption  of  a specialty.  He 
does  not  renounce  the  spirit  of  fellowship,  he  does  not  glorify  his 
own  work  to  the  exclusion  of  any  other,  he  does  not  fasten  his  eyes 
so  exclusively  upon  that  which  is  growing  under  his  hand  as  to  lose 
all  power  of  seeing  it  in  perspective. 

For,  to  reiterate,  the  value  of  any  special  work  depends,  first  and 
chiefly,  upon  the  power  of  the  man  who  does  it,  to  look  at  it  con- 
stantly in  its  relation  to  that  whole  of  which  it  is  a part.  From  a 
failure  to  do  this  arises  all  the  question  as  to  the  value  of  special- 
ties. 

Educators  have  recently  been  considering  with  much  seriousness 
whether  many  of  the  most  defective  methods  of  our  educational  sys- 
tems might  not  be  directly  traceable  to  the  arbitrary  division  of  that 
which  was  never  intended  to  be  divided — the  life  of  man — into 
physical,  mental,  and  spiritual,  the  result  being  unequal,  and,  con- 
sequently, unnatural  development.  It  would  seem  as  if  the  divi- 
sion were  an  imperative  antecedent  on  progress,  the  mistake  being 


86 


WORLD  S HOMOEOPATHIC  CONGRESS. 


that  in  the  division  of  work  each  worker  should  look  upon  his  part 
as  a whole  in  itself.  He  then  might  and  did  isolate  it  and  himself 
from  those  to  whom  the  work  of  perfecting  the  other  parts  had 
fallen,  and  the  morbid  conditions  thus  created  have  spread  into  every 
branch  of  study  and  of  practice,  and  have  worked  endless  disintegra- 
tion where  wholeness  should  have  been. 

You  will  bear  with  me  if  I seem  to  be  dealing  too  long  with  ab- 
stractions. In  the  daily  routine  which  absorbs  our  every  faculty  as 
physicians  into  one  tremendous  effort  to  restore  and  preserve  such 
physical  perfection  as  is  possible  to  suffering  humanity,  we  have 
little  time  or  opportunity  to  think  of  that  which  it  were  worth  our 
while  not  to  forget, — which  is  not  alien  to  the  practical  side  of  our 
work,  but  an  integral  part  of  it, — the  fact  that  even  before  we  are 
physicians  we  are  men,  and  that  the  highest  physical  life  is  at  its  best 
but  an  expression  of  the  intellectual  and  spiritual  life. 

We  who  have  chosen  for  our  calling  the  physical  redemption  of 
man  cannot  look  too  broadly  upon  our  work,  and  that  will  not  be 
lost  time  which  we  spend  in  getting  it  so  in  focus  that  we  can  have 
indelibly  printed  upon  our  mental  negative  a picture  of  what  we  are 
doing,  and  the  relation  our  work  sustains  to  the  moral  and  intellec- 
tual life  of  our  race.  Still  more  is  this  necessary  if  we  have  taken 
but  a small  part  of  the  medical  practice  for  our  field.  The  same  laws 
hold  good  here  as  those  that  work  thronghout  the  whole  wide  range 
of  human  experience.  Unity  is  strength,  life  ^ division  is  disintegra- 
tion, death. 

No  one  part  of  the  human  economy  can  be  disturbed  without 
affecting  in  some  degree  every  other  part ; and  it  would  be  at  vari- 
ance with  every  law  that  we  know  in  nature  or  in  life  to  believe  that, 
in  studying  thoroughly  one  branch  of  medicine,  one  might,  without 
more  than  a very  superficial  knowledge  of  anything  else,  treat  suc- 
cessfully the  one  part  to  which  faithful  attention  has  been  given. 

In  the  practice  of  a specialty  one  may  not  do  any  work  outside 
of  certain  lines,  but  one  must  do  a vast  amount  of  study  and  in- 
vestigation outside  of  those  lines,  and  the  work  within  must  be 
constantly  connected  and  fitted  into  that  which  lies  without.  One 
must  work  steadfastly  in  a restricted  field,  yet  with  constant  refer- 
ence to  the  whole;  must  be  able  to  work  alone,  yet  in  a spirit  of 
fellowship,  to  work  in  accordance  with  the  great  world-law  of  uni- 
fication, and  not  against  it 


THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 


87 


When  this  has  become  not  only  possible,  but  habitual,  then  and 
then  only  is  one  in  a position  to  understand  and  to  prove  the  great 
value  of  specialization,  by  the  concentration  of  force  in  one  di- 
rection. 

This  concentration  of  force  develops  power  in  two  ways.  It 
makes  possible  a more  profound  intellectual  grasp  of  the  subject 
specialized,  and  if  it  be  in  the  line  of  technical  work,  it  gives  tactile 
fineness  and  manual  skill  to  a degree  impossible  to  derive  from  gen- 
eral work.  The  devoting  of  much  time  to  one  thing  renders  the 
research  and  the  acquisition  of  facts  in  regard  to  it  so  complete  as 
to  often  outrun  all  previous  knowledge,  and  lead  to  discoveries  and 
inventions,  to  new  refinements  of  diagnosis,  added  instruments  of 
precision,  and  to  scientific  methods  of  investigation  and  practice 
that  seem  little  short  of  marvellous;  and  it  is  a wonderful  power  of 
eye  and  hand,  a wonderful  acuteness  of  sight  and  touch,  that  are 
developed  by  doing  intelligently  one  thing  over  and  over  again. 

The  value  of  this  knowledge  and  technique  is  three-fold.  First, 
to  the  specialist  himself,  since  knowledge  is  power,  and  “ All  power,’7 
as  Emerson  says,  “ is  a sharing  of  the  nature  of  the  world.”  Second 
(second  only  in  order  of  sequence,  not  in  importance)  is  the  value  to 
the  large  number  of  those  whose  increased  soundness,  and  therefore 
increased  power,  is  the  direct  result  of  the  physician’s  dealing  with 
the  things  that  make  strength.  And  third  (in  order  of  sequence)  is 
the  value  to  the  world  at  large;  for  all  increase  of  knowledge  and. 
power  and  strength  becomes  a part  of  the  world’s  inheritance,  and 
this  is  perhaps  the  widest  and  most  positive  value  of  all. 

We  see,  then,  the  specialist  taking  his  little  bit  out  of  the  work 
that  lies  waiting  for  who  can  and  will  do  it,  giving  to  it  the  best  of 
his  time,  his  strength,  his  intellect,  perfecting  it  more  and  more 
until  he  returns  it  to'the  world  again,  as  a sculptor  might  the  stone 
into  which  he  has  wrought  his  brain,  his  heart,  his  life,  and  which 
has  become,  in  the  process,  of  a value  immeasurable. 

The  practical  proof  of  the  value  of  specialization  in  medicine 
lies,  of  course,  in  what  has  been  accomplished  through  specialties 
that  would  not  have  been  possible  under  the  time  and  opportunities 
afforded  by  general  medicine. 

This  is  somewhat  difficult  to  specify  with  exactness ; but  it  is  safe 
to  say  that  the  enormous  results  that  have  recently  been  obtained  in 
surgery,  gynaecology,  obstetrics,  neurology,  and  ophthalmology  could 


88 


world’s  HOMCEOPATHTO  CONGRESS. 

not  have  been  reached  but  by  that  deliberate  concentration  which  is 
indeed  the  a secret  of  strength.”  I need  not  dwell  upon  the  work 
that  has  been  done  by  the  men  in  each  of  these  different  fields,  al- 
though it  would  be  pleasant  to  do  so,  for  with  much  of  it  you  are 
familiar,  and  to  begin  would  make  my  task  an  endless  one.  But  of 
the  results  of  special  work  in  bacteriology — a comparatively  new 
field  for  specialization — I wish  to  speak  a little  more  at  length. 

Whatever  a man’s  work  may  be,  whether  generalist  or  specialist, 
whether  Old  School  or  New,  bond  or  free,  if  he  is  a physician  at  all, 
one  thing  he  must  be  familiar  with,  so  far  as  study  and  investigation 
can  make  him  so,  and  that  is  the  nature  of  disease.  This,  I think, 
will  be  admitted  without  question,  and  no  further  argument  will  be 
necessary  when  it  is  remembered  that  no  less  a subject  than  that — 
the  nature  of  disease — has  come  to  be  entirely  reconsidered  in  con- 
sequence of  the  light  thrown  upon  it  by  the  investigations  and  dis- 
coveries of  bacteriologists  during  the  last  few  years. 

I have  somewhere  read  that  the  “ new  ” opinion  which  now  obtains 
was  held  by  some  several  centuries  before  Christ,  and  has  found  cre- 
dence in  every  age  since,  but  it  eluded  proof,  and  consequently  could 
not  gain  general  acceptance  until  the  specialization  of  bacteriology 
has  brought  knowledge  on  these  lines  to  such  a point  of  perfection 
as  to  establish  as  a fact  what  more  than  eighteen  previous  centuries 
failed  to  render  more  than  “ probable.” 

The  contest  between  the  bacterium  and  the  phagocyte  has  added 
a new  factor  to  our  study  of  disease,  and  has  made  necessary  a re- 
statement of  every  pathological  equation.  It  has  robbed  tubercu- 
losis of  half  its  terrors  by  localizing  its  origin  and  making  largely 
possible  its  prevention.  It  has  lowered  the  mortality  in  surgery  to 
a phenomenal  degree.  It  has  demonstrated  the  source  of  typhoid 
fever  and  diphtheria,  and  it  has  proven  the  germicidal  character  of 
cholera  and  enabled  us  to  keep  it  at  bay.  It  has  elevated  sanitation 
to  a position  of  first  rank,  and  makes  it  possible  for  us  to  deal  more 
intelligently  with  matters  of  dietetics  and  hygiene. 

Not  all  our  problems  are  yet  solved,  but  we  may  now  deal  with 
them  in  a more  direct  and  scientific  way,  and  are  much  further 
advanced  toward  their  correct  solution  by  reason  of  the  data  put 
into  our  hands  through  bacteriological  research. 

As  brilliant  and  important  as  have  been  the  additions  to  our 
medical  equipment  through  the  medium  of  specialism  in  the  past, 


THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 


89 


I cannot  but  believe  that  greater  things  are  in  store  for  us  when  we 
have  learned  more  practically  that  specialization  does  not  mean  sep- 
aration, and  when  specialists  work  more  constantly  in  unison. 

And  now  let  us  hear  the  conclusion  of  the  whole  matter,  in  words 
more  strong  and  beautiful  than  I could  hope  to  equal,  words  taken 
from  the  “ Ethics  of  the  Dust/7  by  John  Ruskin  : 

“The  highest  and  first  law  of  the  Universe,  and  the  other  name 
of  life,  is  1 help.7  The  other  name  of  death  is  ‘ separation.7  Gov- 
ernment and  co-operation  are,  in  all  things  and  eternally,  the  laws 
of  life;  anarchy  and  competition,  eternally  and  in  all  things,  the 
laws  of  death. 

“ Exclusive  of  animal  decay,  we  can  hardly  arrive  at  a more  ab- 
solute type  of  impurity  than  the  mud  or  slime  of  a damp  or  over- 
trodden path  in  the  outskirts  of  a manufacturing  town.  That  slime 
we  shall  find  in  most  cases  composed  of  clay  (or  brick-dust,  which 
is  burnt  clay),  mixed  with  soot,  a little  sand,  and  water. 

“All  these  elements  are  at  helpless  war  with  each  other,  and 
destroy  reciprocally  each  other’s  nature  and  power ; competing  and 
fighting  for  place  at  every  tread  of  your  foot ; sand  squeezing  out 
of  clay,  and  clay  squeezing  out  water,  and  soot  meddling  every- 
where and  defiling  the  whole.  Let  us  suppose  that  this  ounce  of 
mud  is  left  in  perfect  rest  and  that  its  elements  gather  together,  like 
to  like,  so  that  their  atoms  may  get  into  the  closest  relations  possible. 

“ Let  the  clay  begin.  Ridding  itself  of  all  foreign  substances,  it 
gradually  becomes  a white  earth,  already  very  beautiful,  and  fit, 
with  the  help  of  congealing  fire,  to  be  made  into  finest  porcelain, 
and,  painted  on,  can  be  kept  in  king’s  palaces.  But  such  artificial 
consistence  is  not  its  best.  Leave  it  still  quiet,  to  follow  its  own 
instinct  of  unity,  and  it  becomes  not  only  white  but  clear  ; not  only 
clear  but  hard,  but  so  set  that  it  can*'  deal  with  light  in  a wonderful 
way,  and  gather  out  of  it  the  blue  rays  only,  refusing  the  rest.  We 
call  it  then  a sapphire. 

“Such  being  the  consummation  of  the  clay,  we  give  similar  per- 
mission of  quiet  to  the  sand.  It  also  becomes  first  a white  earth ; 
then  proceeds  to  grow  clear  and  hard,  and  at  last  arranges  itself  in 
mysterious,  infinitely  fine,  parallel  lines,  which  have  the  power  of 
reflecting  not  only  the  blue  rays,  but  the  blue,  green,  purple,  and 
red  rays  in  the  greatest  beauty  in  which  they  can  be  seen  through 
any  material  whatever.  We  call  it  then  an  opal. 


90 


world’s  HOlMCEOPATHIC  CONGRESS. 


“In  next  order  the  soot  sets  to  work.  It  cannot  make  itself 
white  at  first,  but  it  comes  out  clear  at  last,  and  the  hardest  thing  in 
the  world,  and  for  the  blackness  that  it  contained  obtains  in  exchange 
the  power  of  reflecting  all  the  rays  of  the  sun  at  once,  in  the  vivid- 
est  rays  that  any  solid  thing  can  shoot.  We  call  it  then  a diamond. 

“ Last  of  all,  the  water  purifies  itself,  contented  enough  if  it  only 
reach  the  form  of  a dew-drop ; but,  if  we  insist  on  its  proceeding 
to  a more  perfect  consistence,  it  crystallizes  into  the  shape  of  a star. 
And  for  the  ounce  of  slime  which  we  had  by  the  political  economy 
of  competition  we  have,  by  political  economy  of  co-operation,  a 
sapphire,  an  opal,  and  a diamond,  set  in  the  midst  of  a star  of  snow.” 

In  this  wonderful  description  we  have  seen  the  earth  elements 
struggling  in  the  mire  of  discord,  until  the  law  of  unity  came  to 
work  and  created,  out  of  apparently  hopeless  confusion,  the  most 
transcendent  harmony  and  beauty. 

You  have  noticed  that  all  they  require — these  earth  elements — 
that  they  may  begin  the  work  which  is  to  lead  them  to  the  utmost 
perfection,  is  only  that  they  shall  be  allowed  absolute  freedom  of 
action,  that  no  one  should  interfere  with  any  other,  and  then  they 
may  work  out  their  own  salvation,  each  in  his  own  way,  not  like 
any  of  the  others,  but  each  its  best,  and  though  separating  itself,  and 
accepting  only  what  its  own  special  developments  require,  still  fol- 
lowing the  law  of  unity,  and  proving  that  not  in  concentration  alone, 
but  in  co-operation,  there  is  strength. 

When  we  speak  of  law  in  nature,  we  mean  the  formulated  results 
of  close  observation  of  the  working  of  nature. 

Nature  is  behind  and  higher  than  law,  or  in  other  words,  law  is 
the  right  interpretation  of  nature.  It  is  worth  our  while,  therefore, 
to  study  nature  and  to  observe  how  similarly  she  works  in  great 
things  and  small,  so  that  beyond  question  the  formulated  result  of 
our  observation,  that  is,  the  law,  which  controls  atoms,  is  the  law 
which  must  govern  all  rightly  directed  life  of  man. 

The  value  of  the  widest  collection  of  facts,  the  greatest  achieve- 
ment of  mechanical  skill,  the  deepest  insight  into  the  source  and 
operation  of  distinctive  forces  and  its  prevention,  lies  in  the  perfect 
application  of  such  special  knowledge  to  the  needs  of  humanity,  to  its 
best  physical  development. 

“ What  matters  it,”  says  Longfellow,  “ whether  you  or  I or  another 
did  such  a deed  or  wrote  such  a book,  so  that  the  deed  and  book 


THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 


91 


were  well  done?”  When  something  more  of  this  high  spirit  shall 
permeate  every  branch  of  our  medical  practice,  shall  have  become 
the  highest  directing  force  through  which  every  man  works,  then 
will  have  dawned  a new  day  in  which  the  value  of  our  work  will  be 
beyond  all  power  of  computation. 

The  Chairman  of  the  Committee  of  Arrangements  made  a number 
of  announcements. 

The  hour  for  adjournment  having  arrived,  the  discussion  of  the 
paper  of  Dr.  Lewis  on  the  Value  of  Specialties  in  Medicine  was 
deferred  until  the  morning  session  of  May  31st. 

On  motion  the  meeting  adjourned. 


May  30,  1893. 

At  3 o’clock  p.m.,  the  Sectional  meeting  in  Surgery  was  held  in 
the  Hall  of  Washington.  In  the  absence  of  Dr.  Wm.  B.  Van  Len- 
nep,  Chairman  of  the  Section,  Dr.  George  F.  Shears  of  Chicago,  111., 
was  chosen  temporary  Chairman  of  the  Sectional  Meeting. 

(For  the  Papers  and  Discussions,  see  the  “ Report  of  the  Section 
in  Surgery.”) 


SECOND  DAY’S  SESSION. 

May  31,  1893. 

The  second  day’s  session  of  the  Congress  of  Homoeopathic  Phy- 
sicians and  Surgeons  convened  at  10.30  o’clock,  pursuant  to  adjourn- 
ment, Chairman  J.  S.  Mitchell,  M.D.,  of  Chicago,  presiding.  After 
making  the  announcements  of  the  day  the  Chairman  called  upon 
Dr.  W.  A.  Dunn,  the  Secretary,  for  his  report  on  Foreign  Corres- 
pondence, which  report  was  accepted  and  was  as  follows: 

Report  on  Foreign  Correspondence. 

The  Secretary  begs  to  report  that  the  Foreign  Correspondence 
connected  with  the  Congress  has  been  exceedingly  extensive.  Let- 
ters and  circulars  were  sent  more  than  a year  ago  to  all  foreign  rep- 
resentatives of  our  school  whose  names  could  be  secured.  The  aims 
and  plans  of  the  Congress  were  explained  and  letters  have  been  re- 


92 


world’s  homoeopathic  congress. 


ceived  of  cordial  endorsement  and  tenders  of  assistance  from  Dr. 
Richard  Hughes,  of  Brighton,  England  ; Dr.  John  W.  Hayward, 
of  Liverpool,  England ; Dr.  A.  C.  Clifton,  of  Northampton,  Eng- 
land ; Dr.  Alfred  C.  Pope,  of  Grantham,  England  ; and  Dr.  Edwin 
A.  Neathby,  of  London,  England.  Also,  from  Dr.  Theodore 
Kafka,  of  Carlsbad,  Germany;  Dr.  Emil  Schlegel  of  Tubingen, 
Germany;  Dr.  Theophilus  Buckner,  of  Basle,  Switzerland;  Dr. 
Tommaso  Cigliano,  of  Naples,  Italy ; Dr.  P.  C.  Majumdar,  of  Cal- 
cutta, India;  Dr.  B.  M.  Banarjee,  of  Calcutta,  India;  Dr.  C. 
Bojanus,  of  Samara,  Russia;  Dr.  Oscar  Hansen,  of  Copenhagen, 
Denmark;  Dr.  F.  R.  Day,  of  Honolulu,  Sandwich  Islands;  Dr. 
Edward  Adams,  of  Toronto,  Canada;  Dr.  E.  Vernon,  of  Toronto, 
Canada,  and  Dr.  John  C.  Clarke,  Secretary  British  Homoeopathic 
Society,  and  many  others. 

The  thanks  of  the  Congress  are  due  to  Dr.  Alexander  Villers,  of 
Dresden,  Saxony,  for  copy  of  his  Directory  of  Foreign  Homoeo- 
pathic Physicians  for  the  use  of  the  Committee;  to  Dr.  J.  W. 
Hayward,  of  Liverpool,  England,  for  copy  of  names  of  British 
physicians;  to  Dr.  Edward  Adams,  of  Toronto,  Canada,  for  copy  of 
names  of  Canadian  physicians : to  Dr.  B.  N.  Banarjee,  of  Calcutta, 
India,  for  reports;  Dr.  Emil  Schlegel,  of  Tubingen,  for  copy  of  the 
work  of  the  Homoeopathic  Clinic  at  Tubingen ; to  Dr.  Louis  Paez, 
of  Bogota,  Colombia,  for  copies  of  works  on  Materia  Medica;  to 
C.  Hurtado  Curazoa  for  copy  of  his  Compendium  of  Botany ; to 
Dr.  Theophilus  Buckner,  of  Basle,  Switzerland,  for  Journal  notice 
of  the  Congress ; to  Dr.  Tommaso  Cigliano,  of  Naples,  Italy,  for  copy 
of  his  grand  Repertoire  of  Clinical  Homoeopathy  ; also  for  the  copy 
of  his  Homoeopathic  Materia  Medica , and  a paper  upon  Morphia. 

The  Committee  will  move  at  the  proper  time  that  a vote  of  thanks 
be  tendered  these  gentlemen. 

Your  Committee  would  report  that  the  requests  for  reports  and 
papers  from  our  foreign  confreres  have  met  with  most  generous 
response  and  that  the  interest  shown  in  the  Homoeopathic  Congress 
throughout  the  world  has  been  very  great.  The  number  of  our  for- 
eign confreres  in  attendance  upon  the  session  of  the  Congress  testifies 
to  this  deep  interest. 

Respectfully  submitted, 

Wesley  A.  Dunn, 

Secretary. 


THE  VALUE  OF  SPECIALTIES  IN  MEDICINE. 


93 


The  Chairman  : So  many  of  the  State  delegates  have  already 
reported  to  the  American  Institute  of  Homoeopathy  that  this  item 
of  business  will  be  passed,  and  we  will  proceed  to  the  discussion  of 
* Dr.  F.  Parke  Lewis’s  paper,  “ The  Value  of  Specialties  in  Medi- 
cine.” Dr.  Julia  Holmes  Smith  has  the  floor. 

Discussion. 

Julia  Holmes  Smith,  M.D. : Mr.  President , Ladies  and  Gen- 
tlemen: There  are  some  things  so  dainty  imcookery  (being  a woman, 
I naturally  refer  to  that),  so  dainty  that  they  can  never  be  taken  up 
a second  time.  The  spirituality  has  gone  out  of  things,  the  beauty 
of  a thing  has  departed  after  it  has  been  presented  and  furnished 
upon  the  table.  Now,  it  seems  to  me  a trying  thing,  indeed,  to  take 
up  the  discussion  of  this  exquisitely  scholarly  paper  with  its  sug- 
gestiveness all  forgotten,  because  things  go  out  of  our  mind  after  we 
have  had  a dose  of  ether  in  the  afternoon.  Just  think  of  this  won- 
derful paper,  and  I have  got  to  come  in  this  morning  and  talk  about 
it.  ‘‘The  Value  of  Specialities  in  Medicine.”  The  ground  was 
thoroughly  covered,  the  arguments,  pro  et  eon , well  presented,  and 
what  can  I say  except  that  I approve  ? What  should  we  have  for 
our  Materia  Medica  but  such  men — men  who  have  made  a specialty 
like  Dr.  Dake  and  Dr.  Hughes  and  Dr.  Hale?  What  should  we  do 
about  surgery  except  for  the  skilled  surgeons  who  yesterday  pre- 
sented us  with  their  theories?  What  should  we  do  for  culture  and 
colleges  but  for  the  men  who  have  given  their  lives  to  education  in 
medicine,  the  all-around  men,  and  where  would  we  be  for  our  speci- 
alities but  for  the  men  who  give  their  time  to  that?  And  I can 
only  emphasize  earnestly  and  imperatively  the  necessity,  while  we 
acquire,  as  far  as  one  human  mind  can,  the  thorough  knowledge  of 
our  profession  that  we  should  go  beyond  and  chose  some  one  thing 
in  which  we  should  excel.  And  I repeat  what  I said  on  Monday 
evening  that  the  reason  we  have  so  few  women  on  our  programme  is 
because  it  is  difficult  to  find  women  specialists  in  our  schools.  Let 
us  start  young  women  who  are  going  to  woo  and  wed  the  profession 
of  medicine.  Let  all  of  you — it  is  past  my  time — let  you  who  are  be- 
ginning in  your  career  as  medical  women  chose  some  particular  line 
of  work  in  which  you  will  excel,  and  when  the  next  World’s  Con- 
gress is  held  you  will  rival  the  specialists  among  the  men. 

The  Chairman : Is  there  any  further  discussion  of  this  paper? 
If  not,  the  address  of  Dr.  J.  P.  Dake,  of  Nashville,  Tennessee,  on 
“The  Future  of  Homoeopathy,”  is  in  order. 

Dr.  Dake  addressed  the  Congress  as  follows  : 


94 


world’s  homoeopathic  congress. 


ADDRESS. 

THE  FUTURE  OF  HOMCEOPATHY. 

By  Jabez  P.  Dake,  A.M.,  M.D.,  Nashville,  Tenn. 


Mr.  President  and  Members  of  the  Congress : 

In  proceeding  to  the  discussion  of  the  topic  assigned  for  this  oc- 
casion I pause  to  remark  that  expositions  of  the  varied  resources  and 
products  of  nature  and  of  art  have  been  made  in  one  country  and 
another,  but  nowhere  and  at  no  time  has  there  been  one  organized 
so  well  calculated  to  show  the  intellectual  and  moral,  as  well  as  the 
physical  possibilities  and  achievements  of  our  race,  as  the  one  in 
which  we  are  now  taking  part. 

The  series  of  Congresses  devised  by  the  Exposition  Auxiliary  for 
the  display  of  the  various  departments  of  science,  morality  and  re- 
ligion, which  aim  to  elevate  and  ennoble,  as  well  as  prolong,  human 
life,  is  destined  to  mark  a new  era  in  the  advance  of  civilization  on 
the  globe. 

The  step  taken  by  America,  in  this  Columbian  year,  toward  a 
more  free  expression  and  interchange  of  views  upon  a recognized 
platform,  the  new  beside  the  old,  and  the  heterodox  beside  the  or- 
thodox, must  tend  to  soften  harsh  antagonisms  and  lead  on  to  more 
united,  as  well  as  earnest,  efforts  for  human  welfare. 

As  we  approach  the  end  of  our  Medical  Congress,  held  at  this 
time  in  commemoration  of  one  of  the  greatest  events  noted  in  his- 
tory, it  is  well,  in  addition  to  the  views  and  reviews  relating  to  the 
past  and  present,  to  let  our  mental  vision  run  on  before  to  see  what 
the  future  has  in  store  for  the  healing  art. 

That  the  condition  of  medicine  and  medical  organizations  is  long 
to  remain  as  we  see  it  to-day  is  not  to  be  expected,  nor  should  it  be 
desired.  Well  satisfied  as  we  may  be  with  much  in  the  constitution 
and  resources  of  Homoeopathy,  we  yet  look  forward  to  what  is  even 
better.  It  is  my  mission,  in  the  brief  address,  to  speak  of  some  of 


THE  FUTURE  OF  HOMCEOPATHY. 


95 


the  better  things  therapeutic  that  continued  observation  and  experi- 
ence may  bring.  Had  I the  gifts  of  a prophet,  enabling  me  to  look 
forward  a few  decades  clearly  to  discern  coming  changes,  my  task 
would  be  easy  and  you  would  doubtless  enjoy  a rare  intellectual 
treat. 

The  Retrospect. — As  it  is,  I must  ask  you,  for  a brief  time,  to 
cast  the  search-light  of  memory  back  upon  the  way  we  have  come, 
and  the  eye  of  observation  over  the  fields  now  occupied  by  our  school 
of  medicine,  as  we  look  forward  only  in  the  light  of  the  past,  calcu- 
lating what  will  be  from  what  has  been  and  what  is. 

The  retrospect  at  the  outset  brings  to  view  one  great  fact,  never 
to  be  forgotten,  namely,  that  the  discovery  of  the  Homoeopathic 
principle  was  unlike  any  other  discovery  concerned  in  the  art  of 
healing,  in  that  it  brought  to  light  a natural  law,  fixed  and  para- 
mount in  therapeutics.  It  defined  the  relationship  that  must  exist, 
between  the  medicinal  agent  and  the  disease  to  be  overcome,  in  the 
words  Similia  Similibus  Curantur. 

So  many  have  been  the  changes  for  the  better  in  the  current  medi- 
cal teaching  and  practice  of  the  world  since  that  day,  it  is  not  easy  for 
us  to  realize  the  surprise  and  even  consternation  that  prevailed  upon 
the  announcement  of  Hahnemann’s  discovery.  What  was  then  feared, 
in  due  time  became  a reality,  the  knights  of  venesection,  and  the  cup- 
ping and  leeching  barber,  and  the  blister-spreading  and  heroic  dose- 
mixing apothecary  were  sent  into  comparative  retirement. 

With  feelings  of  satisfaction  we  look  back  upon  the  steady  develop- 
ment and  spread  of  the  therapeutic  system  based  on  the  law  of  simi- 
lars, especially  upon  the  decided  triumphs  over  such  great  destroyers 
of  life  as  the  Asiatic  cholera  and  the  yellow  fever.  Had  it  done  no 
more  to  demonstrate  its  worth  down  to  this  time,  than  the  indubi- 
table records  show  it  has  done  in  the  epidemics  of  those  two  well- 
marked  and  fatal  diseases,  it  would  deserve  the  confidence  and  es- 
teem of  the  world. 

The  reception  we  see  accorded  to  the  new  therapeutic  doctrine  by 
the  medical  men  of  the  early  part  of  the  century,  was  hardly  such 
as  became  scientific  men.  The  attitude  of  medical  journalism  was 
decidedly  adverse  to  its  discussion. 

Hufeland  was  the  only  editor  with  magnanimity  and  courige 
enough  to  open  his  pages  to  Hahnemann.  In  his  journal  for 
1796  had  appeared  the  dawning  of  Homoeopathy,  the  first  sugges- 


96 


world’s  homoeopathic  congress. 


tion  of  its  basic  principle.  But  even  Hufeland  afterward  closed  his 
columns,  in  deference  to  the  wishes  of  medical  men  who  were  unable 
to  bear  the  criticisms  of  Hahnemann,  and  in  obedience  to  an  authori- 
tative medical  censorship.  And  the  prevailing  policy  from  that 
time  on  has  been  either  to  ignore  or  simply  ridicule  Homoeopathy. 
Hence  the  necessity  for  journals  of  our  own,  through  which  the  new 
truth  could  reach  the  profession  and  the  public,  and  by  which  its 
triumphs  could  be  made  known. 

But  as  time  went  on  and  the  followers  of  Hahnemann  became 
more  numerous,  a curious  state  of  things,  puzzling  to  men  of  the 
other  learned  professions,  developed  in  the  ethical  attitude  of  the 
dominant  school.  Graduates  from  the  old  colleges  were  cut  off  from 
fellowship  and  declared  no  physicians  because  they  had  ventured  to 
push  their  studies  beyond  the  old  curriculum  and  to  give  their  pa- 
tients the  benefit  of  the  farther  inquiry  ; and  some  students,  avowing 
their  intention,  after  graduating,  to  investigate  and  probably  adopt 
the  Homoeopathic  method,  were  refused  diplomas.  Doctors  with  a 
less  complete  education  and  less  extended  medical  armamentarium, 
assuming  an  attitude  of  superiority,  refused  them  professional  aid. 
But  the  effect  of  such  professional  manners,  while  temporarily  em- 
barrassing to  the  ostracised  physicians  and  their  clients,  was  after- 
ward very  greatly  in  their  favor.  It  led  on  to  the  organization  of 
colleges  and  societies  devoted  to  the  new  cause,  while  it  revealed  to 
the  public  a tableau  anything  but  creditable  to  the  good  sense  of  the 
Old  School — they  on  the  one  side  looking  down  with  apparent  con- 
tempt on  us  of  the  other,  and  denouncing  us  as  ignoramuses  and 
quacks,  when  possessed  of  the  same  learning  as  themselves,  plus  a 
knowledge  of  Homoeopathy  ! Beside  individual  and  organized  pro- 
fessional attacks,  calling  for  organized  means  of  defense,  the  New 
School  had  to  contend,  in  many  countries,  with  an  unfriendly  gov- 
ernmental censorship. 

Examining  boards  with  assumed  and  arbitrary  standards,  author- 
ized by  the  State,  have  had  a tendency  to  keep  medical  practice  in 
the  old  ruts,  and  such  will  always  be  their  tendency  whether  called 
Allopathic,  Homoeopathic  or  Eclectic.  And  great  military  establish- 
ments with  dictatorial  surgical  staffs  and  red-tape  methods,  have 
always  been  unfavorable  to  the  careful  consideration  and  ready 
adoption  of  new  therapeutic  measures.  The  traditional  supply  table 
for  the  army  and  navy  surgeons  and  for  hospitals  under  govern  men- 


THE  FUTURE  OF  HOMOEOPATHY. 


97 


tal  control,  have  known  little  change  from  generation  to  generation. 
Considering  the  influence  of  great  standing  armies  and  of  authorita- 
tive boards  of  medical  censors,  it  need  not  be  surprising  that  Homoe- 
opathy has  had  to  make  its  way  inch  by  inch,  in  Germany,  Austria, 
Italy,  France  and  even  England.  As  might  be  expected  the  fairest 
field  presented  for  its  adoption  and  growth  has  been  in  America, 
away  from  the  domination  of  military  medical  staffs  and  arbitrary 
censorships. 

But  our  retrospect,  if  it  shows  obstacles  met  with  also  shows  ad- 
vantages enjoyed,  in  the  progress  of  the  new  medical  philosophy. 

We  see  that  among  medical  men,  not  alone  in  this  country,  those 
who  have  been  most  ready  to  examine  and  adopt  it,  have  been  the 
well  educated  and  most  enterprising. 

Physicians  weighed  down  by  an  inordinate  sense  of  authority  and 
“ regularity  ” or  industriously  plying  their  art,  as  in  a tread-mill, 
never  looking  or  moving  about  to  see  what  may  be  found  that  is 
better,  are  not  the  first  to  appreciate  what  is  new.  And  among  the 
people,  the  very  first  to  comprehend  the  value  of  curative  methods 
based  on  a law  of  nature,  have  been  the  educated  and  most  cultured, 
classes. 

If  the  old  medical  journals  were  closed  against  us  the  columns  of 
the  public  press  were  not.  If  unfair  representations  appeared  in  the 
daily  papers  calculated  to  mislead  the  public  and  create  prejudice 
against  our  cause,  the  opportunity  was  freely  accorded  for  reply  and 
defense.  If  suits  in  court  were  instituted  for  our  injury,  judges  and 
juries  with  few  exceptions,  sustained  us  in  our  rights.  And  in  mat- 
ters of  legislation  where  efforts  have  been  made  to  check  our  progress 
or  curtail  our  freedom,  law  makers  have  listened  to  our  arguments 
and  refused  to  deal  unfairly  with  us. 

The  Present  Status. — In  surveying  the  present  fields  occupied 
by  the  New  School,  much  is  to  be  seen  that  is  encouraging.  There 
are  numerous  journals  indifferent  countries  and  different  tongues, 
devoted  to  the  therapeutic  measures  of  Homoeopathy  and  covering 
likewise  every  department  of  medical  and  surgical  inquiry.  More 
than  a score  of  them  are  issued  monthly  in  the  United  States  alone. 
And  our  colleges,  each  with  a full  curriculum,  and  all  up  to  the 
highest  standard — indeed  foremost  in  the  extension  of  the  general 
course  and  lengthening  of  annual  sessions,  are  a source  of  credit  and 
support  to  our  cause. 


7 


98 


world’s  homoeopathic  congress. 


In  the  matter  of  colleges,  the  disadvantages  imposed  by  the  cen- 
sorship system  of  the  Old  World  is  very  plainly  seen.  They  have 
prevented  charters  for  our  schools,  so  that  we  have  not  to-day  a 
whole  school  of  our  own  in  Europe,  possessed  of  the  power  to  confer 
medical  degrees  upon  its  students.  Even  in  enlightened  and  liberal 
England,  our  school  based  on  the  London  Homoeopathic  Hospital 
and  conducted  by  some  of  the  very  ablest  medical  men  in  Great 
Britain,  cannot  grant  a diploma  after  ever  so  much  study  or  upon 
ever  so  thorough  and  satisfactory  an  examination. 

Hospitals  and  dispensaries  extending  the  benefits  of  our  practice 
to  the  poor  are  seen  in  nearly  all  parts  of  the  enlightened  globe. 
Fortunately  boards  of  censors  cannot  always  intervene  between  the 
people  and  the  desired  means  of  physical  relief  even  in  despotic 
countries. 

In  its  relations  to  other  principles  that  have  to  do  with  the  art  of 
healing,  I desire  to  say  that  Homoeopathy  has  no  antagonism  what- 
ever. What  surgery  can  and  should  do,  or  chemistry  or  mechanics, 
to  remove  useless  or  burdensome  tissues  and  products,  or  destructive 
parasites  or  poisons;  and  what  palliatives  should  do  to  save  life  or 
mitigate  useless  suffering,  we  are  agreed  that  they  shall  do.  We  are 
prepared  to  hail  with  pleasure  every  discovery  and  improvement  in 
the  ways  and  means  of  preventing  or  removing  disease.  If  we  hesi- 
tate and  take  time  to  consider,  when  the  inventions  of  Brown- 
Sequard  and  Koch  are  heralded  over  the  world,  it  is  for  the  want  of 
more  affirmative  proofs  of  their  value. 

The  Future. — I come  now  to  the  point  where  I must  ask  you  to 
turn  your  gaze  from  the  past  and  present  of  Homoeopathy  to  its 
future.  Many  and  various  have  been  the  predictions  made  as  to  its 
destiny,  some  saying  : “ Like  other  popular  delusions  it  will  have  its 
day  and  pass  away.”  And  others  : u It  will  be  the  prevailing  and 
exclusive  mode  of  practice.” 

Applying  analogy  to  the  facts  hurriedly  passed  in  review,  and 
reasoning  from  cause  to  effect,  what  do  we  really  see  before  us? 
Let  us  consider : 

Unquestionably  the  future  has  in  store  more  exact  methods  of  ob- 
servation and  clearer  lines  of  reasoning,  which  must  lead  to  a more 
definite  understanding  of  the  cases  of  disease  amenable  to  the  Hom- 
oeopathic remedy. 

1.  Taking  this  view,  my  first  proposition  is,  that  the  true  field  or 
sphere  of  the  Homoeopathic  law  will  he  more  clearly  defined . 


THE  FUTURE  OF  HOMOEOPATHY. 


99 


The  first  and  one  of  the  most  important  questions  presented  to  the 
physician  in  assuming  the  care  of  a patient,  is  as  to  the  particular 
department  of  the  healing  art  from  which  help  must  come.  Is  it  a 
case  for  surgery,  for  chemical  antidotes,  for  anti-parasitics,  for  change 
of  residence,  or  occupation,  or  diet,  or  one  admitting  of  palliatives 
only;  or  is  it  one  requiring  the  Homoeopathic  remedy? 

It  is  possible  for  a case  to  require  help  from  two  or  more  of  these  de- 
partments at  one  and  the  same  time.  In  that  case  the  agencies  em- 
ployed must  be  such  as  to  co-operate  with  and  not  antagonize  each 
other.  But  in  determining  the  question  whether  a Homoeopathic  rem- 
edy is  required,  the  physician  must  very  definitely  and  clearly  under- 
stand what  affections  come  under  the  Homoeopathic  law  or  within  its 
domain.  It  is  a childish  view  to  suppose  that  the  physician  calling 
himself  a Homoeopath  is,  in  all  cases,  bound  only  to  search  his  own 
Materia  Medica  for  the  needed  remedy  ; and  it  is  criminal  for  him 
to  shut  his  eyes  to  other  means  where  the  Homoeopathic  remedy  is 
not  required  and  can  do  no  good.  Diseases,  according  to  the  help 
required,  very  readily  fall  into  classes;  and  the  Homoeopathic  class 
is  made  up  of  all  such  as  are  similar  to  those  producible  by  patho- 
genic means,  existing  in  organisms  having  the  integrity  of  tissue  and 
reactive  power  necessary  to  recovery,  the  essential  cause  having  been 
removed  or  having  ceased  to  be  operative  in  the  case. 

For  this  class  the  Homoeopathic  law  is  supreme  and  universal, 
while  for  all  others  it  has  no  application  and  no  meaning.  Years 
ago,  while  lecturing  upon  the  principles  and  practice  of  medicine  in 
Philadelphia,  for  convenience  I divided  the  great  field  of  therapeu- 
tics into  two  parts — general  and  special — the  latter  embracing  such 
cases  only  as  call  for  the  Homoeopathic  remedy,  and  the  former  in- 
cluding all  others.  The  special  I also  denominated  the  pathogenic, 
inasmuch  as  the  curative  agency  in  the  sick  was  also  the  sick-making 
power  in  the  healthy. 

In  truth,  the  different  principles  presiding  over  the  several 
measures  concerned  in  the  restoration  of  the  sick  and  the  injured  are 
complementary  and  not  antagonistic  to  each  other.  The  ardent 
Homoeopath,  conscious  of  the  transcendent  value  of  his  method,  need 
have  no  fear  that  a strict  construction  of  the  law  he  rests  upon,  and 
proper  recognition  of  its  limitations,  will  belittle  its  importance  and 
weaken  its  hold  upon  the  world.  Confined  to  its  legitimate  sphere 
it  covers  ground  enough  and  calls  upon  its  ministers  for  enough 


100 


world’s  homceopathic  congress. 


work  to  employ  the  brightest  intellect  and  most  stalwart  energies  of 
a man  for  a very  long  life-time. 

2.  In  regard  to  the  future  of  Homoeopathy,  my  second  proposition 
is,  that  its  basis  and  governing  principle  will  survive  all  changes  that 
may  come,  only  more  clearly  defined  and  strongly  established  by  human 
experience . 

It  cannot  in  future,  more  than  now,  supply  to  the  physician  fac- 
ulties to  observe  and  note  the  symptoms  of  a case  of  disease  on  the 
one  side  nor  of  drugs  on  the  other;  nor  can  it  furnish  him  with 
reasoning  faculties  rightly  to  compare  them  ; but  it  most  unmistakably 
points  out  the  relationship  between  the  two  sets  of  symptoms  which 
must  be  present  when  cures  result.  1 can  conceive  of  no  discoveries 
possible  in  any  department  of  medicine  that  can  supersede  or  invali- 
date the  truth  arrived  at  by  Hahnemann’s  generalization  of  facts, 
and  over  and  over  again  confirmed  in  the  treatment  of  the  sick. 

So  long  as  the  human  organism  is  what  it  is,  and  the  impressions 
of  morbific  causes  and  the  resisting  efforts  of  the  vital  forces  what 
they  are,  there  is  an  everlasting  necessity  that  the  medicinal  influence 
that  proves  curative  shall  make  its  impression  upon  the  same  tissues 
and  in  a manner  similar  to  that  of  the  morbific.  That  medicines 
acting  otherwise  may  prove  palliative  or  remove  the  causa  morbi  and 
thus  be  needed  at  times,  we  do  not  doubt,  but  most  cheerfully  ac- 
knowledge. 

The  whole  order  of  man’s  physical  nature  must  be  reversed,  so 
that  reaction  does  not  follow  action,  and  so  that  the  continuing  or 
lasting  functional  condition  is  not  opposite  to  that  directly  induced 
by  pathogenic  agencies,  if  a time  ever  comes  when  the  Homoeopathic 
method  fails.  Terms  may  be  changed,  and  explanatory  theories  may 
be  different,  but  the  essential  relationship  between  the  disease  and 
the  remedy  will  ever  be  Homoeopathic ; and,  I may  add,  that  such 
must  be  the  case,  however  the  curative  impression  is  made,  whether 
by  a single  drug  or  a combination  of  drugs,  by  heat  or  cold,  by  elec- 
tricity or  massage. 

3.  My  third  proposition  as  to  the  future  is,  that  the pathogenesy , or 
drug  symptomatology  constituting  the  Homoeopathic  Materia  Medica, 
will  be  more  thoroughly  obtained  and  carefully  displayed.  When 
Hahnemann  came  to  understand  the  requirements  of  the  Homoeopa- 
thic law,  and  saw  the  necessity  of  true  drug  pictures,  for  comparison 
with  the  various  disease-pictures  presented  to  the  physician,  he  soon 


THE  FUTURE  OF  HOMOEOPATHY. 


101 


realized  how  poorly  adapted  to  his  purpose  were  the  current  works 
on  materia  medica.  The  most  he  could  there  learn  of  the  remedies 
related  to  their  cathartic,  emetic,  antispasmodic,  and  other  such  gen- 
eral effects  on  the  sick.  Experimentation,  to  ascertain  their  physio- 
logical or  positive  influence  on  the  healthy  human  organism,  had  not 
then  been  started.  He  soon  announced  the  necessity  of  proving  drugs 
upon  the  healthy  instead  of  the  sick,  and  himself  became  a prover. 
But,  poorly  supplied  with  means,  and  assisted  at  times  by  students 
of  his  method,  he  worked  on  with  one  drug  after  another,  adding  to 
the  symptoms  thus  obtained  what  he  could  gather  from  reported 
cases  of  poisoning,  till  he  was  able  to  form  a new  Materia  Medica, 
which  he  published  in  1805  with  the  modest  title  Fragmenta  de 
Viribus  Medicamentorum  Positivis. 

Good  as  were  the  results  of  his  work,  compared  with  the  collec- 
tions of  the  old  Materia  Medica,  they  yet  came  short  of  the  demand 
of  similia.  It  must  ever  be  regretted  that  he  allowed  symptoms 
taken  from  the  sick,  while  using  remedies,  to  be  recorded  as  drug 
symptoms.  And  his  neglect  to  preserve  and  publish  the  records  of 
each  proving  in  the  narrative  form  has  been  a lamentable  defect. 
His  publication  of  drug  symptoms  in  schematic  form,  disconnecting 
and  putting  them  out  of  their  natural  order,  left  them  less  useful 
to  the  practitioner  and  the  writer  of  Materia  Medica  than  they  would 
or  should  have  been.  In  following  the  Homoeopathic  principle,  it 
is  often  quite  as  important  to  have  a similarity  in  the  order  as  in 
the  other  qualities  of  the  symptoms  compared.  With  regret  I men- 
tion the  fact,  that  subsequent  pro  vers,  with  few  exceptions,  possessed 
of  superior  advantages  for  the  undertaking,  have  allowed  the  same 
defects  to  mar  their  work.  Only  of  late  has  there  been  an  attempt 
to  gather  and  publish  our  drug  provings  in  narrative  form.  The 
British  Homoeopathic  Medical  Society  and  the  American  Institute  of 
Homoeopathy,  a few  years  ago,  together  secured  the  publication  of 
the  Cyclopaedia  of  Drug  Pathogenesis , under  the  lead  of  the  great 
Materia  Medica  scholar,  Dr.  Richard  Hughes.  The  four  large  vol- 
umes contain  all  known  records  of  reliable  provings,  except  those 
embraced  in  the  Materia  Medica  Pura  and  Chronic  Diseases  of 
Hahnemann,  which  it  was  thought  best  to  let  stand  by  themselves. 
Valuable  as  the  Cyclopaedia  is,  it  would  have  been  yet  more  valuable 
had  all  the  provings  detailed  been  made,  and  the  symptoms  recorded, 
in  a more  thorough  and  discriminating  manner.  While  it  is  the  best 
we  have,  it  is  not  equal  to  the  future  best. 


102 


world’s  homoeopathic  congress. 


At  this  point,  I beg  to  be  excused  for  a slight  personal  mention. 
Just  thirty-six  years  ago,  in  this  city,  I read  a paper  before  the 
American  Institute  of  Homoeopathy  upon  the  defects  of  our  patho- 
genesy,  and  proposed  for  its  improvement  a college  of  drug  provers 
— an  institution  under  competent  management,  having  a body  of 
students,  male  and  female,  acting  as  subjects  of  drug  influence  while 
receiving  medical  instruction,  during  the  long  vacations  in  the  ordi- 
nary medical  schools  : and,  while  under  expert  observation,  all  the 
means  for  detection  and  measurement  of  abnormalities,  useful  in 
diagnosing  diseases  in  the  sick,  being  employed.  I showed  the  un- 
avoidable defects  in  provings  made,  here,  there,  and  everywhere,  by 
busied,  wearied,  and  worried  physicians,  exposed  to  the  vicissitudes 
of  weather  and  sick-room  influences,  with  little  if  any  critical  obser- 
vation of  their  symptoms.  Again,  and  again,  in  after  years,  I urged 
the  profession  to  take  hold  of  the  work,  and  make  our  Materia 
Medica  more  in  keeping  with  our  matchless  therapeutic  law.  I am 
happy,  on  this  great  occasion,  to  say  that  the  tendency  is  now  toward 
more  thorough  and  careful  drug-experimentation,  not  only  in  our 
school,  but  in  the  Old  School  as  well. 

Dr.  T.  Lauder  Brunton,  one  of  the  brightest  of  all  the  orthodox 
teachers  of  Materia  Medica  in  England,  writing  of  the  therapeutist, 
not  long  ago,  said  : 

“ Evidently  it  is  his  special  province  to  find  out  what  are  the 
means  at  command,  what  the  individual  drugs  in  use  do  when  put 
into  the  human  system.  It  is  seemingly  self-evident  that  the  physi- 
ological action  of  a remedy  can  never  be  made  out  by  a study  of  its 
use  in  disease.” 

The  increasing  number  of  liberally  educated  young  men  in  our 
ranks,  who  are  critical  and  logical,  not  satisfied  with  observations 
casually  made  and  experiments  not  properly  guarded  against  sources 
of  error  and  corruption,  look  with  surprise  upon  the  rank  and  file 
of  the  profession  apparently  satisfied  to  go  on  year  after  year,  depend- 
ing upon  a hash  and  rehash  of  what  was  not  entirely  sure  and  reli- 
able at  the  outset.  It  need  not  be  surprising  if,  ever  and  anon, 
some  of  them  become  disgusted  with  the  “Tithing  of  mint,  anise  and 
cummin”  in  those  who  are  apparently  heedless  of  the  “weightier 
matters  of  the  law.”  If  the  plan  of  a college  of  provers  is  Utopian, 
and  if  the  influence  and  power  of  drugs  cannot  be  ascertained  by 
direct  and  scientific  experimentation,  we  may  as  well  consider  the 
abandonment  of  drugs. 


THE  FUTURE  OF  HOMCEOPA TH Y. 


103 


One  alternative  is  left,  if  the  present  encouraging  prospects  fails 
and  the  physiological  laboratories  and  thorough  drug  provings  do 
not  come,  the  trade  circulars  of  the  great  drug  houses,  displaying  the 
refreshing  romance  of  clinical  experience,  that  are  being  showered 
upon  our  desks  like  the  leaves  of  Vallambrosa,  may  enable  us  to 
practice  empiricism  with  some  hope  if  with  no  satisfactory  fruition. 
But,  jesting  aside — the  healthy  vital  test  will  not  fail. 

I leave  its  consideration  now,  with  the  remark  that  the  great  uni- 
versity that  shall  lead  the  way  by  devoting  its  entire  medical  depart- 
ment to  Original  Research  in  Physiology  and  Pathogenies  will  cover 
its  name  with  glory  and  bring  to  its  regents  and  faculty  and  student- 
experimenters  the  gratitude  of  the  world  during  all  time. 

4.  Looking  again  to  the  future  of  Homoeopathy  I remark  that  some 
changes  are  to  come  in  matters  of  pharmacy  and  posology.  While 
drug  substance  will  be  commuted  far  enough  to  render  its  particles 
susceptible  of  absorption  and  conveyance  to  the  tissues  to  be  im- 
pressed, or  to  expand  its  surface  for  more  ready  contact;  and  while 
it  will  be  attenuated  and  mixed  with  neutral  vehicle  enough  to  render 
it  easy  of  division  into  proper  doses,  it  will  not  be  treated  by  bottle- 
washing methods  in  the  effort  to  get  rid  of  the  drug  altogether  and 
secure  only  its  disembodied  spirit. 

The  unmerited  odium  that  our  peerless  law  of  cure  has  been 
obliged  to  bear,  these  many  years,  by  reason  of  the  unwillingness  of 
some  of  its  adherents  to  employ  the  sensible  doses  with  which  the 
law  itself  was  demonstrated  and  with  which  its  most  striking  victor- 
ies were  won,  will  be  wiped  away. 

I have  now  spoken  of  the  leading  changes  destined  to  come  in  the 
interior  economy  of  Homoeopathy  and  its  practical  applications, 
namely,  as  to  its  legitimate  domain,  its  persistency  or  permanency,  its 
pathogenesy  and  its  posology. 

I must  now  briefly  refer  to  its  future  position  and  relations  in  the 
general  medical  world. 

External  Relations. — It  is  a great  mistake  to  suppose  that  Ho- 
moeopathy is  found  only  in  the  practice  of  men  calling  themselves 
Homoeopaths.  Not  only  has  its  negative  influence  wrought  changes 
in  the  therapeutic  measures  of  the  masses  of  medical  men  in  all  en- 
lightened countries  causing  them  to  abandon  blood  letting,  blister- 
ing and  heavy  doses  of  poisonous  drugs — it  has  brought  the  most 
intelligent  of  them  to  prescribe  many  of  our  remedies,  as  we  do,  in 


104 


world’s  homceopathic  congress. 


obedience  to  the  rule  of  similars,  and  in  small  and  pleasant  doses. 
It  has  caused  them  to  look  upon  the  healthy  human  test  as  the 
proper  mode  for  the  study  of  drug  influence  in  the  formation  of 
materia  medica.  It  has  also  led  them  to  pay  a great  deal  more  atten- 
tion to  dietetics  and  general  hygienic  measures;  and  why,  pray, 
should  it  not  do  so,  since  they  have  often  attributed  our  undeniable 
cures  altogether  to  such  regulations? 

Our  successes  and  evident  favor  among  intelligent  and  influential 
people  have  gradually  raised  us  in  the  esteem  of  our  Old-School 
brethren,  till  their  society  doors  are  open  to  us  on  the  simple  condi- 
tion that  we  drop  the  qualifying  term  “ Homoeopath  ” from  our  list 
of  titles.  And  we  are  no  longer  regarded  as  beyond  the  pale  of  pro- 
fessional recognition  and  help  by  reason  of  our  additional  acquire- 
ments in  therapeutic  knowledge ! But,  putting  all  levity  aside,  we 
hail  with  satisfaction  the  growing  acceptance  of  our  views  and  adop- 
tion of  our  measures,  and  would  be  far  from  saying  one  word  calcu- 
lated to  prevent  so  great  an  improvement  in  the  current  medical 
practice  and  such  positive  benefits  to  the  sick  under  its  care. 

We  do  not  insist  upon  their  calling  themselves  “ Homoeopaths”  in 
order  to  enjoy  the  use  of  remedies  that  we  know  cure  Homoeopathic- 
ally  ; nor,  on  the  other  hand,  do  we  see  any  occasion  for  us  to  drop 
that  title  from  our  institutions  because  we  recognize  and  employ  now, 
as  always,  surgical,  chemical  and  mechanical,  and  other  means  which 
are  neither  Homoeopathic  nor  Allopathic.  I fail  to  see  why  we 
should  be  any  worse  for  the  use  of  a name  that  indicates  very  cor- 
rectly our  confidence  in  the  principle  similia,  when  no  medical  man 
can  be  so  ignorant  as  to  suppose  that  we  do  not  understand  and  follow 
other  principles  and  use  other  measures  as  occasion  demands. 

In  conclusion,  upon  our  future  name  and  relations,  I would  say 
that  when  the  right  of  every  educated  physician  to  choose  his  method 
and  means  of  cure  becomes  generally  recognized,  and  his  privilege 
to  candidly  state  his 'views  and  temperately  criticise  the  views  of 
others  on  the  floor  of  any  medical  society  or  in  any  medical  journal, 
is  accorded  without  reproach  or  abuse — then,  and  not  before,  may  it 
be  expected  that  the  societies  and  institutions  of  the  New  School 
will  be  disbanded  or  known  by  no  distinct  sectarian  title. 

It  cannot  be  forgotten  fhat  our  organizations,  our  journals,  col- 
leges, hospitals  and  dispensaries  were  matters  of  necessity  for  the 
maintenance  of  our  freedom  to  choose  and  apply  the  new  therapeutic 


THE  FUTURE  OF  HOMOEOPATHY. 


105 


measures  and  to  extend  their  benefits  to  suffering  humanity.  But 
for  them,  the  most  important  reform  in  the  art  of  healing  now  en- 
joyed would  have  been  arrested  at  the  start. 

With  the  freedom  existing  in  associations  for  scientific  research 
and  the  promotion  of  social  reforms,  where  each  idea  and  proposi- 
tion may  have  a hearing  and  due  consideration,  there  would  be  no 
excuse  for  different  schools  or  separate  organizations  in  medicine. 
The  only  unity  possible  among  medical  men  and  medical  associations 
will  be  the  kind  that  consists  with  diversity  and  with  the  liberty  on 
all  sides  to  think  and  work,  with  all  due  respect,  each  on  his  own 
lines.  Physicians  should  be  as  free  to  criticise  each  other’s  opinions 
and  measures  as  are  lawyers,  whose  sharp  contests  make  them  none 
the  less  personal  friends  to  each  other  and  none  the  less  worthy 
members  of  the  bar. 

As  matters  stand,  the  right  forward  step  to  secure  unity  is  one  of 
common  politeness  by  one  medical  man  toward  another  and  by  one 
association  toward  others.  It  requires  no  disagreeable  concession  or 
damaging  compromise  for  one  to  treat  another  with  the  courtesy  due 
among  men  equally  educated  and  equally  devoted  to  the  same  cause. 
There  needs  to  come  among  us  a “ Y.  M.  M.  A. a Young  Men’s 
Medical  Association,  that,  like  the  “ Y.  M.  C.  A.,”  can  practically 
solve  the  great  problem  of  unity  in  diversity  and  secure  working 
relations  between  medical  men  and  medical  organizations,  which- 
with  a common  purpose  in  view,  are  now  moving  forward  on  dif- 
ferent lines. 

A special  dispensation  of  mercy  alone  can  save  us,  if  we  are  more 
bigoted  and  touchy,  or  have  less  of  practical  sense  than  the  religious 
sects,  that  the  Christian  young  men  are,  even  now,  gradually  pull- 
ing together. 

Discussion. 

The  Chairman  : This  paper  will  now  be  discussed  by  Dr.  B.  W. 
James,  of  Philadelphia,  Pa. 

Dr.  James,  of  Philadelphia  : Mr.  Chairman  ; This  papers  covers 
the  ground  so  thoroughly  that  if  I only  said  that  I approve  of  all 
the  views  expressed  therein,  I think  I might  rest  my  discussion 
there.  But  I will  say  that  I agree  with  him  in  several  points,  and 
yet  there  are  other  points  on  which  he  might  have  touched  in  which 
I think  the  future  of  our  system  in  its  development  will  be  grand 
and  progressive.  I agree  that  it  has  nothing  in  opposition  to  other 
principles  of  medicine — other  true  principles  of  medicine — that  will 


106 


world’s  homceopathic  congress. 


conflict  with  it  in  its  progress.  That  its  rise  and  the  discovery  of 
the  law  was  peculiar — and  its  progress  is  peculiar  simply  because  in 
past  centuries  there  was  no  known  scientific  law,  I might  say  of  per- 
manency in  the  Old  School,  which  could  guide  every  physician  in  the 
application  of  his  remedy  to  every  known  set  of  symptoms  or  to 
any  known  disease,  and  we  know  that  whenever  an  epidemic  occurs 
we  care  not  for  the  man  ; we  care  simply  for  the  symptoms,  and  we 
treat  those  symptoms  by  the  law  of  similars  scientifically,  and  I be- 
lieve that  the  application  of  these  remedies  in  diminutive  doses  is 
the  proper  mode,  the  only  one,  that  will  ever  be  demonstrated  phys- 
iologically to  be  the  true  one. 

Anatomists  and  histologists  tell  us  that  the  different  organs  are 
made  up  of  tissues,  and  these  tissues  are  sub-divided  into  minute 
forms,  and  these  are  built  up  of  cells  microscopically  small,  and  that 
these  minute  cells  have  a special  and  definite  action,  not  only  in  the 
formation  of  those  tissues  but  in  their  ability  to  carry  through  these 
tissues  the  principle  of  life,  removing  the  waste  and  supplying  new 
material  ; and  when  there  is  a disturbance  in  these  minute  micro- 
scopic cells  we  have  disease.  How  are  those  cells  to  be  brought 
again  into  harmony?  I believe  that  remedies  must  be  so  diluted, 
or  made  so  fine,  that  they  must  reach  these  microscopic  cells,  and 
that  the  method  which  came  in  along  with  the  law  of  similars  is  the 
one  which  divides  the  remedy  so  that  it  can  reach  the  cells.  But 
beyond  all  that,  these  cells  each  have  their  own  respective  spheres 
of  action,  and  you  take  the  cell  of  one  organ,  for  instance  the  cell  of 
the  pancreatic  gland,  and  the  cell  of  the  liver,  and  of  the  salivary 
gland,  and  each  will  carry  its  own  product.  It  will  have  the  food 
which  makes  its  impression  upon  the  others  individually  and  sepa- 
rately ; and  I believe  that  such  is  the  action  of  remedies  in  the  prov- 
ings upon  a healthy  body.  Each  remedy  selects  certain  tissues,  just 
as  the  nutritious  principles  do,  and  there  is  the  need  of  the  proving 
of  our  remedies  upon  the  healthy  system  as  Dr.  Dake  has  stated. 
The  proving  of  these  remedies  upon  the  healthy  tissues  points  out 
the  definite  ultimate  cells  upon  which  each  remedy  acts.  Thus  we 
know  that  some  remedies  act  upon  the  nervous  system;  some  upon 
another  part.  The  scientific  application  of  a remedy  to  these  cells, 
and  structures,  and  organs,  must  be  upon  some  definite  plan  such  as 
we  have  found  out  through  Hahnemann’s  law  of  similars,  and  the 
proving  of  drugs.  But  I will  call  your  attention  to  the  indelible 
nature  of  the  impress  which  Homoeopathy  has  made  upon  the  world. 
It  has  been  made  not  only  upon  the  profession,  but  upon  the  laity 
and  I believe  it  will  be  permanent. 

Difficulties  have  arisen  along  the  pathway  of  Homoeopathy  but 
they  have  been  all  overcome ; and  the  future  difficulties,  as  they  may 
arise,  will  all  be  surmounted  and  our  system  in  the  future  will  grow 
and  strengthen  throughout  the  ages. 


THE  FUTURE  OF  HOMOEOPATHY. 


107 


The  Chairman  : This  paper  will  be  farther  discussed  by  Dr. 
Lizzie  Gutherz,  of  St.  Louis,  Mo. 

Dr.  Gutherz:  Mr.  President , Ladies  and  Gentlemen:  A mother  , 
in  India  once  said  to  me:  “ My  dear,  when  the  bread  is  not  prop- 
erly baked  and  the  meat  is  not  thoroughly  done,  don’t  call  the  atten- 
tion of  your  guests  to  it  for  they  will  probably  never  find  it  out.” 
And  yet,  after  listening  to  the  essayist  saying  that  thirty-six  years 
ago  in  this  city  he  read  a paper  before  a convention,  I hesitate  to 
discuss  a paper  written  by  so  able  and  gifted  a man  as  Dr.  J.  P. 
Dake,  and  on  a subject  so  far  reaching,  so  vast,  so  pregnant  with  in- 
terest to  all  as  the  future  of  Homoeopathy.  The  essayist  takes  the 
ground  that  Homoeopathy  will  be  more  clearly  defined  in  the  future, 
yet  the  principle  of  similia  similibus  curantur , taught  by  the  im- 
mortal Hahnemann  is  the  same  to-day  as  it  was  in  the  past.  He 
tells  us  that  the  governing  principle  will  survive  all  the  ages,  only 
it  will  be  more  clearly  defined  and  more  strongly  established  in 
human  experience.  In  this  free  land  of  ours  the  great  future  of 
Homoeopathy  is  to  be  placed  before  the  world,  and  in  our  city  the 
pharmacists  and  druggists  tell  us  that  where  Homoeopathy  has  most 
thrived  it  has  modified  the  healing  art  of  the  Old  School,  that  they 
don’t  give  their  poisonous  doses  in  the  same  heavy  way  that  they 
once  did.  It  is  through  the  colleges  and  their  high  standards  that 
our  cause  will  be  benefited  further.  Examining  boards,  when  com- 
posed of  only  one  school,  are  political  machines  and  ought  to  be 
abolished  from  the  face  of  the  earth.  The  educated  people  of  the 
country  are  coming  to  the  front  and  accepting  our  school  in  a way 
that  never  would  have  been  acknowledged  had  it  not  been  for  this 
association.  The  intellectual  men  who  compose  this  body,  through 
their  intellectual  ability,  purity  and  truth,  have  placed  a gem  in  the 
diadem  of  Homoeopathy  that  no  other  school  has  ever  known. 

The  Chairman:  Dr.  I.  T.  Talbot,  of  Boston,  will  now  discuss 
Homoeopathy  in  the  medical  colleges  and  hospitals  of  the  United 
States. 


108 


WORLD  S HOMCEOrATHIC  CONGRESS. 


ADDRESS. 

MEDICAL  EDUCATION  IN  THE  HOMCEOPATHIC 
HOSPITALS  AND  COLLEGES  OF  THE 
UNITED  STATES. 

By  I.  T.  Talbot,  M.D.,  Boston,  Mass. 


At  the  Fourth  Quinquennial  Session  of  the  Homoeopathic  Con- 
gress held  at  Atlantic  City  in  1891,  I had  the  honor  to  present  a 
paper  on  “ The  Duties  and  Responsibilities  of  Homoeopathic  Col- 
leges as  Leaders  in  Medical  Progress.”  This  essay  met  with  the 
approval  not  only  of  the  Congress  but  of  the  American  Institute  of 
Homoeopathy  and  of  its  Intercollegiate  Committee  and  some  of  its 
suggestions  have  been  adopted  by  those  bodies.  The  four  years’ 
course  of  required  study  has  been  made  the  rule  for  all  our  recog- 
nized colleges.  Without  question,  this  single  step  was  the  most  im- 
portant one  ever  taken  in  the  cause  of  medical  education  in  this 
country.  With  mature  age,  a thorough  preliminary  training,  a year 
spent  in  the  study  of  the  collateral  branches  of  medical  science,  and 
three  subsequent  years  of  solid  work  in  properly  equipped  medical 
colleges,  there  can  be  no  doubt  of  the  great  elevation  thereby  of  the 
standards  of  medical  education  and  of  the  rapid  development  of 
medical  science  in  all  its  departments. 

In  considering  at  this  time  the  subject  of  “ Medical  Education  in 
the  Homoeopathic  Colleges  and  Hospitals  of  the  United  States,”  I 
desire  to  refer  to  the  paper  mentioned  as  containing  certain  im- 
portant matters  on  which  the  subject  of  future  medical  education 
properly  rests,  and  without  repeating  what  was  then  said,  to  con- 
sider our  present  position  and  the  proper  methods  for  future  pro- 
gress. 

In  the  first  place  let  us  consider  and  acknowledge  the  debt  we 
owe  to  our  medical  colleges  which,  established  and  sustained  at  great 
effort  and  expense,  have  done  so  much  for  the  development  and 


MEDICAL  EDUCATION  IN  HOSPITALS  AND  COLLEGES.  109 


spread  of  Homoeopathy,  and  with  it  the  advancement  of  medical 
science  in  this  country. 

From  these  schools  within  the  last  forty -live  years,  about  ten 
thousand  physicians  have  been  graduated  and  are  scattered  in  vari- 
ous parts  of  this  and  foreign  countries.  The  great  majority  of  these 
have  become  good  practicing  physicians  with  a knowledge  of  Ho- 
moeopathy which,  but  for  these  schools,  they  probably  would  never 
have  attained,  while  many  have  become  distinguished  in  science  as 
well  as  medicine. 

These  medical  schools  and  colleges  have  often  labored  under  the 
greatest  disadvantages.  Not  only  have  the  instructors  at  times  been 
unable  to  illustrate  sufficiently  their  teachings  by  clinical  results, 
but  students  have  oftentimes  been  debarred  from  the  chance  of  visit- 
ing hospitals  in  which  they  could  practically  study  disease.  With 
effort  and  energy  these  obstructions  have  been  largely  overcome,  and 
the  schools  which  from  the  first  could  find  their  counterparts  in  the 
greater  number  of  other  medical  schools,  have  as  a rule  so  utilized 
their  possible  opportunities  that  even  their  clinical  instruction  now 
equals  the  average  amount,  and  in  many  cases  far  exceeds  it.  At 
the  present  time  there  are  sixteen  Homoeopathic  colleges  recognized 
by  the  Institute,  and  three  or  four  others  which  have  been  organ- 
ized. While  I shall  not  in  this  paper  attempt  to  do  justice  to  any 
college,  those  represented  in  the  American  Institute  of  Homoeopathy 
will  be  briefly  mentioned.  Of  these,  three  are  connected  with  State 
Institutions,  viz. : The  Homoeopathic  Departments  of  the  Universi- 
ties of  Michigan,  Iowa  and  Minnesota,  and  are  supported  by  their 
several  States.  If  these  schools  continue  to  be  properly  conducted 
and  successfully  managed,  there  is  no  doubt  that  the  people  of  those 
states  will  feel  sufficient  pride  in  their  success  to  contribute  the 
necessary  means  for  their  support  and  proper  equipment. 

The  Hahnemann  Medical  College  and  Hospital,  of  Philadelphia, 
is  the  successor  of  the  Homoeopathic  Medical  College  of  Pennsyl- 
vania, established  in  1848,  and  while  it  has  done  valuable  work 
from  the  beginning,  it  has  within  the  last  ten  years  made  its  greatest 
advance.  It  has  secured  an  eligible  location,  and  erected  thereon  a 
fine  building  for  a college,  dispensary  and  hospital ; and  its  success 
fully  warrants  the  far-seeing  policy  which  planned  and  executed 
these  improvements.  Of  the  work  which  is  being  done  there,  any 
college  may  well  be  proud,  and  its  graduates  are  an  honor  to  the 
medical  profession. 


110 


world's  homoeopathic  congress. 


In  Cleveland,  the  second  Homoeopathic  college  was  established  in 
1849,  and  though  it  has  labored  under  many  disadvantages  yet  it 
has  made  much  of  its  opportunities,  and  the  greatest  credit  is  due  to 
the  courageous,  self-sacrificing  founders  and  supporters  of  that  in- 
stitution. Earnest  and  faithful  work  has  been  done  therein  and 
upon  its  roll  of  graduates  are  to  be  found  some  of  the  ablest  physi- 
cians of  our  school.  Later  a division  of  the  school  established  a 
second  college  in  that  city,  the  Cleveland  Medical  College  and 
though  many  regretted  the  division,  yet  we  cannot  say  but  what  the 
stimulus  of  enthusiasm  and  determination  which  opposition  some- 
times engenders  may  make  both  of  these  schools  in  the  future  more 
efficient  than  either  would  be  alone. 

In  1858  the  Homoeopathic  Medical  College  of  Missouri  was  estab- 
lished, and  though  it  has  met  with  many  changes  and  alterations  in 
fortune,  yet  there  can  be  no  question  that  much  work  of  real  value 
to  the  profession  has  been  accomplished  there,  and  at  present  its  pros- 
pects are  perhaps  brighter  than  ever. 

In  1859  the  Hahnemann  Medical  College  of  Chicago,  chartered 
four  years  previously,  opened  its  doors  to  students,  and  there  are 
some  here  present  who  remember  the  severe  struggles  and  sacrifices 
which  were  required  to  establish  and  support  this  school  in  its  ear- 
liest years.  The  amount  of  energy  displayed  and  the  success  which 
has  attended  it  are  only  characteristic  of  the  wonderful  city  in  which 
it  is  located,  and  among  its  alumni  are  found  many  of  the  most  in- 
fluential men  of  the  profession.  The  experience  of  this  school,  like 
that  of  Cleveland,  shows  that  differences  of  opinion  may  widely  sep- 
arate friends,  and  the  establishment,  in  1876,  of  the  Chicago  Homoeo- 
pathic Medical  College  caused  much  severe  criticism,  yet  the  success 
which  has  attended  it  and  the  amount  of  good  work  done  may  per- 
haps justify  its  founders. 

In  1860  the  Metropolitan  City,  New  York,  established  the  New 
York  Homoeopathic  Medical  College,  and  from  the  large  number  of 
distinguished  physicians  in  that  city  it  has  always  secured  an  excep- 
tionally able  faculty.  That  it  has  had  its  struggles  goes  without 
saying,  but  in  the  establishing  of  hospitals  which  could  be  used  for 
clinical  teaching,  New  York  exceeds  in  number  any  other  city.  The 
wealth  and  influence  of  that  city  should  give  advantages  to  the  col- 
lege which  no  other  location  in  this  country  could  excel. 

In  1863  the  New  York  Medical  College  and  Hospital  for  Women 
was  established  under  favorable  auspices,  and  though  colleges  for 


MEDICAL  EDUCATION  IN  HOSPITALS  AND  COLLEGES.  Ill 


women  alone  have  met  with  strong  opposition,  even  from  their  own 
sex,  yet  it  has  struggled  on  until  it  has  obtained  a success  gratifying 
to  its  early  friends. 

In  1872  the  Pulte  Medical  College,  of  Cincinnati,  was  established, 
named  for,  and  to  a certain  extent  assisted  by,  our  distinguished 
confrere,  Dr.  J.  H.  Pulte.  That  it  has  done  much  valuable  work  is 
certain,  and  many  of  its  graduates  are  to  be  found  holding  prominent 
positions. 

In  1873  Boston  University  established  its  School  of  Medicine. 
It  was  not  an  easy  matter,  but  it  has  proved  a success,  and  from  the 
first  has  maintained  a high  grade  of  scholarship.  An  entrance 

(?)  which  shall  be  in  preliminary  branches, — and  during  this 

first  year  students  may  be  under  special  instruction  of  a physician, — 
after  which  three  years  must  be  spent,  before  graduation,  in  attend- 
ance upon  the  college  courses. 

When  we  consider  the  great  advance  in  the  methods  of  medical 
study  which  has  been  made  in  the  last  few  years,  and  see  the  very 
decided  changes  from  didactic  to  clinical  instruction  ; when  students 
who,  not  many  years  ago,  were  graduated  simply  in  recompense  for 
fees  taken,  while  now  examinations  more  or  less  stringent  are  required 
in  every  case,  we  can  but  feel  that  these  changes  in  method  are  doing 
much  for  the  improvement  of  medical  instruction  and  the  advance 
of  medical  science. 

The  change  has  indeed  been  very  great,  and  while  the  tendency  is 
still  in  the  direction  of  improvement,  and  the  whole  sentiment  of  the 
schools,  the  profession,  and  the  community  requires  more  thorough 
instruction,  is  it  not  well  for  us  to  consider  how  far  we  may  progress 
in  this  direction  to  advantage,  and  not  to  hesitate  or  stop  until  we 
have  reached  the  most  useful  limit? 

It  has  often  been  the  case  that  the  student  who  acquired  his  de- 
gree in  the  shortest  possible  time  and  knew  the  least  of  medical  sci- 
ence was  the  most  confident  of  his  own  superior  knowledge,  and  was 
sure  that  he  knew  about  all  there  was  to  be  learned.  On  the  other 
hand,  the  physician  who  has  been  thoroughly  instructed  finds  open 
to  him  so  many  sources  of  learning  and  so  much  of  the  unknown  in 
the  ever- varying  forms  of  disease,  that  he  is  the  more  ready  to  de- 
vote himself  to  study  until  he  has  mastered  at  least  a modicum  of 
what  science  has  revealed  in  medicine.  The  ignorant  u doctor,”  if 
such  a solecism  may  be  allowed — in  which  to  acquire  all  that  is  nec- 


112  world’s  homoeopathic  congress. 

essary  for  his  purposes;  how  much  time  is  essential  for  the  student 
to  spend  in  acquiring  the  necessary  amount  of  knowledge  to  make 
him  the  learned  physician — the  one  who  is  to  give  such  character 
and  tone  to  the  profession  as  shall  command  the  respect  of  the  com- 
munity and  the  confidence  of  his  associates?  The  four  years’  course 
as  marked  out  by  the  Intercollegiate  Committee  of  the  American 
Institute  of  Homoeopathy  is  certainly  excellent,  but  does  it  go  far 
enough  ? The  first  year  is  given  to  elementary  medical  study  ; there 
are  then  but  three  subsequent  years  given  to  the  whole  of  that  sci- 
ence and  art,  than  which  none  is  more  comprehensive  and  varied. 
After  the  most  careful  study  of  this  subject  in  its  various  phases, 
this  time  seems  altogether  too  short  to  accomplish  the  needed  work, 
and  at  least  five  years  should  be  required  from  the  time  of  leaving 
the  ordinary  literary  studies  to  acquire  essential  knowledge  of  a sub- 
ject so  intricate  as  medicine. 

The  following  presents  a comprehensive  schedule  of  the  required 
work : 

First  Year. 

General  Chemistry  (Laboratory  Course  and  Recitations). 

Physics  (Laboratory  Course  and  Recitations). 

Zoology  (Laboratory  Course  and  Recitations). 

Botany  (Laboratory  Course  and  Recitations). 

Microscopy  (Laboratory  Course). 

Medical  History. 

Latin. 


Second  Year. 

General  Anatomy  (Recitations  and  Dissections). 

Physiology  (Recitations  and  Laboratory  Work). 

Histology  (Laboratory  Course). 

Pharmaceutics  (Laboratory  Course  and  Recitations). 

Minor  Surgery. 

Sanitary  Science. 

Dietetics. 

Third  Year. 

Anatomy  of  Nervous  System  and  Special  Organs  (Dissections). 
Embryology. 

Physiology  (Laboratory). 


MEDICAL  EDUCATION  IN  HOSPITALS  AND  COLLEGES.  113 


General  Pathological  Anatomy  (Demonstrations  and  Recitations). 
General  Surgery. 

Materia  Medica. 

Obstetrics. 

Fourth  Year. 

Pathology  and  Therapeutics. 

Special  Pathological  Anatomy  (Laboratory  Work). 

Operative  Surgery  (with  Clinics  and  Laboratory  Course). 
Topographical  Anatomy  (Dissections). 

Materia  Medica. 

Obstetrics  (Clinical  and  Operative). 

Diseases  of  the  Chest  and  Throat. 

Clinics. 


Fifth  Year. 

Pathology  and  Therapeutics. 

Diseases  of  the  Nervous  System. 

Diseases  of  the  Skin. 

Diseases  of  Women. 

Diseases  of  the  Ear. 

Diseases  of  the  Eye. 

Electro-Therapeutics. 

Medical  Jurisprudence  and  Ethics  of  Medicine. 

Dispensary  Practice. 

Clinics  and  Clinical  Reports. 

Thesis. 

In  addition  to  the  subjects  already  enumerated,  there  are  con- 
stantly arising  many  points  of  practical  instruction  suggested  by  the 
different  forms  of  disease  and  the  accompanying  circumstances, 
which  can  be  discussed  by  the  various  instructors  with  great  value. 
Time  becomes  an  element  of  importance,  and  the  student,  however 
stupid,  by  continued  contact  with  those  well  learned  in  the  various 
subjects,  will  gain  a large  amount  of  knowledge. 

But  it  can  be  readily  seen  that  a medical  school  for  the  proper 
teaching  of  all  these  subjects  requires  the  most  extensive  facilities, 
which  are  necessarily  attended  with  great  expense.  The  hospital 
should  be  large  and  commodious,  the  dispensaries  sufficient  to  afford 
the  greatest  amount  of  clinical  work,  the  numerous  laboratories 

8 


114 


world’s  homceopathtc  congress. 


thoroughly  equipped,  with  a sufficient  number  of  competent  in- 
structors to  properly  direct  the  course  of  the  student,  and  clinical 
material  should  be  secured  to  illustrate  as  fully  as  possible  all  the 
essential  points  in  medicine.  The  very  detail  of  this  work  is  start- 
ling, almost  appalling,  but  the  end  to  be  gained — the  physical  ad- 
vantage of  the  whole  human  race — makes  the  subject  one  well 
worthy  of  the  greatest  human  effort. 

Is  there  any  class  of  physicians  to  whom  we  could  appeal  for  this 
with  better  reason  than  to  those  of  our  own  school  ? From  the  time 
of  Hahnemann  to  the  present,  those  who  believe  in  his  principles 
have,  as  a class,  been  independent,  earnest,  progressive  men,  not 
accustomed  to  shrink  from  sacrifice  or  personal  effort ; are  they  not 
equally  ready  now?  It  is  not  a matter  of  a few  months,  or  even 
years ; but  it  is  for  us  to  set  our  standard  of  what  should  be  done 
as  high  as  possible,  and  then  bend  our  efforts  to  its  accomplishment, 
whatever  time  it  may  require. 

We  are  now  nearly  at  the  close  of  the  nineteenth  century,  envi- 
roned by  mental  activity  and  a rapidity  of  progress  before  unknown 
in  the  world’s  history.  Here  in  the  City  of  Chicago,  which  stands 
pre-eminent  for  its  energy  and  powers  for  great  success,  may  we  not 
take  on  some  of  the  qualities  of  our  surroundiugs,  and  determine 
that  at  the  beginning  of  the  twentieth  century  in  all  the  Homoeo- 
pathic colleges  of  this  country  we  will  aim  to  reach  the  high  stand- 
ard of  medical  education  which  five  years  of  close  study  can  alone 
give  to  the  physician. 

Discussion. 

The  Chairman  : The  address  will  first  be  discussed  by  Dr. 
O.  S.  Runnels,  of  Indianapolis. 

Dr.  Runnels  : Homoeopathy  to-day  holds  pre-eminence  in  mat- 
ters educational,  and  we  want  to  do  nothing  here  that  shall  in  any 
way  take  her  down  from  that  proud  position.  We  must  keep  our 
forces  well  to  the  front  and  be  the  leaders  in  all  educational  matters, 
for  it  is  a fact  that  the  American  Institute  of  Homoeopathy  is  the 
only  national  body  that  requires  the  high  standard  that  she  does. 
There  is  no  college  there  recognized  that  does  not  require  a four 
years’  course  from  her  students.  That  is  a great  advance.  And  for 
several  years  students  matriculating  have  been  informed  that  they 
are  to  have  a thorough  education  first,  and  that  they  can  get  their 
degree  in  no  other  way.  I am  sure  that  Dr.  Talbot  has  taken  the 
right  stand  here  to-day  in  looking  forward  to  a time  when  greater 
requirements  must  be  had,  when  the  student  shall  have  to  pass 


MEDICAL  EDUCATION  IN  HOSPITALS  AND  COLLEGES.  115 


five  years  in  preliminary  work  before  he  can  go  forth  to  practice. 
A great  deal  depends  upon  the  stand  the  laity  takes  in  this  mat- 
ter. Medical  colleges  can  will  to  do  certain  things,  but  unless  they 
are  supported  by  the  profession  at  large  they  will  be  powerless  to 
accomplish  that  work.  I think  the  medical  profession  should 
patronize  no  college  which  does  not  require  the  highest  of  their  stu- 
dents. From  the  earliest  times  in  Homoeopathy  we  have  been  friends 
of  education.  We  look  back  to  a founder  who  was  not  a mounte- 
bank, but  who  stood  at  the  very  top  of  medical  requirement,  and  so 
all  along  down  the  line,  our  leaders  have  been  men  who  have  shone 
in  the  firmament  of  knowledge. 

The  Chairman  : The  address  will  be  further  discussed  by  Dr. 
A.  P.  Hanchett,  of  Council  Bluffs,  Iowa. 

Dr.  Hanchett  : I feel  illy  prepared  to  discuss  this  question,  for 
I have  only  heard  the  paper  as  you  have  heard  it.  I have  a feeling 
of  pride  and  of  great  satisfaction  at  all  times  to  know  that  the  repre- 
sentatives of  our  school  of  medicine  could  feel  that  their  position  was 
on  firm  ground,  that  we  had  taken  the  lead  in  the  matter  of  a higher 
education. 

A few  years  ago  when  one  of  our  Western  States  organized  its 
board  of  examiners,  and  the  question  of  schools  and  colleges  came 
up,  the  diplomas  from  which  should  be  accepted  as  credentials,  the 
whole  field  of  the  medical  colleges  was  thoroughly  and  carefully  can- 
vassed. Something  like  150  schools  that  issued  diplomas  were  found 
to  be  in  existence  in  this  country ; of  that  number  but  fifteen  were 
Homoeopathic.  Ten  per  cent,  of  the  Allopathic  schools  were  ruled 
as  unworthy  to  have  their  diplomas  recognized,  whereas  100  per 
cent,  of  the  Homoeopathic  colleges  were  pronounced  by  this  non- 
partisan board  as  thoroughly  reliable,  and  whose  diplomas  should  pass 
current. 

It  strikes  me  there  was  one  point  in  this  paper  which  was  over- 
looked, and  that  was  the  requirement  for  preliminary  education. 
Before  a student  approaches  us  we  should  say,  are  you  ready  young 
man,  or  young  woman,  to  commence  the  study  of  medicine?  have  you, 
had  the  mental  training  that  must  precede  it?  And  then  if  we 
should  positively  demand  such  preparation  we  would  bring  a better 
class  of  men  and  women  into  our  colleges.  I contend  that  the  medi- 
cal profession  must  make  the  same  requirement  made  by  some  of 
our  religious  denominations.  I understand  that  in  some  of  them 
they  are  not  admitted  to  the  theological  schools  until  they  bring  a 
diploma  showing  a classical  education  and  thorough  mental  train- 
ing. It  is  this  preparation  that  I am  laboring  for,  and  I have  many 
times  expressed  the  conviction  that  I should  accept  no  student  who 
has  not  had  a thorough  training  or  a college  course.  In  that  way 
only  I believe  are  we  to  bring  the  standard  of  our  medical  men  up  to 
where  it  should  be. 


116 


world’s  homceopathic  congress. 


The  Chairman  : The  paper  will  be  farther  discussed  by  Dr.  T. 
G.  Comstock,  of  St.  Louis,  Mo. 

Dr.  Comstock  : I was  very  much  pleased  with  Dr.  Talbot’s  paper, 
and  I thought  the  Congress  might  be  proud  to  know  that  the  Boston 
University  was  the  first  to  insist  upon  a four  years’  course  of  study, 
and  if  you  will  look  over  the  catalogue  of  the  Boston  University  you 
will  find  for  several  years  that  one- third  of  the  students  are  A.B.’s. 
Now  one  year  ago  at  Philadelphia  I had  the  honor  of  being  the  Presi- 
dent of  the  Alumni  of  the  Hahnemann  Medical  College,  and  made 
an  address  there  in  which  I insisted  that  hereafter  none  should  enter 
a medical  college  unless  they  had  the  degree  of  A.B„,  and  moreover, 
I made  the  prediction  that  within  ten  years  from  now  every  medical 
college  would  require  a course  of  five  years  instead  of  three  as  at 
present. 

The  Chairman  : As  there  is  no  further  discussion  on  this  ad- 
dress the  paper  of  Dr.  Alexander  Villers,  of  Dresden,  Germany,  on 
“ Historical  Development  of  Homoeopathy  in  Germany,”  will  be  read 
by  the  Secretary. 


HISTORY  OF  HOMCEOPATHY  IN  GERMANY. 


117 


ADDRESS. 

HISTORY  OF  HOMCEOPATHY  IN  GERMANY . 


By  Dr.  Alexander  Villers,  Dresden. 


At  an  international  meeting,  like  our  Congress  in  Chicago,  I can- 
not, nor  dare  I,  discharge  the  duty  allotted  to  me,  to  give  the  “ His- 
torical Development  of  Homoeopathy  in  Germany,”  in  the  ordinary 
manner  as  is  customary  with  such  retrospective  work.  You  may 
read  in  all  newspapers,  of  the  numerical  increase  or  decrease  of  the 
adherents  and  the  representatives  of  Homoeopathy.  The  interest  re- 
garding hospitals  having  been  erected  or  having  ceased  to  exist,  does 
not  extend  beyond  the  respective  country  or  city.  But  considering 
the  total  aspect  of  the  development  of  Homoeopathy  in  Germany,  we 
must  be  surprised  at  the  fact,  that  Homoeopathy  has  made  so  little 
progress  in  the  land  of  its  birth,  and  why  now,  after  existing  almost 
a hundred  years,  its  representation  in  medical  circles  in  Germany  is 
still  so  limited,  whilst  the  general  public  is  continually  increasing  its 
demand  for  it.  If  we  compare  other  countries  in  this  direction, 
especially  the  United  States,  we  find  that,  since  Homoeopathy  has 
been  introduced  in  America,  a much  stronger  development  has  been 
accomplished  there,  in  a much  shorter  period.  Although  we  know 
from  pathology,  that  fresh  germs  develop  more  rapidly  than  older 
ones,  we  cannot  attribute  this  wide  difference  in  the  evolution  in  both 
countries  to  the  “ need  of  expansion  ” of  the  newly  established  medi- 
cal fraternity  only.  At  the  time  when  even  here,  the  first  disciples 
of  the  master  came  forward  with  apostolic  inspiration,  their  number 
was  small,  their  activity  rarely  exceeding  their  near  surroundings. 

The  progress  of  civilization  is  warranted  by  the  continuation  of 
intellectual  work,  not  merely  by  single  individuals,  but  also  by  entire 
nations,  as  soon  as  the  love  or  the  power  to  work,  has  weakened  in 
the  predecessor.  Thus  the  entire  medical  science  during  the  Middle 
Ages  was  under  the  influence  of  Humoral  pathology  delivered  down 
from  the  Arabs,  until  German  labor  broke  this  spell,  and  the  first 


118 


world’s  homoeopathic  congress. 


standard-bearers  of  a new  medical  era  appeared  in  the  persons  of 
Vesalius  and  Paracelsus.  While  Vesalius  introduced  the  anatomical 
investigation,  and  in  consequence,  the  foundation  of  the  objective 
proofs  for  medical  conception,  Paracelsus  opened  the  way  to  a view 
of  life  and  the  living  body,  which  we  find  a remarkable  admixture 
of  physical  interpretation  and  purely  philosophical  speculation.  It 
is  natural  to  the  average  man  that  he  is  more  attracted  towards  the 
fantastic  centre  of  theoretical  views,  than  toward  the  cultivation  of 
dry,  barren  soil  of  thorough  investigation.  Thus  the  contemplative 
part  of  the  teachings  of  Paracelsus  were  strongly  brought  forward, 
and  the  Archaeus  Maximus  still  reigned  supreme  in  Germany,  whilst 
the  Romans  and  Anglo-Saxons,  already  showed  more  interest  for  a 
physiological  and  anatomical  basis  of  their  theories.  From  the 
Archaeus , Stahl  constructed  the  conception  of  a “ soul,”  which  was 
worthless  to  natural  science,  thus  originating  the  school  of  the  Ani- 
mists,  and  the  main  object  of  the  natural  philosophers  at  that  time 
was  the  interpretation  and  formulation  of  life-force. 

At  this  period  Hahnemann  makes  his  appearance.  He  emphati- 
cally demands  the  experiment;  only  upon  such  a safe  foundation 
will  he  erect  the  new  structure  of  his  Similia  Similibus  therapy.  In 
this  he  is  a follower  of  Vesalius  and  a most  prominent  pioneer  of 
modern  physiology  and  pathology.  But  on  the  other  hand,  he 
studies  the  life-force  and  its  derangements  and  seeks  to  remedy  the 
latter  by  the  administration  of  medicinal  potencies,  which  are  to  work 
only  dynamically,  not  physically.  At  that  time  of  philosophical 
speculation,  his  demands  for  experimental  proofs  were  not  under- 
stood, and  later  on  when  the  experimental  objective  tendency  of  the 
French  anatomical  school  became  prevalent  also  in  the  medical  sci- 
ence of  Germany,  his  superabundance  of  views  on  life-force,  dyna- 
mism, etc.,  prevented  the  appreciation  which  he  fully  deserved.  If 
but  only  one  of  his  many  opponents  had  really  read  him  and  if  this 
reader  had  taken  pains  to  strip  his  arguments  of  the  garments  which 
they  had  to  wear  in  accordance  with  the  fashion  of  his  day,  it  would 
have  been  long  established,  that  Homoeopathy  is  the  medicine  of  the 
future,  because  it  always  admits  the  proof  of  its  assertions,  thus  rest- 
ing upon  facts  in  the  most  modern  sense.  Naturally,  Homoeopathy 
refrains  from  using  rounded  expressions,  so  to  speak,  scientific  idioms 
like  other  therapeutic  schools;  as  for  these  it  is  too  clear  and  despises 
the  cloak  of  phraseology  or  the  finely  formed  technical  terms  for  the 
designation  of  conditions  of  which  the  recognition  is  wanting. 


HISTORY  OF  HOMOEOPATHY  IN  GERMANY. 


119 


But  the  attempt,  to  adapt  Homoeopathy  to  the  dominant  school  of 
medicine,  has  been  made  repeatedly  ; partly  by  competent  students, 
partly  by  men  who  did  not  grasp  their  object.  The  Homoeopath- 
ische  Therapie  auf  Grundlage  der  Pkysiologischen  Schule,  by  Dr.’ 
Joseph  Kafka  is  undoubtedly  the  most  able  attempt  in  this  direction 
in  German  literature.  Kafka  possessed  the  knowledge,,  the  intelli- 
gence and  the  energy  to  accomplish  such  a task.  If  he  did  not  suc- 
ceed, the  failure  was  not  due  to  his  want  of  ability  but  because  of  the 
inadequacy  of  the  object.  Let  us  hope  that  Physiology  will  explain 
to  us  in  the  future,  why  certain  remedies  will  affect  various  organs 
of  our  body ; for  even  if  we  recognize  “ organic  remedies”  for  con- 
venience, as  for  instance,  heart,  stomach  remedies,  etc.,  we  only  wish 
to  thus  indicate  that  we  know  their  action  on  those  organs  more 
thoroughly  than  that  on  any  other  regions;  but  we  have  to  insist  on 
the  totality  of  symptoms  for  prescription.  Pathological  names  of 
diseases  are  least  suited  as  guides  in  the  difficult  selection  of  a 
remedy,  as  they  mainly  refer  to  an  artificially  constructed  conception. 
The  best  proof  for  this  is  the  latest  investigation  of  causes  of  dis- 
ease. None  of  the  vital  functions  of  diseased  germs  can  influence 
our  selection  of  drugs,  nor  even  the  setiological  points  which  pre- 
dispose the  body,  for  the  development  of  the  former  will  help  us  in 
this  direction  ; but  still  our  therapeutic  success  vastly  exceeds  that  of 
the  Old  School  in  the  treatment  of  infectious  diseases,  even  when  we 
do  not  know  the  character  of  the  infection. 

While  Kafka’s  work  is  an  excellent  one  of  its  kind,  there  is  an- 
other book  by  an  anonymous  editor,  published  by  Wilmer  Schwabe, 
the  Homoeopathic  pharmacist,  at  Leipsic,  which  has  done  much  to 
injure  Homoeopathy.  It  makes  the  attempt  to  adapt  Homoeopathy 
to  the  physiological  school  in  a purely  mechanical  way.  It  simply 
substitutes  names  of  Homoeopathic  remedies  in  the  place  of  Allo- 
pathic ones,  after  each  chapter  on  special  diseases,  after  a fashion  of 
the  small  domestic  treatises  written  for  the  laity.  This  book  has 
done  a great  deal  of  mischief,  especially  in  the  hands  of  younger 
physicians  intending  to  study  Homoeopathy. 

Iu  Germany,  as  well  as  every  where,  the  general  progress  of  Hom- 
oeopathy vastly  depends  upon  its  practical  success  with  the  public. 
The  patients  and  their  friends  induce  its  spread ; notwithstanding 
their  gratitude  they  really  do  little  to  actually  further  it.  Only  in 
one  state  of  the  German  Empire,  in  Wurtemberg,  the  local  society, 


120 


world’s  homoeopath ic  congress. 


Hahnemannia,  successfully  agitated  the  state  government  and  the 
legislature.  Hundreds  of  other  minor  societies  who  bear  the  name 
“ Homoeopathic  ” have  done  nothing,  their  only  aim  being  to  get 
their  remedies  and  periodicals  at  wholesale  prices.  For  decades  the 
business  centre  of  these  societies  has  been  the  pharmacy  of  the  above- 
mentioned  Dr.  Schwabe  in  Leipsic,  who,  as  a thorough  business' 
man,  has  furthered  and  assisted  them  in  every  possible  manner  until 
he  founded  a private  polyclinic  as  a branch  of  his  establishment  for 
the  benefit  of  his  customers,  and  became  at  last  the  greatest  publisher 
of  German  Homoeopathic  literature.  Thus  Schwabe’s  pharmacy, 
with  its  branches,  appears  to  be  the  centre  of  all  Homoeopathic  in- 
terests in  Germany  in  the  eyes  of  those  who  stand  outside  the  real 
Homoeopathic  fraternity,  but  who  incline  towards  them.  Certainly 
five-sixths  of  those  young  physicians  who  became  Homoeopaths 
during,  the  last  ten  years  have  there  received  their  Homoeopathic 
training,  or  have  at  least  spent  some  time  there.  Therefore,  these 
young  men  have  taken  Schwabe’s  book,  with  the  anonymous  editor 
for  a guide  in  their  studies.  For  those  who  have  been  so  familiar 
with  the  Allopathic  fashion  of  having  the  remedy  fitting  the  disease, 
this  book  naturally  seems  very  convenient  and  promising.  Only 
later  on,  after  they  have  become  acquainted  with  a thoroughly  edu- 
cated Homoeopathic  physician,  they  begin  to  perceive  that  the  study 
of  Homoeopathic  Materia  Medica  is  something  entirely  different,  and 
that  real  success  can  be  gained  only  by  the  careful,  dry  study  of 
symptoms.  This  is  the  reason  why  a large  number  of  Homoeopathic 
physicians,  now  practicing  in  Germany,  are  not  in  the  position  to 
make  a scientific  propaganda  for  their  method.  They  do  not  much 
exceed  the  enthusiastic  laity  in  the  defence  of  their  views.  But 
for  this  reason  again  our  colleagues  of  the  dominant  school  find  no 
interest  for  a science  in  the  public  representatives  of  which  they  rec- 
ognize mainly  laymen  or  half-educated  physicians. 

In  Germany  it  is  the  traditional  duty  of  every  Homoeopathic 
physician  to  first  acquire  all  general  medical  knowledge  like  all  his 
professional  colleagues,  and  after  the  close  of  his  studies  receive  the 
permit  to  practice  as  a physician  by  a state  examination.  We  are  not 
sorry  for  this  indirect  way,  as  we  thus  gain  the  proof  that  we  are 
scientifically  educated  physicians,  if  doubted  by  our  opponents.  A 
future  time  may  perhaps  give  us  separate  institutions  for  clinical  in- 
struction, for  until  now  we  are  still  restricted  to  private  studies  for 


HISTORY  OF  HOMOEOPATHY  IN  GERMANY. 


121 


a specifically  Homoeopathic  education.  There  is  only  one  clinical 
institution,  aided  by  the  state  government,  under  the  control  of  the 
Homoeopathic  Central  Society  in  Leipsic,  but  this  is  much  curtailed 
by  the  flourishing  private  clinic  of  Schwabe’s  pharmacy. 

The  hospital  of  the  Central  Society  in  Leipsic  is  successful,  but 
has  not  been  assisted  by  general  interest. 

Munich  has  a small  Homoeopathic  hospital,  under  the  supervision 
of  Dr.  Koeck,  but  this  is  not  generally  known. 

Berlin  has  the  funds  for  the  erection  of  a hospital,  but  the  society 
for  its  erection  has  not  yet  been  granted  the  governmental  permit, 
without  which  the  undertaking  cannot  proceed.  The  government  will 
not  support  Homoeopathy  in  the  near  future,  although  many  persons 
of  high  rank  are  its  adherents.  Only  in  the  state  of  Wurtemberg 
the  official  physicians  are  compelled  to  acquire  a general  knowledge 
of  Homoeopathy. 

Homoeopathic  literature  in  Germany  is  represented  by  one  of  the 
oldest  existing  Homoeopathic  periodicals : Die  Allgemeine  Homceo- 
patisclie  Zeitungun  Leipsic;  (2)  Die  Zeitschrift  des  Vereins  Berliner 
Homoeopatischer  Aerzte  ; (3)  Archiv  fuer  Homceopathie,  founded  by 
me ; (4)  Die  Leipzig er  Populaere  Zeitschrift  fuer  Homceopathie;  (5) 
the  publications  of  the  “ Hahnemannia ” in  Wurtemberg;  and  (6) 
Dr.  Schlegel’s  Wegweiser  zur  Gesundheix  in  Thuebingen. 

Of  these  periodicals,  the  first  one  has  no  programme  any  more,  as 
it  has  three  different  editors.  It  also  publishes,  in  the  interests  of  a 
small  circle,  who  congregated  under  the  name  of  Epidemieological 
Society,  which  hopes  to  improve  Homoeopathy  by  the  teachings  of 
Dr.  Weihe,  who  adds  a number  of  sensitive  nerve  points  to  the 
symptoms  of  individual  remedies,  at  the  same  time  attempting 
to  revive  the  old  theories  of  Rademacher  with  regard  to  epidemic 
remedies. 

The  Berliner  Zeitschrift  tends  to  find  a modern  expression  for  the 
doctrines  of  Homoeopathy,  hoping  to  advance  the  latter  by  adding 
pathological  and  physiological  views  in  the  selection  of  the  remedy. 

The  Archiv  represents  the  older  tendency  of  Homoeopathy,  the 
purely  symptomic  selection,  and  the  use  of  high  potencies.  It  is 
the  only  paper  which  cultivates  international  relations  as  much  as 
possible.  The  other  publications  are  written  for  the  laity  and  are 
excellently  edited,  although  their  views  cannot  always  be  accepted, 
but  they  all  show  a decided  aversion  to  concede  to  the  physicians  the 


122 


world’s  homoeopathic  congress. 


leadership  of  the  party,  for  they,  as  laymen,  consider  the  laymen 
supreme. 

The  pharmacies  dispensing  Homoeopathic  medicines  exclusively 
are  good  and  flourishing.  Most  all  the  German  drug-stores  have 
Homoeopathic  departments,  and  it  must  be  admitted  that  the  apothe- 
caries who  are  celebrated  for  their  conscientiousness  also  try  their 
best  in  this  somewhat  heterodox  territory.  There  are  a few  fanatics 
and  immature  youths  who  try  to  spite  Homoeopathy  by  preparing 
and  dispensing  Homoeopathic  drugs  in  a careless  manner;  but  it 
must  be  emphasized  that  such  dishonorable  conduct  is  rare.  I, 
therefore,  advocate  that  Homoeopathic  physicians  should  cease  to 
dispense  medicines  themselves.  In  Prussia,  the  physician  can  re- 
ceive a permit  by  passing  an  examination;  in  other  prominent  states 
such  a law  does  not  exist.  However,  with  this  view  of  giving  up 
the  dispensing  of  medicines  by  physicians,  I stand  isolated  with  a 
very  small  number  of  friends,  although  we  argue  that  for  diplomatic 
reasons  also  we  should  not  insist  upon  a right  which  we  use  exclu- 
sively, and  which  has  caused  the  enmity  of  the  entire  drug  trade. 
We  should  at  once  assist  in  an  agitation  for  all  physicians  to  prepare 
and  dispense  their  own  medicines,  but  we  do  not  wish  that  this  de- 
mand should  apply  to  Homoeopathic  physicians  only. 

If  we  now  recapitulate  all  that  is  to  be  said  about  the  position  of 
Homoeopathy  in  Germany,  it  is  that  we  are  again  at  the  beginning 
of  a rising  tendency.  A younger  generation  with  modern  views 
and  education  has  joined  our  party;  individuals  of  all  circles  of 
society  needing  medical  assistance  show  greater  interest  in  the  new 
method  of  the  healing  art,  and  even  though  it  be  the  economical  side 
of  our  treatment  which  rouses  the  interest  of  the  general  public,  as, 
for  instance,  the  shorter  duration  of  disease  and  the  greater  cheap- 
ness of  the  medicines,  this  is  sufficient  to  guarantee  the  gradual 
recognition  which  we  deserve. 

We  Homoeopathic  physicians  are  scattered  in  all  directions  and  are 
overworked  ; therefore,  it  cannot  be  expected  for  some  time  to  come 
that  Homoeopathy  in  Germany  will  appear  prominent  upon  the 
great  battlefield  of  scientific  labor,  but  also  among  us  indications  ap- 
pear of  an  increased  interest  for  a thorough  investigation  of  our 
knowledge  and  for  the  good-will  to  join  actively  in  the  development 
of  our  school.  But,  above  all,  after  a period  of  hopeless  decline,  we 
are  inspired  with  the  consciousness  that  we,  as  Homoeopaths,  need 


HISTORY  OF  HOMOEOPATHY  IN  GERMANY. 


123 


not  care  whether  we  are  acceptable  to  others,  nor  how  we  might 
make  ourselves  agreeable  to  them,  but  that  we  may  expect  to  be 
asked  for  advice,  for  we  consider  ourselves  the  standard  bearers  of 
medical  progress,  so  long  as  we  remain  true  disciples  of  our  Master, 
who  held  up  to  his  contemporaries  the  warning  and  admonition  : 
Aude  Sapere  ! 

Discussion. 

The  Chairman  : This  address  will  be  discussed  by  Dr.  Dake. 

Dr.  Dake  : I want  to  say  that  I am  exceedingly  sorry  that  Dr. 
Villers  was  prevented  from  being  here  to  read  this  paper  himself.  I 
had  the  pleasure  of  meeting  him  two  years  ago,  and  know  that  he 
would  be  a very  interesting  member  in  this  Congress.  We  are  glad 
to  hear  something  of  Homoeopathy  in  that  country ; we  are  glad  of 
these  notes  of  progress  and  to  be  assured  that  our  cause  is  living  and 
growing  there.  A few  years  ago  I made  the  acquaintance  of  a phy- 
sician of  our  school  who  told  me  that  the  greatest  trouble  they  had 
in  Germany,  and  I believe  in  other  European  countries,  has  been  the 
control  of  the  surgical  staff  of  the  army.  They  like  to  dominate 
and  they  do  dominate,  and  so  Homoeopathy  has  a poor  chance  to 
progress  compared  with  what  it  has  in  America.  They  won’t  give 
them  a charter;  they  cannot  have  a school  of  their  own  to  educate 
men  in  their  own  way;  they  have  to  go  through  the  mill  of  the  Old 
School,  with  its  autocratic  methods,  and  hence  are  laboring  under 
difficulties;  and  they  have  our  sympathies. 

Dr.  Fisher,  of  Sydney,  Australia  : A^ery  many  of  the  older  men, 
and  at  that  time  the  most  scientific  men  of  Germany,  were  charmed 
with  Homoeopathy,  for  Hahnemann’s  language  was  strong,  power- 
ful, and  good.  At  the  Berlin  University  Homoeopathy  was  flour- 
ishing. Chairs  of  Homoeopathy  were  established  even  in  Heidel- 
berg. We  are  not  allowed  to  establish  colleges  for  ourselves  ; there- 
fore Homoeopathic  colleges  under  that  name  are  few,  but  I have  just 
been  travelling  over  Germany,  and  Homoeopathy  has  not  diminished. 
The  Allopath  adopts  most  of  our  views,  though  not  under  the  name 
of  Homoeopathy.  Every  pharmacy  in  Germany  and  in  Prussia  is 
obliged  to  keep  a Homoeopathic  department,  under  the  supervision 
of  the  government.  The  book  on  therapeutics,  published  by  Schwabe, 
of  Leipsic,  has  done  a great  deal  of  good,  and  I am  astonished  it  has 
not  been  translated  into  English  ; it  gives  every  disease  and  its  treat- 
ment, and  has  induced  many  to  make  further  investigation  into  Ho- 
moeopathy. 

The  Congress  adjourned  until  the  following  morning  at  10.30  a.m. 

The  Sections  in  Surgery  and  in  Ophthalmology,  Otology,  and 
Laryngology  held  separate  sessions  at  3 p.m.  and  at  8 P.M.,  at  which 
numerous  valuable  papers  were  presented  and  discussed.  (See  the 
reports  on  these  subjects.) 


124 


world’s  homoeopathic  congress. 


THIRD  DAY’S  SESSION. 

June  1,  1893. 

The  Congress  reconvened  at  10.30  a.m.  Chairman  Mitchell  pre- 
siding. 

Upon  motion,  the  hour  of  meeting  for  Friday  morning  was  changed 
from  10.30  to  11.30. 

The  Chairman:  The  Address  of  Dr.  T.  F.  Allen,  of  New  York 
city,  on  “ The  Selection  of  the  Homoeopathic  Remedy,”  is  now  in 
order. 

Dr.  Allen  addressed  the  Congress  as  follows  : 


THE  SELECTION  OF  THE  HOMOEOPATHIC  REMEDY.  125 


ADDRESS. 

THE  SELECTION  OF  THE  HOMCEOPATHIC  REMEDY. 

By  Timothy  Field  Allen,  M.D , New  York,  N.  Y. 


The  method  of  selecting  the  Homoeopathic  remedy,  promulgated 
by  Hahnemann,  required  that  the  effects  of  the  drug  selected  should 
correspond  as  closely  as  possible,  both  in  number  and  in  character, 
to  those  of  the  patient.  This  rule,  requiring  Homoeopathists  to  study 
the  totality  of  the  symptoms  of  the  patient,  must  certainly  be  re- 
garded as  a safe  one  in  practice,  and  a rule  which  must,  in  many 
cases,  be  carefully  followed ; but,  as  Homoeopathic  therapeutics  has 
developed  and  its  practice  extended,  we  see  that  this  rule  is  usually 
disregarded,  and  that  some  who  have  endeavored  to  apply  it,  have 
abandoned  the  practice  of  Homoeopathy,  as  too  difficult  or  too  labor- 
ious to  be  followed  in  ordinary  prescribing,  or  have  resorted  to  the 
use  of  polypharmacy. 

The  obstacles  to  the  application  of  the  rule  requiring  a totality  of 
the  symptoms  should  receive  careful  attention.  They  seem  to  be  : 

First.  The  exigencies  of  business.  It  is  practically  impossible  for  a 
physician  to  apply  this  rule  and  prescribe  for  many  patients  in  a day. 
Even  Hahnemann  himself,  it  is  said,  was  not  only  a careful  prescriber, 
but  usually  a somewhat  rapid  prescriber,  and  it  seems  probable  that 
he  did  not,  in  a majority  of  instances,  apply  this  method.  Since  his 
time,  it  has  been  observed  that  the  greatest  prescribers  our  school  has 
known  have  been  very  rapid  prescribers.  This  was  notably  the  case 
with  the  late  Dr.  Lippe,  of  Philadelphia,  who  is  said  to  have  been 
one  of  the  most  accurate  as  well  as  one  of  the  most  rapid  prescribers 
in  the  world. 

Second.  The  difficulty  in  applying  Hahnemann’s  rule  of  totality 
is  frequently  noticed  in  the  lack  of  a complete  development  of  essen- 
tial symptoms  in  individuals,  especially  in  epidemics ; and  it  often 
happens  that  the  proper  prescription  in  a given  case  must  be  based 


126 


world’s  homoeopathic  congress. 


upon  additional  symptoms  observed  in  other  somewhat  similar  cases 
of  the  prevailing  type  of  disease. 

Third.  The  difficulty  in  applying  the  totality  is  nowhere  so  much 
experienced  as  in  the  imperfection  of  our  symptomatology,  due  partly 
to  the  fact  that  the  provings  are  insufficient  in  number  to  develop 
a complete  parallel  to  the  case  in  hand,  or  to  the  fact  that  the  provers 
have  carelessly  observed  and  imperfectly  recorded  their  symptoms. 
Incomplete  symptoms  may  be  said  to  be  the  rule  in  our  materia 
medica. 

The  above  practical  difficulties  to  the  application  of  Hahnemann’s 
rule  should  lead  to  a revision  in  methods  of  teaching,  of  study,  and 
of  the  application  of  our  materia  medica.  Fortunately,  other  methods 
are  available  for  many  cases,  and  must,  sometimes,  be  resorted  to.  To 
these  I briefly  call  your  attention. 

First.  The  impressionist  method — for  I can  call  it  by  no  better 
name.  A physician  who  has  studied  well  the  development  of  the 
pathogeneses  of  any  drug,  will  obtain  a more  or  less  clear  idea  of 
its  sphere  of  action,  and  of  its  peculiarities,  which  will  produce  an 
impression  apart  from  the  memorizing  of  individual  symptoms. 
Thus,  the  study  of  the  potashes  produces  a general  impression  of 
salts  which  give  rise  to  depression  and  paralysis,  without  febrile  ex- 
citement, with  great  sensitiveness  to  cold,  a general  impression  of 
sharp  pains,  of  catarrhal  affections,  and  with  secretions  varying  in 
quantity  in  the  different  salts  rather  than  in  character,  etc.  One  who 
studies  Aconite  obtains  a lasting  impression  of  mental  and  physical 
distress,  restlessness,  sometimes  with  profound  cardiac  weakness,  at 
other  times  with  violent  neuralgia,  but  always  a picture  of  anxiety 
and  distress;  and  so  on,  through  the  Materia  Medica.  These  im- 
pressions of  drugs,  derived  from  a study  of  their  provings  or  cases 
of  poisoning,  are  of  the  greatest  value,  especially  in  the  treatment  of 
patients  who  cannot  relate  their  symptoms,  such  as  children,  or  insane 
people,  or  those  in  delirium  ; and  a drug  may  be  prescribed  from 
such  vivid  impressions,  even  when  the  symptoms  may  not  be  known 
to  correspond  with  those  of  the  drug;  sometimes,  it  seems  as  though 
a correspondence  of  isolated  symptoms  was  a matter  of  very  little 
consequence,  so  long  as  the  general  characteristic  indications  for  the 
drug  are  present.  Some  of  the  most  brilliant  prescriptions  I have 
ever  known  have  been  made  by  this  method,  and  our  knowledge  of 
the  sphere  of  the  curative  power  of  the  drug  may  thereby  be  greatly 


THE  SELECTION  OF  THE  HOMOEOPATHIC  REMEDY.  127 


extended.  It  is  a method  to  be  used  only  by  a master  of  our  art, 
and  if  used  carelessly  it  leads  to  disaster  and  failure. 

A second  method  is  the  key-note  system.  A physician  selects 
one,  or  two,  prominent,  distressing  or  peculiar  symptoms  in  a patient, 
which  he  takes  to  be  characteristic,  and  bases  his  prescription  upon 
them.  It  may  be,  perhaps,  a single  symptom  which  suffices  to  in- 
dicate the  remedy.  This  method,  carelessly  followed,  will  lead  either 
to  the  removal,  one  by  one,  of  the  isolated  symptoms,  without  any 
marked  effect  upon  the  totality  of  the  symptoms,  or,  the  selection  is 
apt  to  be  faulty,  and  the  symptom  taken  as  characteristic,  or  a key- 
note, proves  not  to  be  one  about  which  cluster  the  majority  of  the 
patient’s  symptoms,  or  even  of  those  of  the  drug;  all  this  may  lead 
to  discouragement,  and  to  the  selection  of  different  remedies  for  dif- 
ferent symptoms,  to  alternation,  or  to  polypharmacy. 

Right  here  I would  like  to  say  a few  words  about  the  selection  of 
keynotes,  for  it  seems  to  me  that  sometimes  this  method  judiciously 
applied  may  lead  to  most  important  results.  Its  proper  application, 
however,  depends,  in  my  opinion,  upon  a thorough  appreciation  of 
the  pathological  nature  of  the  disease  from  which  the  patient  is  suf- 
fering. This  may  sound  heterodox,  but  I thoroughly  believe  that 
the  relative  value  of  symptoms  can  only  be  appreciated  by  a knowl- 
edge of  the  special  pathology  of  the  patient. 

If  you  will  permit  me  to  illustrate,  I will  take  the  familiar  ex- 
amples of  the  Homoeopathic  treatment  of  epilepsy  on  the  side  of 
symptomatology  and  of  chronic  degeneration  of  the  kidney  from  the 
point  of  view  of  pathology.  In  properly  apprehending  and  classi- 
fying the  symptoms  for  the  cure  of  epilepsy,  very  small  account 
should  be  made  of  the  immediate  symptoms  of  the  paroxysm  : to  be 
sure,  this  explosion  or  fit  enables  one  to  make  the  diagnosis  of  epi- 
lepsy, and  without  these  symptoms  the  disease  could  scarcely  be 
diagnosticated ; but  really  these  symptoms  are  of  little  or  no  value 
in  the  selection  of  the  Homoeopathic  remedy.  Their  development 
depends  usually  upon  a more  or  less  chronic  cachexia  which  under- 
lies and  determines  the  disease.  A condition  of  malnutrition  or,  if 
you  will,  of  psoric  taint  which  has  been  inherited  or  acquired,  which 
may  have  been  of  slow  development,  which  must  be  studied,  and 
from  which  only  will  one  be  enabled  to  obtain  indications  for  the 
remedy  which  will  remove  it.  The  Homoeopathic  physician  who 
attempts  to  get  his  keynote  from  the  character  of  the  spasm  will  fail 


128 


world’s  homceopathic  congress. 


as  a rule  to  cure  his  patient,  while  it  may  happen  that  one  or  two 
prominent  characteristics  of  the  patient,  derived  from  its  cachexia, 
will  enable  a physician  to  select  the  curative  remedy. 

In  chronic  kidney  disease  we  find  also  a history  of  ill-health  pre- 
ceding the  development  of  the  kidney  trouble,  but  this  condition  be- 
comes modified  by  the  development  of  the  kidney-lesion,  owing  to 
the  fact  that  the  disease  of  the  kidney  itself  gives  rise  to  a series  of 
secondary  modifications  of  health,  which  have  nothing  to  with  the 
prodromal  symptoms  which  determine  the  development  of  this  kid- 
ney lesion.  A correct  understanding  of  the  kidney  disease  and  of 
its  effect  upon  the  entire  organism  becomes  necessary  in  order  to 
separate,  as  far  as  possible,  these  later  developments  from  the  earlier 
determining  and  essential  features  of  the  diseased  condition  of  the 
patient,  which,  alone,  will  furnish  the  characteristic  symptoms  from 
which  to  select  the  curative  remedy,  and  one  who  bases  his  prescrip- 
tion upon  these  later  developments  from  the  kidney  trouble,  will 
only  succeed  in  palliating  his  patient,  because  the  essential  disease 
determines  the  continuance  of  the  original  trouble. 

This  difficulty  in  selecting  characteristic  symptoms  is  not  infre- 
quently observed  in  the  treatment  of  violent  or  acute  diseases,  es- 
pecially zymotic  diseases. 

I presume  it  will  be  accepted  by  most  of  my  hearers  that  persons 
in  vigorous  health,  whose  vitality  is  high,  whose  tissues  are  well 
nourished,  and,  in  consequence,  whose  resistance  to  disease  is  at  the 
maximum,  will  rarely,  if  ever,  contract  contagious  or  miasmatic  dis- 
eases. These  germs,  which  are  ever  about  us,  are  ready  to  seize 
upon  individuals  of  a lower  condition  of  vitality,  and  which  will  at- 
tack and  flourish  in  a vitiated  constitution,  can  be  expelled  from  the 
system  only  by  the  restoration  of  the  system  to  its  normal  condition 
of  resistance.  So  that,  it  is  clear,  that  in  some  cases  at  least  we 
must,  in  order  to  arrest  the  progress  of  the  disease,  look  beyond  the 
immediate  development  of  the  symptoms  of  the  acute  disorder  to  the 
underlying  and  predetermining  ill-health  of  the  patient,  and  seek 
therein  the  characteristics  which  must  determine  the  selection  of  the 
remedy,  and  the  physician  to  be  successful  must,  for  a time  at  least, 
cease  the  attempt  to  palliate  the  immediate  distressing  symptoms  by 
the  administration  of  the  curative  remedy. 

These  and  other  considerations  which  might  be  mentioned,  did 
time  permit,  lead  me  to  the  belief  that  reliance  upon  a single  symp- 


THE  SELECTION  OF  THE  HOMCEOPATHIC  REMEDY.  129 


tom,  or  even  upon  a few  isolated  symptoms,  is  apt  to  lead  the  pre- 
scriber  into  discouragement,  and  while  it  must  be  admitted  that  sin- 
gle,  distressing  symptoms  must  at  times  be  prescribed  for,  in  order 
to  give  relief  to  the  patient  (parenthetically,  it  may  be  remarked 
that  the  greatness  of  the  Homoeopathic  law  is  illustrated  by  the  fact 
that  it  enables  one  to  relieve  distressing  manifestations  of  diseases 
without  being  able  radically  to  cure  apparently  hopeless  and  incura- 
ble diseases),  yet  we  are  obliged  to  deprecate  the  habitual  selection 
of  supposed  keynotes  or  characteristic  symptoms  as  a basis  for  a 
proper  Homoeopathic  prescription. 

The  third  method  which  may  he  resorted  to  is  the  method  of 
Boenninghausen,  which  was  evidently  appreciated  and  used  by  Hah- 
nemann himself,  and  which  has  stood  the  test  of  a great  many  care- 
ful prescribes  from  that  time  to  the  present.  It  consists  essentially 
in  the  selection  from  the  symptoms  of  the  patient  and  from  the 
symptoms  of  the  drug  of  the  elements  of  symptoms,  rather  than  of 
the  symptoms  themselves.  It  may  be  said  that  a complete  symptom 
should  consist  of  a sensation,  a locality  and  a modality  (or  condition 
of  aggravation  or  amelioration),  and  it  is  noticed  in  the  study  of 
drugs,  as  well,  indeed,  as  in  the  study  of  the  symptoms  of  patients, 
that  certain  sensations,  like  cuttings  or  tearings,  are  apt  to  appear  in 
various  parts  of  the  body,  and  are  apt  to  appear  in  various  provers,. 
sometimes  becoming  quite  a characteristic  feature  of  the  provings  of 
any  given  drug.  The  same  thing  may  also  be  said  of  locality.  Many 
drugs  have  their  favorite  localities  in  which  symptoms  of  various 
sorts  are  apt  to  develop,  and  this  remark  is  still  more  applicable  to 
modalities.  Drugs  have  their  peculiar  times  or  other  conditions  of 
aggravation  or  amelioration,  and  the  modalities  of  a patient  are  very 
apt  to  be  constant,  not  only  for  one  sensation  and  locality,  but  for  all 
sensations  and  for  all  localities  affected.  Thus,  a Bryonia  patient 
complains  of  being  made  worse  by  motion  in  every  part.  Lycopo- 
dium symptoms  are  very  apt  to  occur  at  4 o’clock  in  the  afternoon, 
whether  there  be  pains  in  the  hips  or  distress  in  the  stomach  or  feb- 
rile excitement.  The  Nux  vomica  patients  are  worse  in  the  morning 
and  directly  after  eating  ; the  Sulphur  patients  are  worse  at  night — 
all  sorts  of  things  are  worse  at  night,  etc. 

Illustrations  might  be  multiplied,  but  students  of  Materia  Medica 
are  sufficiently  well  aware  of  these  facts,  and  it  is  unnecessary  to 

9 


130  world’s  homceopathic  congress. 

dwell  upon  them.  Boenninghausen  states  that  the  Materia  Medica 
ought  to  be  studied  in  this  way ; that  the  prevailing  modalities 
should  be  noted,  and  also  the  prevailing  sensations  and  localities. 
But  he  complains,  as  we  all  have  complained,  that  the  symptoms  are 
imperfectly  recorded,  and  in  many  cases  the  provings  are  so  insuffi- 
cient in  number  that  our  fragmentary  knowledge  must  be  supple- 
mented by  clinical  observation,  and  asserts  that  many  of  the  imper- 
fectly recorded  symptoms  may  be  filled  out  by  clinical  observations 
of  the  curative  effects  of  the  remedy.  He  therefore  combines  thera- 
peutics with  the  Materia  Medica  in  his  “ Pocket-book.”  He  then 
studies  the  patient  from  this  three-fold  point  of  view,  obtaining  the 
chief  modalities,  sensations  and  locations,  recombining  them  in  a 
drug  which  has  the  prominent  features  of  all  three  essentials  ; thus, 
for  a tearing  pain  in  the  left  hip,  aggravated  during  rest,  he  would 
select  Lycopodium,  not  because  Lycopodium  has  ever  developed 
such  a symptom  in  its  provers,  for  it  never  has ; but  because  it  ought 
to,  and  doubtless  will  in  some  future  prover,  because  Lycopodium 
produces  prominently  “ tearing  pains  ” in  various  parts  of  the  body, 
it  affects  the  left  hip  most  prominently,  and  its  general  symptoms 
are  mostly  relieved  by  motion ; therefore,  he  recombines  these  three 
essentials  of  Lycopodium  and  manufactures  a new  symptom  for  Ly- 
copodium. This  removes  the  sciatica,  it  may  be,  and  secures  a new, 
verified,  clinical  symptom. 

We  must  all  acknowledge  that  in  the  present  incomplete  condition 
of  our  Materia  Medica,  and  for  many  years  to  come,  perhaps  for 
generations,  clinical  experience  must  be  a decided  factor  in  our  thera- 
peutics, especially  when  based  upon  well-recognized  Homoeopathic 
principles.  I say  “ Homoeopathic,”  because  it  seems  to  me  perfectly 
fair  and  legitimate  to  study  drugs  according  to  Boenninghausen’s 
methods,  and  to  supplement  our  fragmentary  knowledge  by  our 
clinical  experience  and  observations. 

This  is  a matter  for  an  interesting  discussion,  and  to  which,  it 
seems  to  me,  time  can  profitably  be  devoted ; namely,  how  far  we 
are  justified  in  taking  the  elements  of  our  symptomatology  instead  of 
the  fully  developed  symptoms  themselves,  and  prescribe  from  these 
elements  with  the  almost  certain  assurance  that  complete  provings 
will  develop  the  missing  symptoms  of  the  drug. 


THE  SELECTION  OF  THE  HOMOEOPATHIC  REMEDY. 


131 


Discussion. 

The  Chairman  : Dr.  Conrad  Wesselhoeft  will  discuss  this 
paper. 

Dr.  Wesselhoeft:  Mr.  President,  Ladies  and  Gentlemen : Dis- 
cussion means  criticism.  Some  people  think  that  criticism  means 
fault-finding.  It  is  nothing  of  the  kind.  If,  therefore,  I discuss 
this  paper  it  is  merely  to  say  that  I have  nothing  to  add  to  it,  noth- 
ing to  take  from  it,  but  to  express  my  full  accord  with  it  and  the  way 
in  which  it  was  written.  It  is  a paper  which  well  deserves  reading 
over  carefully.  It  is  the  multum  in  parvo.  It  embraces  all  the  most 
important  principles  involved  in  our  selection  of  remedies.  I hope 
that  when  it  is  printed  you  will  all  study  it  carefully  for  you  will 
find  a great  deal  more  in  it  than  you  can  possibly  catch  in  the  rapid 
delivery  necessary  here.  If  I say  anything  about  it  it  will  merely 
be  to  supplement  and  explain,  perhaps,  a few  points  of  the  paper. 
We  attach,  in  our  selection  of  a remedy,  too  much  importance  to  the 
words  used  by  the  prover.  I never  read  through  a proving  in  my 
life  that  I did  not  see  the  difficulty  of  understanding  exactly  what 
the  prover  meant,  especially  if  I had  been  fortunate  enough  to  have 
proved  the  medicine  myself.  I then  saw  the  enormous  difficulty  in 
expressing  exactly  the  same  thing.  I might  have  felt  the  same  thing, 
others  might  have  felt  it,  but  the  words  which  express  it  are  very 
inadequate  to  convey  the  actual  meaning  and  it  is  very  difficult  to 
do  so.  Something  may  be  expressed  in  a variety  of  words  used  by 
the  English  or  any  other  language,  and  I think  that  all  of  us,  when 
we  select  a remedy,  do  so  by  an  intuitive  knowledge  of  it,  that  we 
acquire  by  reading  not  only  the  words  but  the  meaning  between  the 
lines.  We  sympathize  with  the  prover  and  put  ourselves  in  his 
place,  as  we  do  in  the  place  of  the  patient  sick  in  bed.  We  doctors 
do  not  always  get  credit  for  feeling  a great  deal  of  sympathy,  and 
the  doctor  who  weeps  over  his  patient  has  the  credit  of  being  very 
sympathetic,  while  one  who  listens  attentively  to  the  patient  is  said 
to  be  inattentive  and  unsympathetic  when  he  is,  perhaps,  the  most 
sympathetic,  because  he  is  digesting  what  the  patient  says,  and  feel- 
inginhisown  life  the  sickness  of  the  patient,  and  interpreting  it 
with  regard  to  the  Materia  Medica.  Our  knowleege  then,  of  the 
Materia  Medica  and  our  ways  of  selecting  medicine  are  often  intui- 
tive and  not  fairly  expressed  in  words ; hence,  as  Dr.  Allen  says, 
rapid  prescribing  is  that  intuitive  prescribing  which  arises  from  a 
clear  conception  and  sympathy  with  not  only  the  words  of  the  book, 
but  the  meaning  of  the  remedy  applied  to  the  case.  I do  not  believe 
I can  make  myself  perfectly  understood  to  you,  especially  to  the 
younger  members  ; but  those  who  have  puzzled  over  cases  must  have 
felt  that  rapid  prescribing  is  often  intuitive  and  not  to  be  explained 
in  words.  At  the  same  time  I do  not  want  to  encourage  it.  I do 
not  want  to  say  that  it  is  the  proper  way  to  do.  It  is  best  to  be 


132 


world's  homoeopathic  congress. 


very  careful  about  it  and  not  allow  our  intuitions  to  run  away  with 
us.  Intuition  should  not  take  the  emotional  form  entirely  it  should 
be  governed  by  reason  and  intellect  in  the  end,  and  for  that  we  have 
no  better  means  than  the  study  of  the  wards  of  the  provings.  This 
is  merely  with  regard  to  rapid  prescribing.  In  regard  to  keynotes 
it  applies  to  that  and  is  intended  to  cover  that  ground  and  to  supple- 
ment something  of  Dr.  Allen's  paper  in  which  I concur  most  fully. 

A word  more  about  Boenninghausen's  Repertory.  People  say  to  me 
often,  “ What  do  you  think  of  it?  " I have  known  it  ever  since  I was 
a boy.  It  has  been  in  our  family  long  before  I studied  medicine.  I 
value  it  as  highly  as  1 ever  did,  and  I value  it  all  the  more  because 
I now  understand  it..  I see  its  uses,  and  its  faults.  The  faults  are, 
as  Dr.  Allen  has  told  you,  in  the  imperfections  of  the  Materia 
Medica ; not  in  the  principles  upon  which  the  book  was  composed 
and  written.  I think  the  principle  underlying  the  method  of  ar- 
rangement of  the  book  is  one  of  the  best  if  not  the  best  in  our  Hom- 
oeopathic literature.  He  gives  generalities.  He  leaves  out  details, 
as  Dr.  Allen  has  told  you,  and  as  you  know  by  the  book — as  you 
are  acquainted  with  it.  He  gives  you  conditions  and  aggravations  ; 
the  time,  place,  condition, under  which  aggravations  take  place.  Those 
are  very  important  things.  Those  are  the  very  things  which  come 
intuitively  in  our  selection  of  a remedy,  and  which  if  taken  into 
consideration,  allow  us  to  make  rapid  prescription.  But  the  faults 
of  the  book  lie  in  the  imperfections  of  the  Materia  Medica. 

Boenninghausen  has  a very  valuable  preface  to  that  book  which 
every  one  should  read..  I had  the  book  in  my  office  for  years  before 
I ever  read  the  preface  to  it  and  I made  a great  mistake.  Although 
Boenninghausen  recognizes  the  incompleteness  of  the  Materia  Med- 
ica, he  did  not  know  exactly  where  the  incompleteness  was,,  nor  ex- 
actly how  to  get  over  it.  He  considered  a great  many  things  in  it  as 
facts  which  to  us,  to-day,  do  not  appear.  We  cannot  demonstrate 
them  as  facts.  For  instance,  he  will  say  in  one  place — I cannot  find 
a very  good  example  but  I will  make  one  for  illustration — say,  Pul- 
satilla, or  the  symptoms  of  aggravation  at  night.  He  will  give  half 
a page  of  medicines  printed  in  different  types,,  some  emphasized  by 
black  types  and  other  forms,  indicating  his  preference  for  certain 
medicines  or  for  aggravations  at  night,.  You  turn  over  the  book 
and  you  stumble  across  that  same  list  of  medicines  under  the  head 
of  “ improvements  in  the  morning."  That  occurs  very  often.  It  is 
a deduction  and  general  conclusion  of  his,,  which  does  not  arise  from 
the  Materia  Medica,  but  which  are  merely  conclusions  which  he 
thinks  he  is  warranted  in  making,  i.e.,  aggravations  at  night  must 
have  improvement  in  the  morning.  It  doesn't  follow  at  all.  Look 
it  over  in  the  Materia  Medica  and  you  will  find  it  difficult  yourself. 
That  is  an  imperfection  in  the  book  which,  is  misleading,  and  those 
who  take  books  as  inspired  and  unalterable  make  a mistake.  There 


THE  SELECTION  OF  THE  HOMOEOPATHIC  REMEDY.  133 


is  nothing  absolute  in  our  knowledge  of  Materia  Medica  and  I hope 
in  the  futnre  editions  of  Boenninghausen  the  Materia  Medica  will  be 
more  carefully  sifted  before  medicines  are  printed  with  capitals,  and 
italics,  and  common  types,  to  give  the  reader  the  impression  that  these 
are  absolute  medicines  and  that  there  is  no  doubt  about  the  value  of 
these  symptoms.  Those  are  the  imperfections  of  the  book  arising 
from  imperfections  of  the  Materia  Medica  and  too  great  faith  in  the 
result  of  provings  which  are  imperfect. 

I merely  want  to  call  your  attention  and  make  a plea  in  a few 
words  for  the  method  of  finding  out  how  the  value  of  provings 
should  be  determined.  One  swallow  does  not  make  a summer,  one 
proving  by  one  prover  is  almost  worthless  except  to  him  who  has  a 
great  deal  of  knowledge  on  the  subject  The  principle  of  modern 
science  is,  that  to  determine  a fact  and  get  at  the  root  of  a thing  a 
great  many  observations  must  be  made.  The  result  of  these  obser- 
vations must  be  compared,  whether  it  is  in  mechanical  science,  elec- 
trical science,  engineering  science,  in  physiology  or  in  anatomy. 
Numerous  facts  must  be  brought  up  before  anybody  can  attach  the 
slightest  importance  to  them.  Fifty  years  ago  one  fact  stated  posi- 
tively by  one  man  was  a law.  That  method  is  played  out.  We 
have  got  to  have  provings  by  a good  many  intelligent  persons,  and 
these  must  be  compared,  and  with  the  greatest  care ; that  which  is 
incongruous  set  aside  in  preference  to  that  in  which  the  provings 
agree.  That  is  the  method  which  I wish  to  impress  upon  you.  The 
words  of  a proving  may  be  the  same,  and  yet  mean  different  things ; 
but  by  that  intuitive  knowledge  which  we  acquire  by  a long  prac- 
tice of  reading  provings,  as  well  as  by  studying  our  patients,  we 
may  find  them  of  great  service. 

The  Chairman:  The  address  will  be  further  discussed  by  Dr. 
A.  W.  Hinman,  of  Dundee,  Illinois. 

Dr.  Hinman  : Ladies  and  Gentlemen : When  such  a gentleman 
as  Dr.  Allen  comes  before  us  and  makes  the  statement  that  we  have 
incomplete  provings,  it  is  evident  to  me  that  there  is  something 
wrong.  There  have  been  times  in  my  practice  that  I have  asked 
myself:  “Do  I know?  Is  there  a certainty  that  I am  using  the 
best  means  for  my  patients  ? ” Then  when  Dr.  Wesselhoeft  says 
nothing  to  the  contrary,  and  we  find  it  a fact,  doesn’t  it  seem  that 
we  ought  to  do  something  to  remedy  this  deficiency?  Isn’t  there 
some  way  by  which  we  can  have  our  remedies  reproved  and  brought 
up  to  a standard  of  certainty  from  some  scientific  standpoint?  It 
seems  to  me  that  we  are  wasting  time,  and  if  Samuel  Hahnemann 
were  here  to-day,  he  would  say,  “Gentlemen,  what  in  the  world  are 
you  doing?”  We  could  not  erect  a monument  to  Samuel  Hahne- 
mann that  would  be  more  telling  than  to  get  right  down  and  have  a 
corps  of  men  here  who  are  steadily  proving  remedies  that  should 
become  authoritative — that  we  could  stand  upon.  It  would  be  cor- 


134 


world’s  homoeopathic  congress. 


roborative  of  what  Hahnemann  has  done.  For  the  Lord’s  sake 
let’s  do  something.  Let’s  go  into  our  pockets  and  get  a corps  of 
men.  We  have  to  pay  men  to  work  in  these  days.  They  don’t 
work  in  the  same  way  Samuel  Hahnemann  did.  He  worked  for 
the  love  he  had  in  it.  He  had  something  to  work  at,  and  the  mass 
of  us  cannot  afford  to  work  the  way  he  did.  He  was  a trained  ob- 
server. We  want  men  that  are  trained,  and  that  will  become  more 
and  more  trained  as  they  work  at  it.  It  seems  to  me  that  something 
could  be  done  in  this  matter.  We  have  seven  hundred  or  eight 
hundred  physicians  here  recorded,  and  the  basis  of  their  work  is  the 
Materia  Medica.  I don’t  care  what  ology  they  belong  to,  or  what 
particular  department;  they  are  prescribing  every  day  and  depend- 
ing on  this  thing,  and  still  there  is  something  that  is  incomplete. 
Let  us  eradicate  that  thing,  and  get  down  to  some  basis  where  we 
can  say  it  is  a certainty  as  far  as  possible. 

The  Chairman  : Dr.  Allen  will  close  the  discussion. 

Dr.  Allen  : Mr.  Chairman,  I am  glad  of  the  opportunity  of 
saying  an  additional  word,  partly  in  the  line  of  the  gentleman  who 
has  just  spoken,  for  he  has  woke  us  up.  I want  to  ask  this  question 
of  you  all:  What  are  you  doing  about  Materia  Medica?  Are  you 
working,  or  are  you  playing  billiards  or  doing  surgery  or  some  other 
sort  of  specialty  besides  materia  medica?  Every  member  of  the 
Homoeopathic  School  is  a specialist  in  Homoeopathy  and  in  Thera- 
peutics, but  I doubt  if  one  physician  in  a hundred  in  this  country 
does  any  systematic  work  in  Materia  Medica.  The  workers  in  Ma- 
teria Medica  are  so  very  few  we  can  count  them  on  our  fingers,  and 
you  howl  at  us  for  not  giving  you  a perfect  Materia  Medica.  You 
can’t  have  it  in  a thousand  years.  It  is  impossible.  What  you 
must  do  is  to  study,  and  you  don’t  do  it.  Now  I am  scolding.  If 
every  one  of  you  men  and  women  would  take  an  hour  or  half  an 
hour  or  fifteen  minutes  a day,  and  take  the  Cyclopaedia  of  Drug 
Pathogenesy , and  go  through  one  proving  after  another,  and  take  a 
few  minutes  at  any  conclusion  of  Symptomatology  which  is  reliable 
like  the  Cyclopaedia , and  mark  down  those  three  points,  you  would 
be  doing  something.  Select  a drug,  and  study  that  till  you  get 
through  with  it.  Do  you  know  anything  about  Eupian,  which  the 
gentleman  spoke  about?  and  I was  delighted  to  hear  it,  for  I was 
waiting  to  hear  of  that.  Read  that  through,  and  mark  down  if  there 
are  any  conditions  of  aggravation  at  night ; mark  down  those  three 
points  which  Boenninghausen  emphasized.  That  is  the  way  I have 
to  do  it.  I have  a little  card  which  I can  carry  in  my  pocket,  and 
I note,  “Conditions,  so  and  so,  with  such  and  such  pains;  burning 
pains  in  such  and  such  localities.”  I have  that  in  my  mind,  and  I 
am  ready  for  the  patient  that  Eupian  belongs  to,  and  the  next  week 
take  something  else  and  do  it ; but,  for  Heaven’s  sake,  do  some  work  ! 
Why  it  seems  to  me  as  though  members  of  the  American  Institute 


THE  SELECTION  OF  THE  HOMOEOPATHIC  REMEDY. 


135 


and  the  Homoeopathic  School  just  waited  for  half  a dozen  of  us  to 
cut  up  your  food  and  put  it  into  your  mouths.  That  won’t  do.  You 
owe  a little  more  than  that  to  your  patients.  You  make  your  living 
and  reputation  out  of  it ; so  do  some  work  in  it ! 

The  Chairman  : The  next  business  in  order  is  an  address  upon 
“ Homoeopathy  and  Public  Health,”  by  P.  Ludlam,  M.D.,  of 
Chicago. 

Dr.  Ludlam  addressed  the  Congress  as  follows ; 


136 


world’s  homoeopathic  congress. 


ADDRESS. 

HOMCEOPATHY  AND  THE  PUBLIC  HEALTH. 

By  R.  Ludlam,  M.D.,  Vice-Chairman  of  the  World’s  Homoeopathic 

Congress. 


The  public  health  is  the  counterpart  of  the  commonwealth. 
That  a system  of  medicine  which  has  sustained  itself  independently 
and  grown  in  a compound  ratio  for  a hundred  years ; which  has  its 
own  literature  and  its  schools,  its  clinics,  societies,  and  hospitals,  as 
well  as  its  pupils  and  practitioners  in  every  civilized  community,  is 
closely  related  to  the  health  of  the  people  is  self-evident.  To  doubt 
this  proposition  would  be  like  questioning  whether  Protestantism  is 
related  to  Christianity,  charity  to  benevolence,  or  the  sunlight  to  the 
evolution  of  plants  and  flowers.  If  its  recognition  were  commensu- 
rate with  its  deserts,  and  if  its  representatives  had  not  been  the  vic- 
tims of  a class-bias  that  so  far  as  possible  has  excluded  them  from 
the  army  and  the  navy,  the  hospitals  and  the  eleemosynary  institu- 
tions of  this  and  of  other  lands,  I should  have  a more  grateful 
theme  and  a better  prospect  of  pleasing  you  in  what  I have  to  say 
on  this  occasion. 

Toleration  has  been  defined  as  “ the  dogma  of  the  weaker  party.” 
If  the  reformer  did  not  insist  upon  it,  he  would  never  have  a hear- 
ing. When  he  comes  to  be  tolerate<J  within  certain  galling  limits, 
he  has  already  gained  a foothold.  From  that  time  forward  his  suc- 
cess will  depend  upon  the  merit  of  his  cause,  his  own  and  his  com- 
rades’ tact  and  persistency,  and  the  conduct  of  its  followers  when  its 
claims  have  received  the  popular  endorsement. 

I shall  speak  upon  this  latter  point,  for  the  “incomputable  perils 
of  success,”  as  Lowell  styles  them,  are  not  the  least  among  those 
which  beset  our  school  of  medicine  at  the  present  time.  Our  cause  was 
a good  one ; there  was  need  for  a change  in  the  harsh  and  harmful 
methods  of  treatment  that  were  in  vogue  in  Hahnemann’s  time.  He 


HOMOEOPATHY  AND  THE  PUBLIC  HEALTH. 


137 


was  a man  of  science,  as  science  went  in  those  days,  but,  what  was 
infinitely  more  important,  he  was  imbued  with  the  spirit  of  scientific 
doubt.  He  saw  the  defects  of  the  ancient  system,  and  set  to  work 
to  remedy  them.  To  gain  a hearing  he  must  be  aggressive.  He 
characterized  certain  therapeutical  abuses  in  such  a way  that  some  of 
his  phrases  fit  and  stick  like  the  nicknames  that  schoolboys  give  ea.ch 
other.  He  had  the  faith  and  firmness  which  are  moral  weapons  of 
an  invincible  sort.  With  a just  and  benevolent  cause,  he  felt  it  no 
crime  to  be  a dissenter  from  the  established  church  in  medicine.  He 
knew  that  “ while  the  animosities  are  mortal  the  humanities  are 
eternal,”  and  so,  through  a terrible  opposition,  he  went  forward  in 
his  chosen  work.  The  merit  of  his  cause  is  conceded  and  confirmed 
by  thousands  of  physicians  and  by  millions  of  patients  in  our  day. 
If  “the  sweetest  happiness  that  we  ever  know,  the  very  wine  of 
human  life,  comes  from  sacrifice, — from  the  effort  to  make  others 
happy/’  what  shall  we  not  say  for  our  hero  who,  greater  than  Colum- 
bus, opened  up  a new  world  in  therapeutics. 

“Necessity,”  says  Herder,  “is  the  clock-weight  that  keeps  all  the 
wheels  in  motion.”  The  early  followers  of  Hahnemann  were  forced 
to  be  on  the  alert  to  defend  their  cause,  and  at  the  same  time  to  de- 
velop its  resources.  Its  great  qualities  and  small  defects  had  to  be 
looked  after  as  one  would  take  care  of  a legacy.  It  was  a legacy, 
but  not  for  an  individual,  or  even  for  a family.  It  was  a bequest 
for  the  benefit  of  humanity  at  large,  and  for  the  public  health  and 
welfare.  The  abuse  poured  upon  the  early  Homoeopathists,  like 
that  which  was  showered  upon  the  early  ovarioto mists,  is  fast  becom- 
ing ancient  history.  It  is  so  much  easier  to  accuse  than  to  excuse 
them  that  the  fashion  is  to  revive  the  old  bitterness  whenever  their 
methods  or  their  writings  are  mentioned.  We  forget  that,  being 
placed  on  a frontier  post  of  medical  knowledge,  they  must  hold  their 
ground,  and,  if  need  be,  fight  in  its  defence.  Beset  by  furious  and 
unscrupulous  critics,  they  were  forced  to  charge  their  ink  with  gun- 
powder. In  those  days  the  controversial  papers  and  the  professional 
intercourse  of  parties  on  both  sides  abounded  in  brotherly  throat- 
cutting. Almost  every  doctor,  regular,  irregular,  and  defective,  in- 
sisted upon  giving  his  neighbor  “a  piece  of  his  mind,”  notwithstand- 
ing the  fact  that  nobody  had  any  peace  of  mind.  Old  doctors  and 
medical  students  especially  looked  at  Homoeopathy  through  the 
prism  of  their  own  prejudices.  The  medical  journals  became,  like 


138 


world’s  homceopathic  congress. 


Punch , “a  refuge  for  destitute  wit,”  and  almost  every  Old-School 
medical  society  took  up  the  contemptible  business  of  running  a 
partisan  search -light  for  the  detection  and  discipline  of  heretics. 

Under  these  circumstances,  when  their  belief  had  to  be  kept  up 
as  a police  force,  it  is  no  marvel  that  our  brethren  did  and  said  some 
very  unwise  things.  Like  the  lower  brain  centres  that  never  sleep, 
they  had  always  to  be  vigilant,  even  at  the  expense  of  being  some- 
times vindictive.  And  some  one  has  said  that  everybody  has  a little 
speck  of  fight  underneath  his  peace  and  good-will  which  he  keeps 
for  revolutions  and  great  emergencies.  In  such  a medical  upheaval 
one  must  either  fight  for  the  supremacy  of  a faction  or  for  a princi- 
ple, and  in  this  case  it  was  not  merely  a matter  of  medical  labels  and 
liveries,  but  of  deciding  so  important  a question  as  the  best  means  of 
relieving  human  suffering  and  of  curing  disease. 

How  well  our  predecessors  did  their  work ; what  kind  of  fibre 
was  in  their  faith,  and  how  they  defended  it;  how,  as  time  went  on, 
they  were  emancipated  from  controversy  and  left  to  cultivate  their 
views  and  their  peculiar  resources;  how  the. medical  world,  or  the 
best  part  of  it,  has  learned  to  treat  them  with  a decent  spirit  of  tol- 
eration that  has  finally  soaked  through  the  old  rocks  of  prejudice, 
are  matters  of  common  knowledge  in  our  day.  As  their  antagonisms 
faded  their  resources  were  economized  ; as  the  radical  and  uncompro- 
mising spirit  was  torn  down,  the  clinical  quality  took  its  place  in 
their  affections,  their  teachings,  and  their  practice. 

After  the  enthusiasm  with  which  each  discovery  is  received  come 
the  difficulties  of  application,  doubts,  and  reactions.  It  is  a false 
philosophy  which  thinks  more  of  methods  than  of  results,  as  it  is 
a spurious  Christianity  which  puts  a creed  concerning  the  insolu- 
ble matters  of  faith  above  the  mutual  duties  and  interests  of  man- 
kind. 

I think  it  was  Goethe  who  said  that  “ whatever  emancipates  our 
minds  without  giving  us  the  mastery  of  ourselves  is  destructive.” 
We  are  no  longer  engaged  in  an  uncertain  contest.  Faith  and  works, 
and  fighting  and  waiting,  have  secured  us  a hearing,  an  opportunity, 
position,  and  popularity.  But  there  is  the  rub.  Considering  what 
the  outcome  of  all  sorts  of  antagonisms,  moral  and  medical,  has 
been  ; that  those  who  gain  power  and  influence  almost  always  become 
intolerant  and  thereby  cripple  their  cause  and  compromise  their  posi- 
tion ; and  considering  that  doctors  are  subject  to  the  same  infirmities 


HOMCEOPATHY  AND  THE  PUBLIC  HEALTH. 


139 


as  statesmen,  soldiers,  and  politicians ; that,  in  this  instance  espe- 
cially, the  interests  at  stake  are  of  vital  consequence  to  the  welfare 
of  mankind,  why  should  we  not  cultivate  a larger  measure  of  pro- 
fessional toleration?  Surely  we  are  unfit  for  such  an  endowment  if 
we  fail  to  appreciate  the  responsibility  that  it  brings,  or  to  make  the 
best  possible  use  of  it  toward  keeping  our  place  in  the  line  of  the 
liberal  professions. 

In  the  far-away  Northwest  they  sometimes  have  hail-storms  that 
thresh  the  grain  in  the  field  just  before  the  harvest.  There  are  some 
over-zealous  disciples  who  act  like  a Dakota  “ twister  ” when  it  comes 
a few  days  too  soon  for  the  unlucky  farmer.  They  have  a passion 
for  a label  that  amounts  to  an  infirmity.  Like  a vulgar  relation  in 
good  society,  they  invariably  say  the  right  thing  at  the  wrong  time; 
fancy  that  they  are  still  living  in  a debatable  and  not  in  a progres- 
sive age;  are  always  looking  for  the  routes  and  resorts  of  an  enemy  ; 
and  cannot  understand  why  the  asperities  of  medicine  should  yield 
to  the  mellowing  influence  of  time  more  rapidly  than  those  of  the- 
ology have  done.  You  remember  the  old  saying  that  “ an  honest 
man  who  lacks  judgment  is  more  dangerous  that  a thief  who  has 
discretion  ; ” for  so  long  as  you  watch  the  discreet  wretch  he  cannot 
injure  you,  while  there  is  no  escape  from  the  fool  friend. 

In  the  glorious  emergency  in  which  we  are  placed,  there  are  duties 
that  draw  like  the  invisible  chains  of  gravitation.  These  duties 
pertain  to  our  fitness  and  qualification  as  physicians,  and  to  our  tol- 
erance of  those  whose  professional  views  and  opinions  differ  from 
our  own.  The  greatly  improved  facilities  for  obtaining  a sound  and 
thorough  medical  education  are  filling  the  first  of  these  requirements 
in  a most  satisfactory  manner  ; while  the  dissipation  of  the  fog  and 
mist  of  distance  and  Pharisaism  among  the  fraternity  is  doing  the 
rest. 

It  is  true  that  in  certain  quarters  we  still  are  the  victims  of  class- 
bias  and  of  class-legislation.  For  there  are  those  who  continue  to 
regard  the  representatives  of  the  New  School  of  practice  with  a 
muffled  animosity  against  which  our  only  shelter  is  the  satisfaction 
of  being  in  the  right.  But  what  concerns  us  and  those  that  believe 
with  us,  is  of  such  exquisite  importance  and  interest  that  whatever 
the  provocation  we  cannot  afford  to  quarrel  with  them  any  longer 
merely  for  the  theoretical  defense  of  our  faith.  We  must  use  our  own 
clinical  spade,  and  we  cannot  answer  for  what  will  turn  up.  If  some 


140 


world’s  homoeopathic  congress. 


of  the  old  roots  of  error,  tradition,  envy  and  unreason  are  thrown 
out  of  the  medical  field  altogether,  so  much  the  better  for  the  coming 
doctors  and  their  patients,  for  our  literature,  and  for  the  general 
reputation  of  what  used  to  be  styled,  and  should  really  become  a 
liberal  profession. 

The  position  of  Homoeopathy  in  our  charitable  institutions  is  not 
what  it  would  have  been  but  for  the  opposition  that  it  has  encoun- 
tered from  those  who  assume  to  monopolize  all  medical  knowledge. 
Nor  is  it  what  it  will  become  if  we  are  fit  and  worthy  for  the  places 
and  the  responsibilities  that  are  rapidly  falling  into  our  hands  as  a 
simple  matter  of  right  and  of  justice. 

From  those  who  will  follow  me  with  special  reports,  you  will 
have  the  detailed  proof  of  this  growing  freedom  of  medical  opinion. 
You  will  gather  the  most  encouraging  facts,  showing  that  those  who 
had  dug  a moat  around  our  school  of  medicine  to  shut  it  in  to  itself, 
and  to  shut  it  off  from  all  practical  relation  to  the  public  health, 
have  signally  failed.  The  whole  world  of  thought  and  action  is 
permeated,  but  not  saturated,  with  the  principle  of  tolerance,  and  if 
we  continue  to  watch  and  pray,  to  work  and  wait,  a full  share  of 
recognition  will  yet  be  accorded  to  us.  For  it  is  a lucky  thing  that 
the  universal  law  of  change  can  so  modify  our  views  of  liberty  and  of 
justice  that  the  right  may  finally  triumph.  The  powers  that  be  are 
a shifting  quantity,  and  this  is  an  age  of  progress. 

The  repression  of  thought  and  the  stifling  of  medical  investigation, 
except  on  certain  prescribed  lines,  is  an  antiquated  abuse  against 
which  the  spirit  of  this  age  is  in  open  revolt.  There  is  no  toleration 
in  holding  those  who  differ  from  us  in  contempt;  but  there  is  an 
under-current  of  sympathy  with  what  is  new  and  noble,  magnani- 
mous and  merciful,  of  which  we  can  take  advantage.  We  have  had 
a cycle,  or  better,  perhaps,  a cyclone,  of  that  intellectual  agitation 
which  is  the  first  step  towards  reform  ; and  now,  if  our  professional 
views  are  not  twisted,  or  too  narrow,  if  we  do  not  in  turn  become 
intolerant  and  egotistical ; if  we  can  learn  to  forget  all  but  the  ulti- 
mate end  of  our  mission  to  mankind,  and  take  advantage  of  the 
ripening  harvest,  there  is  no  reason  why  all  that  is  good  and  true  in 
Homoeopathy  should  not  be  fully  appreciated  by  the  public  at  large 
as  well  as  by  the  profession. 

The  three  factors  in  the  stupendous  reform  that  Homoeopathy  has 
wrought  were  its  intrinsic  and  relative  utility  ; the  faith  and  fidelity 


HOMOEOPATHY  AND  THE  PUBLIC  HEALTH. 


141 


of  its  early  apostles ; and  the  persistent  political  intrigue  of  its  op- 
ponents, which  was  the  daily  bread  of  the  inquisition.  It  is  enough 
to  say  that  from  the  foundation  of  the  world  these  are  the  precise 
conditions  upon  which  every  reform  that  was  worthy  of  the  name 
has  depended  for  its  evolution  and  establishment. 

Although  the  persecution  that  we  have  suffered  in  times  past  has 
been  a grievous  burden,  and  has  sometimes  put  us  at  a great  disad- 
vantage, it  really  has  been  a blessing  in  disguise.  For  while,  as 
every  Christian  must  know,  the  professional  disabilities  to  which  we 
have  been  subjected  were  indefensible  at  the  bar  of  the  Golden  Rule, 
they  were  indispensable  to  our  sturdy  growth  and  development.  The 
winds  of  opposition  have  rooted  our  tree  of  knowledge.  Left  to  our 
own  resources,  we  were  compelled  to  do  our  best  for  our  patients, 
and  for  our  branch  of  the  healing  art,  at  all  points  of  the  medical 
compass.  Hence  the  all-around  growth  of  our  school  and  the  im- 
possibility, except  here  and  there,  that  we  should  become  and  remain 
mere  fanciful  and  fractional  doctors. 

Show  us  a form  of  quackery  that  can  stand  the  clinical  test  of  ob- 
ject lessons  in  all  the  practical  branches  of  medicine  and  surgery, 
every  day  in  the  year,  and  before  thousands  of  earnest  and  intelli- 
gent pupils  and  physicians;  or  one  that  has  ever  done  first-class 
work  in  surgery,  or  in  any  of  the  specialties.  They  have  not  even 
given  the  world  that  modern  product  of  spontaneous  generation,  a 
decent  gynaecologist  t 

But  this  Congress  in  which  we  are  met  comprises  a host  of  repre- 
sentative men  and  women,  who  in  many  lands  work  as  teachers, 
authors  and  practitioners  in  every  department  of  the  medical  calling  ; 
whose  scientific  attainments  and  professional  probity,  scope,  popular- 
ity and  usefulness  are  equal  to  those  of  a like  number  of  physicians 
from  any  other  school  of  practice.  Judged  by  this  standard  and  by 
the  fruit  of  their  labor,  as  it  is  preserved  in  our  literature  and  noted 
by  the  Recording  Angel,  we  surely  do  not  deserve  to  be  classed  as 
outlaws  and  charlatans. 

Twenty-three  years  ago,  and  within  a stone’s  throw  of  this  spot, 
an  address  was  made  before  our  National  Society  which,  in  the  light 
of  recent  development,  reads  like  a prophecy.  It  sounded  a clear 
note  from  the  warm  and  royal  spirit  of  our  dear,  departed  friend, 
Hr.  Carroll  Dunham.  Liberty  of  medical  opinion  and  action  ; a vital 
necessity  and  a great  responsibility , was  a.  theme  that  was  worthy  of 
the  speaker  and  of  his  cause. 


142 


world’s  homoeopathic  congress. 


As  the  one  man  among  us  best  fitted  to  appreciate  the  peculiar 
position  in  which  we  were  about  to  be  placed ; whose  love  for  hu- 
manity and  for  his  own  calling  was  boundless  ; whose  loyalty  could 
not  be  questioned  ; whose  regard  for  the  opinions  of  others  was 
always  respectful  and  generous,  giving  every  one  credit  for  the  good 
that  was  in  him ; whose  faith  was  firm  and  steady,  not  fickle  and 
foolish  ; whose  opinion  was  worth  more  than  anybody  else’s  argu- 
ment ; whose  writings  are  neither  fierce  and  feeble,  nor  shallow  and 
worthless.  The  text  of  that  discourse  reads  like  the  Sermon  on  the 
Mount. 

“ The  time,  then,  is  passed  which  called  for  defenses  and  expositions  of  Homoeo- 
pathy, appeals  for  equal  privileges  and  protests  against  oppression.  We  stand 
henceforth  on  equal  ground  as  members  of  the  great  body  of  the  medical  profession, 
in  which  we  shall  take  rank  according  to  the  worth  of  our  work  in  the  broad  field  of 
medical  science.” 

After  a clear  statement  of  his  individual  position  on  points  of 
doctrine  that  were  mooted  then,  are  now,  and  always  will  be,  he  says : 

“Notwithstanding  this  belief,  I advocate  entire  liberty  of  opinion  and  practice. 
Nay,  because  of  this  belief,  I plead  for  liberty;  for  I am  sure  that  perfect  liberty 
will  the  sooner  bring  knowledge  of  the  truth  and  that  purity  of  practice  which  we 
all  desire. 

“ So  long  as  we  are  a body  of  physicians  characterized  by  a distinctive  name  de- 
rived from  the  law  of  cure  which  we  profess,  I suppose  that  none  will  seek  member- 
ship in  the  Institute  who  do  not  substantially  accept  the  law.  This  granted,  I would 
have  no  exclusive  creed,  no  restrictions  relating  to  theory  and  practice,  but  would 
receive  into  membership  of  the  Institute  every  applicant  of  suitable  educational  and 
moral  standing.  I deprecate  any  attempt  to  regulate  or  prescribe  the  opinion  and 
practice  of  members  of  our  school,  for  two  principal  reasons.  We  cannot  do  it  if 
we  would , and  we  ought  not  if  we  could. 

“We  cannot.  We  are  not  a body  claiming  to  possess  infallibility.  It  belongs 
not  to  us  to  utter  denunciations  of  what  we  may  believe  to  be  errors  of  faith  and 
practice  ; nor  to  put  forth  an  index  of  the  allowed  and  the  forbidden.  We  are  a 
voluntary  association  of  laborers,  simply  from  the  love  of  knowledge,  as  is  the  case 
with  all  workers  in  science;  and  we  have  no  power  to  enforce  any  restrictions  upon 
which  we  might  determine. 

“ We  ought  not.  Not  until  we  have  reached  the  absolute  truth  should  we  be  justi- 
fied in  establishing  a standard  of  faith  and  practice.  How  far  we  are  from  that 
position  need  not  be  argued  here.  Let  us  remember  the  wise  course  of  the  Bureau 
of  the  Paris  Hospitals,  when,  in  1850,  Tessier  of  St.  Marguerite,  made  known  his 
conversion  to  Homoeopathy,  and  it  was  proposed  to  deprive  him,  on  that  account, 
of  his  position  as  hospital  physician.  'J  he  wise  Chomel  opposed  the  proposition, 
saying  that  every  physician,  who  is  thoroughly  qualified  to  practice  has  the  right 
to  select  his  own  mode  of  treatment  and  to  judge  what  is  best  for  his  patients,  and 
may  not  be  interfered  with,  unless  his  results  are  notoriously  bad  or  he  commit  some 


HOMOEOPATHY  AND  THE  PUBLIC  HEALTH. 


143 


act  of  unquestionable  malpractice.  ‘For/  said  he,  ‘It  is  only  by  the  exercise  of 
this  freedom  that  changes  and  improvements  have  ever  been  introduced  in  practice; 
and  herein  lies  the  only  hope  of  further  improvements.  Tessier,  in  practicing 
Homoeopathy,  has  only  exercised  the  same  freedom  of  selection  which  Bouillaud 
and  Kayer  and  Louis  and  I have  enjoyed  and,  as  his  results  are  as  good  as  ours,  we 
may  not  interfere  with  him.’  .... 

“ Do  we  demand  liberty  of  opinion  ? Then  must  we  take  care  that  our  opinions 
rest  on  a foundation  of  study  and  acquirement  which  embraces  the  entire  circuit  of 
medical  knowledge,  and  takes  in  and  honestly  estimates  every  new  contribution  to 
it,  no  prejudice  of  place  or  person  giving  a bias  to  our  reason.  Then  must  we  act 
in  the  spirit  of  Hahnemann’s  noble  admonition  : ‘ In  a science  in  which  the  welfare 
of  mankind  is  concerned,  any  neglect  to  make  ourselves  masters  of  it  becomes  a 
crime.’  .... 

“ But  touching  the  open  questions  of  medical  opinion  and  practice — while  each 
of  us  earnestly  proclaims  the  opinions  he  has  espoused,  and  zealously  puts  them  in 
practice,  let  us  cultivate  the  catholic  and  noble  spirit  of  Chillingworth  : ‘ I will  take 
no  man’s  liberty  of  judgment  from  him,  nor  shall  any  man  take  mine  from  me.  I 
will  think  no  man  the  worse  man.’  ....  I will  love  no  man  the  less  for  differing 
in  opinion  from  me,  and  what  measure  I mete  to  others  I expect  from  them  again.’  ” 

In  the  light  of  his  leadership  and  wise  counsel  ; in  the  light  of 
what  we  have  learned  since  he  left  this  legacy  ; and  because  of  the 
great  and  growing  influence  of  our  branch  of  the  healing  art,  I 
plead  for  toleration  ; for  increased  breadth  of  culture  and  acquire- 
ment; for  the  careful  fostering  of  the  specialties;  and  for  the 
thorough  and  adequate  fitness  of  our  physicians  for  their  all-around 
duties  and  responsibilities.  These  are  the  industrial  conditions  of 
success  and  stability ; and  if  properly  and  persistently  applied  they 
will  surely  demonstrate  the  vital  relation  that  exists  between  Homoeo- 
pathy and  the  public  health. 

The  Chairman  : The  discussion  on  this  address  will  be  opened 
by  Dr.  I.  T.  Talbot,  of  Boston. 

Dr.  Talbot  : When  I was  asked  to  speak  upon  the  subject  which 
has  just  been  presented  to  you,  I did  not  feel  certain  what  there 
was  to  say,  or  what  the  direct  line  of  argument  in  that  paper  would 
be,  but  as  it  went  on  there  came  so  many  thoughts  that  I feel 
myself  equally  incompetent  to  arrange  them  in  the  way  that  they 
should  be  to  such  an  audience ; but  the  name  of  Carroll  Dunham 
and  the  memories  of  twenty-three  years  ago  certainly  thrills  the 
heart  of  every  one  who  was  present  at  that  time,  who  was  a member 
of  the  American  Institute  of  Homoeopathy,  or  who  had  an  interest 
in  this  subject.  It  was  at  a time  when  there  were  those  who  thought 
that  they  were  right  and  all  the  rest  were  wrong,  and,  in  fact,  there 


144 


world’s  homoeopathic  congress. 


is  that  element  in  the  human  mind  that  thinks  our  thought  must 
be  right  and  everything  that  is  different  from  it  must  be  wrong  ; 
but  it  is  going  further  than  that  to  draw  lines,  to  draw  a creed,  to 
draw  those  stringent  bands  around  the  Homoeopathic  profession 
which  should  define  a certain  line  outside  of  which  they  should  not 
go ; and  it  was  the  work  of  that  one  man,  so  noble,  so  broad,  so 
exact,  so  painstaking  in  all  his  work,  who  never  could  be  doubted 
of  loyalty  to  Homoeopathy,  that  in  that  address,  placed  us  on  the 
platform  that  has  given  us  progress,  additions  to  our  members  and  a 
liberty  to  go  on  in  the  work  in  which  we  are  engaged.  Now  we 
feel  that  influence. 

Our  present  position  is  also  a somewhat  dangerous  one.  When 
we  were  excluded  from  public  institutions  there  was  no  danger  of 
our  committing  any  great  offences,  but  the  day  is  fast  approaching, 
and  has  already  come,  when  we  are  not  only  admitted  but  invited  ; 
and  are  we  ready  for  it?  Have  we  given  that  attention  to  the 
great  work  of  public  health,  that  as  a body  we  should?  We  cure 
our  patients,  we  devote  our  time  to  them  and  it  is  a great  work,  but 
there  is  something  even  more  extensive  than  merely  attending  to 
the  one  individual  case,  or  the  few  that  may  come  to  us.  The  whole 
mass  of  humanity  is  influenced  by  certain  conditions  which  it  is  our 
duty  as  Homoeopathic  physicians  to  meet,  to  maintain  the  public 
health.  We  have  already  representatives  on  boards  of  health  who  do 
good  work,  and  they  will  be  on  other  boards,  and  in  every  state  in 
this  union  we  must  have  men  and  women  prepared  to  do  duty  in  the 
matter  of  caring  for  the  public  health. 

One  other  point  I wish  to  speak  on — our  public  institutions. 
There  are,  as  you  know,  in  Massachusetts,  in  New  York,  in  Michi- 
gan, in  Minnesota,  and  in  California,  institutions  for  the  care  of  the 
insane.  In  the  establishment  of  the  institution  in  Massachusetts 
with  which  I happen  to  be  connected  it  was  a difficult  matter  to  find 
a man  in  the  United  States  at  liberty  who  would  come  to  the  work. 
That  was  eight  years  ago.  It  is  true  we  did  find  one  who  did  won- 
derfully well  but  the  same  difficulty  accompanies  every  such  State 
institution  that  is  established.  Now  it  is  for  us  to  cultivate  men 
and  women  who  can  take  such  positions  when  they  are  presented, 
and  so  be  prepared  to  show  that  the  Homoeopathic  profession  has 
been  so  trained  for  it,  that  at  any  time  they  may  be  prepared  to  take 
up  and  carry  on  these  public  works  with  credit  to  themselves  and 
advantage  to  the  whole  community.  The  subject  of  public  health 
is  one  so  broad  that  we  could  also  discuss  it,  and  I am  sure  there 
are  others  who  will  have  a word  to  say  upon  it,,  and  give  us  an  en- 
couraging word  in  meeting  the  duties  that  are  to  come  upon  us. 

The  Chairman:  Further  discussion  will  be  by  Dr.  McClelland. 

Dr.  McClelland  : I had  no  idea  of  saying  anything  upon  this 
subject  this  morning:  but  of  course  I take  the  interest  which  all  of 


HOMCEOPATHY  AND  THE  PUBLIC  HEALTH. 


145 


you  do,  in  any  of  the  ethical  questions  that  were  brought  before  the 
Congress  by  the  address  of  Dr.  Ludlam.  It  is  a finished  and 
scholarly  paper,  touching  upon  questions  that  should  occupy  the 
attention  of  our  physicians ; they  demand  our  greatest  care  and  solici- 
tude. The  ethical  questions  are  of  importance,  as  for  example,  the 
suggestions  therein  contained  as  to  the  attitude  which  we  should 
occupy  toward  the  general  practice  of  medicine.  It  is  true  that 
there  is  danger  that  we  may  beome  the  intolerant  party.  It  has 
been  made  manifest  to  every  one  that  the  Old  School  of  practice  has 
modified  its  position  very  much  of  late  years.  We  may  say  that  we 
have  won  our  position.  It  is  also  true  that  the  younger  men  of  the 
Old-School  profession  have  no  such  feeling  toward  ourselves  as  that 
which  animated  their  elders  thirty  or  fifty  years  ago.  Now  while 
I say,  and  firmly  take  the  position,  that  we  should  not  lightly  give 
up  our  attitude  as  a distinct  school — that  we  should  not  sell  out  our 
birthright  for  a mess  of  pottage  ; still  it  is  true  that  we  should  recog- 
nize the  fact  that  the  Old-School  physicians  are  making  an  effort  in 
the  same  line  as  ourselves. 

Now,  one  of  the  lines  in  which  the  schools  come  together  ethically 
and  otherwise,  is  that  of  caring  for  the  public  health,  and  I can 
assure  you  that  it  is  a broad  field,  and  Dr.  Talbot,  in  his  remarks 
has  called  attention  to  a very  vital  question  in  connection  therewith. 
Our  patrons  expect  that  their  representatives  shall  take  their  places 
in  serving  the  public  health.  Your  patients  and  my  patients  say — 
“ where  is  our  doctor  ?”  We  hear  of  Dr.  This,  and  Dr.  That,  look- 
ing after  the  general  public  welfare,  but  where  is  our  doctor  ? Now, 
it  behooves  us  to  fit  ourselves  for  the  positions  that  are  being  actu- 
ally thrust  upon  us.  It  behooves  us  to  look  into  public  questions 
and  fit  ourselves  to  occupy  positions  of  public  trust;  for  without 
doubt,  we  shall  be  asked  to  take  our  proper  share  in  the  exercise  of 
public  conscience  in  connection  with  the  State. 

The  Chairman  : The  debate  will  be  further  continued  by  Dr. 
Conrad  Wesselhoeft,  of  Boston,  speaking  for  Dr.  Carl  Bojanus,  of 
Russia,  who  is  unable  to  speak  English. 

Dr.  Wesselhoeft:  I have  the  honor  to  represent  our  venerated 
friend,  but  it  will  probably  very  imperfectly  convey  to  you  his  ideas 
on  the  subject  of  predisposition  of  diseases  in  regard  to  public  health. 
He  handed  me  last  night  three  pamphlets  pertaining  to  that  subject. 
They  were  all  written  as  late  as  1874,  and  relate  to  certain  atmos- 
pheric influences  on  public  health,  and  were  written  by  one  Dr.  F. 
X.  H.  Horn,  and  at  the  time  excited  considerable  interest,  from  the 
careful  manner  in  which  the  subject  was  handled  and  the  data  ad- 
duced. I will  give  you,  very  briefly,  only  the  upshot  of  the  matter. 
It  relates  to  the  production  of  ozone  and  yodosmone  as  products  of 
certain  chemical  conditions  of  the  atmosphere,  or  which  were  then, 
and  I think  are  now,  attributed  to  conditions  of  the  atmosphere. 

10 


146 


world’s  homoeopathic  congress. 


The  author  goes  on  to  show  that  the  presence  of  ozone  or  yodosmone 
influences  or  predisposes  nations  and  the  people  of  the  cities  to  dis- 
eases, particularly  to  the  prevalence  of  cholera.  These  are  broad 
statements,  and  may  be  based  entirely  on  theoretical  reasons  which 
I cannot  go  into  fully  now;  but  when  reading  the  pamphlets,  I saw 
there  was  something  in  the  subject  which  might  influence  everybody. 
Ozone  is  formed  under  the  high  electrical  temperature.  Yodosmone 
is  formed  in  the  presence  of  low  electrical  temperature.  We  all 
know  that  that  exists.  And  one  scientific  experiment  was  carefully 
made  to  demonstrate  the  presence  of  these  bodies  or  gases,  or  nox- 
ious miasmata,  as  they  are  called.  The  effects  of  ozone  and  yodos- 
mone are  to  produce  nitrogenous  combinations.  That  may  not  be 
exactly  true,  but  the  facts  remain  true  that  certain  electrical  condi- 
tions of  the  atmosphere  produce  predisposition  to  disease.  That 
was  stated  in  1847  or  earlier. 

To-day  the  great  question  comes  up,  What  is  the  cause  of  cholera? 
We  have  all  supposed  it  was  the  cholera  bacillus,  just  as  the  bacillus 
of  consumption  produces  consumption,  etc. ; but  it  is  beginning  to 
be  understood  more  and  more  that  something  besides  the  bacillus  and 
its  chemical  products  is  necessary  to  produce  any  disease,  and  that 
the  thing  which  is  necessary  is  a predisposition,  without  which  no 
bacillus  can  have  any  decided  effect.  It  finds  no  grounds  upon  which 
to  lodge.  That  is  a theory,  to  be  sure,  but  a theory  not  entirely 
without  foundation  in  observation.  You  all  know  of  the  wonderful 
controversy  that  has  been  going  on  with  regard  to  predisposition. 
It  has  been  maintained  principally  by  a professor  of  Munich,  who, 
to  test  this  very  fact — whether  the  cholera  bacillus  alone  is  capable 
of  producing  cholera,  or  whether  this  predisposition  is  necessary — 
obtained  from  Paris  some  of  the  cholera  bacilli  which  were  virulent 
and  active,  and  demonstrated  it  by  a great  many  careful  experiments 
on  animals  that  died  from  it.  He,  a man  seventy-five  years  of  age, 
risked  his  own  life  by  swallowing  thousands  of  these  cholera  mi- 
crobes, and  he  is  alive  now.  I think  it  is  a very  fair  demonstration 
although  many  objections  have  been  made — -that  the  bacilli  might 
not  have  been  virulent,  that  they  had  not  been  properly  tested  before 
being  swallowed — but  there  are  not  many  of  us  who  would  undertake 
such  a dangerous  experiment,  especially  as  Koch  has  asserted  that 
the  bacillus  is  present  in  every  genuine  case  of  cholera.  The  inter- 
esting papers  which  Dr.  Bojanus  has  given  me  throw  some  light  on 
the  subject,  showing  under  what  conditions  the  public  health  may  be 
so  impaired  and  predisposed  to  general  epidemics,  and  especially  to 
cholera.  That  is  the  sum  and  substance  of  the  subject  upon  which 
our  venerable  friend  wanted  to  talk  to  you,  and  I have  done  as  well 
as  I could  in  his  name,  and  beg  your  pardon  if  I have  inadequately 
represented  the  subject. 


HOMOEOPATHY  AND  THE  PUBLIC  HEALTH. 


147 


The  Chairman  : The  next  business  in  order  is  the  reports  from 
foreign  delegates.  As  I have  already  said,  our  venerable  friend,  Dr. 
Carl  Bojanus,  of  Samara,  Russia,  is  unable  to  speak  English.  He 
presents  his  compliments  to  the  Congress,  and  will  make  his  report 
in  writing  upon  Homoeopathy  in  Russia.  I have  the  pleasure  of 
introducing  Dr.  Alfred  E.  Hawkes,  of  Liverpool,  England,  who 
will  speak  to  you. 

Dr.  Hawkes  addressed  the  Congress  as  follows ; 


148 


world’s  homceopathic  congress. 


ADDRESS. 

HOMCEOPATHY  IN  GREAT  BRITAIN. 

By  Alfred  E.  Hawkes,  M.D.,  Liverpool,  England. 


In  presenting  to  you  a short  statement  of  the  position  of  Homoeo- 
pathy in  Great  Britain  at  the  present  time,  I must  ask  your  for- 
bearance, as  I have  no  material  at  hand  wherewith  to  refresh  my 
memory.  I may  at  the  outset,  state  that  the  days  are  gone  by  when 
it  is  necessary  in  order  to  check  the  insolence  of  the  President  of  the 
Royal  College  of  Physicians  towards  our  body,  for  the  leader  of  it 
to  challenge  him  to  mortal  combat  as  in  Quin’s  time.  They  would  be 
more  likely  to  call  now  for  China  tea  than  coffee  and  pistols  for  two. 
The  days,  too,  are  gone  by  when  a medical  student  for  striving  un- 
successfully to  cure  his  relative  of  cholera,  after  having  been  given 
up  by  the  Allopaths,  would  be  thrown  into  Newgate,  as  was  the 
case  with  Pearce.  To  be  sure  Pearce  was  speedily  liberated  when 
his  case  came  before  Mr.  Justice  Maule,  but  later  on  it  required 
almost  an  Act  of  Parliament  to  rescue  from  the  limbo  of  suppressed 
truths,  the  awkward  facts  that  our  results  at  the  Homoeopathic 
Hospital  in  London,  during  the  cholera  epidemic  were  better  than 
those  of  our  opponents,  and  too  good  to  be  published  side  by  side, 
with  them.  And  now  with  such  men  as  Dudgeon,  and  Hughes, 
Dyce  Brown,  Hayward,  and  Pope,  Knox,  Shaw,  Blackley,  Burford, 
and  Clarke,  we  have  no  official  recognition  as  a body,  and  no  school 
or  hospital  at  which  a single  lecture  would  count.  Do  you  wonder 
that  I am  compelled  to  say  that  notwithstanding  the  great  energy  of 
the  Secretary  of  the  British  Homoeopathic  Society,  the  recruits  are 
barely  sufficient  to  fill  the  places  rendered  vacant  by  death. 

With  the  cause  of  this  I have  nothing  to  do,  but  I should  indeed 
be  blind  if  after  spending  less  than  a week  on  this  side  of  the  Atlan- 
tic, I could  not  formulate  a reason  and  suggest  a remedy ; but  my 
suggestion  would  fall  flat.  For  already  some  of  those  I have  men- 


HOMOEOPATHY  IN  GREAT  BRITAIN. 


149 


tioned  in  the  nartie  of  the  general  body,  are  firmly  and  in  proper 
form  demanding  a status  in  the  proposed  new  university  of  the 
capital  for  our  system  of  therapeutics.  I am  compelled  to  admit 
that  there  are  fewer  professional  followers  of  Hahnemann  in  Great 
Britain  who  would  confess  their  allegiance,  than  in  your  City  of 
Chicago ; but  many  adopt  the  practice  sub  rosa.  In  the  extreme 
North,  there  still  lives  Reith  of  Aberdeen,  who  discovered  that  his 
original  contributions  to  the  Edinburgh  Medical  Journal , were  in 
fact  admissions  of  the  truth  of  Homoeopathy,  frankly  declared  him- 
self on  the  side  of  those  practicing  that  form  of  the  medical  art, 
and  was  so  boycotted  that  he  had  to  resign  his  post  at  the  infirmary, 
or  remain  its  sole  medical  officer,  a position  he  was  too  wise  to  care 
to  retain. 

Bryce  and  Wolston,  the  latter  of  whom  is  a successful  operator 
on  post-nasal  growths,  ably  represent  us  in  Edinburgh,  where  Prof. 
Henderson,  although  a Homoeopath,  retained  his  position  as  a Pro- 
fessor of  Pathology  up  to  the  time  of  his  death,  all  attempts  to  dis- 
lodge him  having  failed. 

The  cause  is  flickering  only  at  Glasgow.  Across  the  channel  at 
Dublin,  Belfast,  and  possibly  another  place  or  two,  we  have  able 
representatives. 

If  in  South  Wales  there  are  two,  we  are  better  off  than  I think, 
and  North  Wales  is  destitute  of  a Homoeopathic  practitioner. 

In  the  Southwest  of  England  able  men  are  dotted  over  Devon  and 
neighboring  counties. 

We  are  strong  at  Bristol.  Your  old  friend  Clifton  still  holds  the 
fort  in  the  midland  town  of  Northampton,  with  all  the  ability  of 
which  you  know  him  to  be  possessed.  He  has  one  colleague.  His 
brother  at  Leicester  has  more  than  one.  In  Birmingham  we  have 
Blake  and  Thomas  and  others,  and  the  cause  is  strong.  Chester  has 
one  practitioner,  and  many  towns  of  fifty  thousand  inhabitants  or 
more,  and  other  towns  of  large  size  are  worse  off  than  that. 

Able  men  are  scattered  over  the  broad  acres  of  Yorkshire,  and 
Newcastle  is  fairly  strong.  In  Manchester  the  scientific  attainments 
of  C.  H.  Blackley  are  seconded  by  a few  able  colleagues. 

In  Liverpool,  where  for  more  than  fifty  years  the  slight  but  val- 
iant frame  of  J.  J.  Drysdale  held  its  sway,  resisting  all  attempts 
at  alluring  him  to  the  metropolis  on  the  one  hand,  and  all  attempts  to 
diminish  his  influence  on  the  other,  Homoeopathy  flourishes.  Dur- 


150 


world’s  homoeopathic  congress. 


ing  the  twenty-one  years  I have  practiced  there,  more  than  twenty 
able  men  have  gone  to  other  spheres  of  labor.  For  our  House  Sur- 
geonship,  with  its  salary  of  six  hundred  dollars  per  annum,  attracts 
young  men  from  all  parts,  and  our  stipendiary  visiting  posts,  worth 
five  hundred  dollars  per  year,  serve  to  attract  good  men  and  to  help 
them  through  their  early  struggles. 

Through  the  princely  gift  of  Mr.  Henry  Tate  we  have  a hospital 
which  cost  about  one  hundred  and  thirty  thousand  dollars,  well 
equipped  and  with  its  fifty  beds,  much  good  work  in  general  medi- 
cine, surgery,  and  ophthalmic  surgery  and  other  branches  is  done. 

Dr.  Drysdale  and  Dr.  Moore  were  its  consulting  physicians  up  to 
the  time  of  their  lamented  decease.  The  post  is  now  held  by  Dr. 
Hayward. 

Our  dispensary  officers  see  twelve  hundred  out-patients  a week, 
besides  visiting  the  poor  at  their  own  homes.  Within  the  same 
walls  our  medical  society,  originated  by  Dr.  Drysdale  and  three 
others  some  thirty-five  years  ago,  meets  about  eight  times  a year, 
and  does  good  work. 

Our  local  chemists  are  men  of  science.  Mr.  Capper  having  almost 
a unique  collection  and  knowledge  of  the  lepidoptera,  and  Mr. 
Thompson  being  a specialist  in  marine  fauna  and  the  microscope. 

At  the  present  time  a free  bed  in  memory  of  Dr.  Drysdale  is  being 
instituted  at  a cost  of  a thousand  pounds,  which  sum  is  nearly  raised. 
It  was  well  for  him  that  it  was  not  the  guillotine  he  had  called  into 
existence.  Until  his  death  Dr.  Drysdale  was  a member  of  the  Allo- 
pathic Medical  Society,  from  which  Dr.  Skinner  was  excluded  on 
becoming  a Homoeopath — bowing  to  the  absolute  rule  he  had  been 
instrumental  in  initiating  while  still  an  Allopath.  We  are  permitted 
to  join  the  Gynaecological  Society,  but  not  the  Obstetrical,  and  only 
one  of  our  men — Dr.  Sharp — ever  held  the  blue  ribbon  of  the  Royal 
Society.  Consulting  practitioners  are  at  all  times  obliged  to  choose 
on  which  side  of  the  fence  their  centre  of  gravity  must  be  located. 

Thus  we  strive  to  hold  our  own.  The  signs  of  better  things  loom 
in  the  not  distant  future.  We  wait,  but  we  labor.  We  hope  but  do 
not  fear.  We  are  buoyed  up  by  being  assured  of  your  sympathies, 
and  we  grasp  your  hand,  outstretched  across  the  sea,  and  gladly 
absorb  all  the  kind  regard  you  have  to  spare. 

The  Chairman  : Connected  with  Homoeopathy  in  England,  Dr. 
Ludlam  has  a word  to  say  from  Dr.  Dudgeon. 


HOMOEOPATHY  IN  GREAT  BRITAIN. 


151 


R.  Ludlam,  M.D. : Ladies  and  Gentlemen : At  the  last  meeting 
of  the  Congress,  at  Atlantic  City,  a vote  was  taken  requesting  Dr. 
Dudgeon,  of  London,  a distinguished  member  of  our  School,  to 
issue  another  edition  of  his  translation  of  the  Organon  of  Hahne- 
mann. He  has,  with  the  faithfulness  characteristic  of  him,  finished 
that  work  and  furnished  the  book,  and  I received  it  two  days  ago 
by  post.  He  sends  to  this  Congress  the  book,  with  this  inscription  : 
“To  the  World’s  Homoeopathic  Congress  of  1893,  with  Respectful 
Greetings  of  the  Translator,  London,  May  8,  1893.”  It  gives  me 
a great  deal  of  pleasure  to  carry  out  his  request  that  the  volume  be 
handed  to  the  World’s  Congress  of  Homoeopathy,  and  I therefore 
pass  it  to  the  President  of  the  Congress. 

The  Chairman  : I have  the  pleasure  of  introducing  Dr.  P.  C. 
Majumdar,  of  Calcutta,  India,  who  represents  two  hundred  millions 
of  his  countrymen. 

Dr.  Majumdar  addressed  the  Congress  as  follows^ 


152 


world’s  homceopathic  congress. 


ADDRESS. 

HISTORY  OF  HOMOEOPATHY  IN  INDIA. 

By  P.  C.  Majumdar,  M.D.,  Calcutta,  Inuia. 


Ladies  and  Gentlemen : Before  going  into  the  details  of  the  pro- 
gress of  Homoeopathy  in  India,  I take  this  opportunity  of  speaking 
a few  words  about  the  state  of  the  medical  profession  generally  in 
that  country  before  the  advent  of  the  Europeans.  I purposely  take 
this  responsibility,  as  it  has  some  bearing  upon  Homoeopathy  in 
India.  You  are  all  aware,  gentlemen,  that  India  is  a very  ancient 
and  magnificent  country.  It  had  attained  its  highest  state  of  civili- 
zation long  prior  to  all  the  civilized  countries  of  the  world  at  the 
present  day.  It  is  therefore  natural  to  infer  that  laws  governing 
health  and  disease  must  have  received  a due  share  of  attention  at 
the  hands  of  its  people. 

It  was  believed  that  Mohadwa,  the  great  Hindu  deity,  was  the 
promulgator  of  the  science  of  medicine.  He  was  dealing  with  the 
dead  bodies  and  handling  all  sorts  of  deadliest  poisons.  The  truth 
is,  he  was  busy  with  examining  the  human  frame  and  searching 
after  the  medical  virtues  of  all  substances.  From  him  Dhannantori 
got  his  inspiration  of  medical  science  and  practiced  it  for  the  pre- 
servation of  the  human  race.  There  is  a story  in  our  books  that  on 
one  occasion  all  the  minor  gods  and  goddesses  were  eager  to  become 
immortal,  and  for  this  purpose  they  were  agitating  the  ocean  to  get 
Amrita,  the  principle  of  immortality.  But  instead  of  getting  that, 
they  procured  Garal,  the  deadliest  of  poisons.  Nobody  ventured  to 
accept  it;  Mohadwa  came  to  their  help;  he  turned  that  substance  into 
Amrita  by  swallowing  the  poison,  and  became  immortal.  We  Hom- 
oeopaths can  find  out  a great  deal  of  truth  in  it.  Mohadwa  took 
the  poison  into  his  healthy  body — “ proved”  it,  as  we  say — and 
reduced  it  into  the  life-giving  principle  of  medicine.  We  presume, 
however  crude  and  unreliable  this  story  may  be,  that  the  law  ol 


HISTORY  OF  HOMOEOPATHY  IN  INDIA. 


153 


Homoeopathy  which  the  immortal  Hahnemann  discovered  so  recently 
was  known  to  our  ancient  sages  in  India.  This  very  principle  of 
similia  similibus  was  also  embodied  in  one  of  our  ancient  medical 
works  in  the  following  passage,  that  “ poison  is  the  cure  for  poison.” 
How  far  my  contention  may  be  sustained  I am  not  prepared  to  argue, 
but  I am  so  far  confident  that  our  medical  authority  of  ancient  times 
had  some  idea  of  the  Homoeopathic  law  of  cure.  Even  at  the  pres- 
ent time  our  native  system  of  medicine  is  far  better  and  far  more 
efficacious  in  curing  all  varieties  of  chronic  diseases  than  is  that 
of  our  Allopathic  physicians.  Our  native  physicians,  moreover,  use 
very  minute  doses  and  are  more  successful  than  our  brethren  of  the 
Allopathic  School,  with  all  their  vaunted  knowledge  of  science. 
Our  medical  science  suffered  a good  deal  of  loss  during  the  Moham- 
medan invasion  in  India.  These  turbulent  people  destroyed  many 
of  our  valuable  books  in  order  to  introduce  their  system  of  medi- 
cine, but  it  proved  an  utter  failure. 

Later  on,  our  European  physicians  brought  their  own  medical 
science  with  them.  We  are  thankful  to  the  modern  spirit  of  inves- 
tigation. By  their  surgical  skill  and  appliances  our  Allopathic 
physicians  made  a good  name  and  extended  reputation,  but  their 
therapeutic  measures  are  an  utter  failure.  They,  by  the  aid  of  the 
English  government,  establish  medical  colleges,  hospitals  and  chari- 
table dispensaries  throughout  the  length  and  breadth  of  the  country, 
and  are  doing  some  good  to  the  people,  but  not  to  the  entire  satis- 
faction of  the  Indian  community. 

At  this  moment  the  Homoeopathic  system  of  treatment  engages 
the  attention  of  our  people.  People  are  convinced  of  the  superiority 
of  Homoeopathic  methods  of  cure  in  India  through  the  exertion  of 
lay  medical  practitioners ; no  qualified  medical  man  at  an  early  date 
deemed  it  worth  while  to  study  and  practice  it.  It  was  a significant 
fact  in  the  history  of  Homoeopathy  in  India  that  one  Dr.  Honigber- 
ger,  a German  gentleman,  came  here  to  treat  one  of  the  princes  of 
this  country,  whose  case  was  declared  hopeless  by  his  physicians.  I 
understand  Honigberger  gave  juice  of  Dulcamara  to  the  prince,  and 
he  was  much  improved.  This  is  the  first  drop  of  Homoeopathic 
medicine  administered  to  our  countrymen.  However,  since  the  de- 
parture of  this  physician  there  was  no  stir-up  about  Homoeopathy 
till  the  year  1851,  when  Dr.  Tonnere,  a French  physician,  who 
proved  Acalypha  indica,  the  valuable  medicine  of  phthisis  pulmona- 


154 


world’s  homoeopathic  congress. 


lis,  came  to  Calcutta  and  began  practicing  Homoeopathy.  He  was  a 
favorite  of  the  officials  in  India ; so,  by  the  help  of  the  Governor  of 
Bengal,  he  established  a Homoeopathic  hospital  and  charitable  insti- 
tution in  Calcutta.  Our  wealthy  and  generous  townsman,  Baleu 
Rajendra  Dutt,  dissatisfied  with  the  Allopathic  treatment  of  cases, 
began  studying  Homoeopathy.  By  his  energy  and  the  judicious  pre- 
scriptions of  Dr.  Tonnere  many  cures  had  been  effected.  At  this 
time  wo  are  told  that  some  of  the  most  fatal  cases  given  up  by  the 
Allopathic  physicians  were  beautifully  managed  by  these  gentlemen. 
This  is  the  first  planting  of  Homoeopathy  in  this  country.  No 
regular  physician  of  our  country  thought  it  necessary  to  inquire 
about  the  new  system  of  cure. 

Baleu  Rajendra  Dutt  was  a neighbor  of  Dr.  Mohendra  Lai 
Sircar,  who  was  then  a rising  Allopathic  physician.  It  was  a curious 
fact  that  many  of  the  given-up  cases  of  Dr.  Sircar  were  readily  ame- 
liorated and  cured  by  Rajendra  Dutt.  This  attracted  the  attention 
of  Dr.  Sircar,  who,  after  studying  for  some  time,  was  moved  by  the 
genuine  superiority  of  Homoeopathic  methods  of  cure,  and  openly 
declared  his  conviction  in  1867.  Dr.  Sircar’s  Allopathic  friends 
and  associates  were  much  incensed  at  his  conversion  to  Homoeopa- 
thy, and  he  was  ostracised  from  the  Allopathic  medical  associations. 

About  the  year  1865,  Dr.  Berigny,  an  eminent  French  Homoeo- 
path, came  to  Calcutta  to  practice  Hahnemann’s  system  of  medicine. 
He  was  very  successful  in  his  profession  but  was  not  long  to  enjoy 
that  reputation.  A Homoeopathic  pharmacy  was  established  at  this 
time  for  dispensing  medicine.  In  conjunction  with  Dr.  Mohendra 
Lai  Sircar  and  Baleu  Rajendra  Dutt,  Dr.  Berigny  had  done  much 
towards  the  propagation  of  Homoeopathy  in  India. 

At  this  time  Dr.  Bihari  Lai  Bhaduri,  a . graduate  of  the  Calcutta 
Medical  College,  came  to  the  field.  He  was  a studious  and  intelligent 
physician  and  it  was,  I believe,  through  the  exertion  of  this  gentle- 
man that  Homoeopathy  has  gained  a firm  footing  in  India.  I regret 
very  much  to  say  that  we  lost  him  at  a comparatively  early  age  of 
fifty  years  in  March,  1891. 

After  observing  some  miraculous  cures  from  Homoeopathic  medi- 
cines by  Dr.  Bhaduri,  I came  to  study  this  method  of  cure.  I 
graduated  in  the  year  1878  and  after  studying  Homoeopathy  under 
Dr.  Bhaduri  commenced  practicing  it  in  the  year  1880. 

My  good  friend  Dr.  Brojendra  Nath  Banez,  who  graduated  in 


HISTORY  OF  HOMOEOPATHY  IN  INDIA. 


155 


the  same  year  with  me,  commenced  practicing  in  Allahabad,  a town 
about  five  hundred  miles  from  Calcutta.  He  practiced  a few  years 
as  an  Allopathic  physician,  and  subsequently  took  to  Homoeopathy, 
and  came  down  to  Calcutta.  He  is  an  intelligent  and  energetic 
physician. 

At  this  time  many  of  our  class  friends  are  converted  to  Homoe- 
opathy. Among  them  I may  mention  the  names  of  Drs.  C.  S.  Kali, 
B.  V.  Maitra,  P.  N.  Chatterji,  and  A.  K.  Datta.  They  are  all  very 
enthusiastic  followers  of  Hahnemann. 

Our  good  friend  Dr.  Giris  Chandra  Dutta,  has  done  much  to  intro- 
duce Homoeopathy  among  some  of  the  rich  people  in  Calcutta.  Pie 
is  an  old  graduate  and  I believe  a class  friend  of  Dr.  Bhaduri. 
Homoeopathy  is  so  widely  known  at  this  time,  namely,  from  the 
year  1880,  that  one  of  our  countrymen,  Dr.  D.  N.  Bay,  came  to 
study  Homoeopathy  at  New  York.  He  became  a graduate  of  the 
New  York  Homoeopathic  Medical  College  and  began  practicing  at 
Bombay,  He  subsequently  removed  to  Calcutta  and  is  doing  good 
work  there. 

I forgot  to  mention  the  name  of  Dr.  M.  M.  Bose,  who  came  before 
Dr.  Ray  and  graduated  also  from  the  New  York  Homoeopathic 
Medical  College.  He  is  also  a Homoeopathic  physician  at  Calcutta. 

In  Calcutta  we  have  now  about  fourteen  Homoeopathic  physicians 
and  our  works  are  extensive.  But  there  is  still  a great  difficulty  in 
getting  Homoeopathic  help  in  other  parts  of  the  country.  There 
are  some  laymen  practicing  among  the  people  there.  In  order  to 
get  rid  of  this  difficulty  I tried  my  best  to  educate  some  of  our 
countrymen  to  Homoeopathy  and  thus  in  the  year  1883  I succeeded 
through  the  help  of  my  friends  Dr.  M.  M.  Bose  and  Baleu  S.  B. 
Mukerp  in  establishing  our  Calcutta  school  of  Homoeopathy. 
Though  this  school  is  still  in  an  elementary  condition,  yet  much 
good  has  been  accomplished  by  it  in  spreading  our  system  of  medi- 
cine. The  students  on  the  roll  last  year  amounted  to  about  one 
hundred.  The  students  are  required  to  study  for  three  years  here 
and  after  passing  an  examination,  are  supplied  with  certificates  to 
practice.  There  are  eight  teachers  in  the  school.  Dr.  D.  N.  Ray 
is  the  president  and  myself  the  secretary. 

I am  glad  to  bring  to  the  notice  of  our  friends  of  the  World’s 
Homoeopathic  Congress  here  that  Homoeopathy  has  gained  a some- 
what strong  hold  among  our  people  at  the  present  time.  In  proof 


156 


world’s  homoeopathic  congress. 


of  this  I may  call  your  attention  to  the  fact  that  within  a year  or  two 
we  got  some  public  institutions;  I mean  two  dispensaries  and  a hos- 
pital where  poor  patients  get  medical  help.  The  Bhaduri  Chari- 
table Homoeopathic  Dispensary  was  established  as  a memorial  to 
that  gentleman  after  his  death.  Dr.  Banerjee  is  the  secretary  of  that 
institution.  Since  its  establishment  in  June,  1892,  up  to  February, 
1893,  eight  thousand  patients  have  received  medical  help  and 
medicine.  This  dispensary  has  a branch  in  the  crowded  part  of  the 
city,  under  the  supervision  of  Dr.  B.  V.  Maitra  and  I am  glad  to 
say  a greater  number  of  patients  were  treated  here.  Dr.  Maitra, 
moreover,  deserves  our  best  thanks,  for  here  he  used  to  supply  all 
medicines  himself.  The  dispensary  is  useful  in  other  ways  than 
giving  medical  help  to  the  poor;  the  students  of  the  Calcutta 
school  of  Homoeopathy  have  the  opportunity  of  attending  here, 
and  of  learning  how  to  prescribe  and  take  up  a case. 

Subsequently  to  the  establishment  of  this  institution,  a very  rich 
and  respectable  gentleman,  Sir  Rajah  Saurindra  Mohan  Tagore,  es- 
tablished under  the  direct  supervision  of  Dr.  P.  C.  Majumdar,  a 
Homoeopathic  dispensary  in  name  and  honor  of  his  mother.  There 
are  two  paid  medical  officers  who  prescribe  and  distribute  medicines 
for  the  poor  people  gathered  round  them  every  morning.  Deplor- 
ing the  neglect  shown  to  Homoeopathy  by  our  rich  class  of  people 
in  India,  the  medical  officer  says  that  our  best  thanks  are  due  to  the 
generous  Raja  (prince,  as  he  is  styled  by  our  government),  ag  he  is 
the  pioneer  of  giving  public  help  to  our  cause.  The  dispensary 
was  established  in  July  of  1891  and  during  this  short  period,  has 
prospered  greatly.  During  the  year  they  treated  ten  thousand 
cases;  the  number  of  cures  is  very  great.  The  Raja  bears  all  the 
expenses  which  amount  to  about  (150)  one  hundred  and  fifty  rupees 
a month  ; Dr.  Majumdar  is  an  honorary  superintendent.  Here  some 
of  our  students  get  their  opportunity  to  learn  clinical  medicine. 

The  15th  of  June,  1892,  is  especially  memorable  to  us  Homoeo- 
paths in  India,  as  on  that  day  we  established  our  Calcutta  Homoeo- 
pathic Hospital.  This  is  altogether  a new  feature  in  our  country. 
It  is  entirely  a charitable  institution  ; all  the  patients  are  treated 
gratis.  There  are  available  spaces  for  (40)  forty  patients  in  the 
house  where  it  is  located  now,  besides  a ward  is  set  apart  for  receiv- 
ing cholera  patients.  It  is  under  the  charge  of  Dr.  B.  V.  Chatterji. 
There  is  a managing  committee  consisting  of  all  the  teachers  of  our 


HISTORY  OF  HOMOEOPATHY  IN  INDIA. 


157 


Homoeopathic  school  and  many  Homoeopathic  physicians  of  the 
city;  the  secretary  is  Dr.  P.  C.  Majnmdar.  On  this  hospital,  though 
in  its  infancy,  depends  to  a great  measure  the  public  recognition  of 
Homoeopathy  in  our  country.  It  is,  up  to  date,  supported  by  sub- 
scriptions among  the  Homoeopathic  physicians  of  Calcutta.  Our 
students  get  their  clinical  lectures  here  by  the  teachers. 

There  are  about  twenty  Homoeopathic  pharmacies  in  Calcutta  for 
preparing  and  selling  medicines  and  I am  happy  to  say  they  are  in 
a prosperous  condition. 

There  are  very  few  books  published  in  India  in  English,  but 
many  in  our  own  language.  I give  below  the  names  of  the  authors 
and  their  books. 

Dr.  Sircar. — Treatment  of  Cholera  ; Materia  Medica. 

Dr.  Salzer. — Lectures  on  Cholera ; Periodicity  of  Drugs,  Cir- 
rhosis of  Liver. 

Dr.  Bhaduri. — Translation  of  Baehr’s  Science  of  Therapeutics,  2 
vols.  (Bengali) ; Treatment  of  Cholera  (Bengali) ; Materia  Medica 
(Bengali). 

Dr.  Majumdar. — Practice  of  Medicine,  2 vols.  (Bengali) ; Materia 
Medica  (Bengali) ; Translation  of  Bell’s  Therapeutics  of  Diarrhoea, 
Dysentery,  etc.  (Bengali) ; Treatment  of  Cholera  (Bengali) ; Hering’s 
Typhoid  Fever  (English) ; Epitome  of  Practice  of  Medicine  (Ben- 

gal*)- 

Dr.  Banerji. — Theory  of  Homoeopathy  (Bengali). 

Dr.  Maitra. — Diseases  of  Children  (Bengali);  Treatment  of  Diar- 
rhoea, etc.  (Bengali). 

The  Homoeopathic  Record  is  a journal  published  and  edited  by 
Dr.  J.  C.  Lahiri  regularly  every  month. 

The  Indian  Homoeopathic  Review  now  edited  by  P.  C.  Majumdar 
is  an  irregular  visitor. 

We  have  a Hahnemann  Society  in  Calcutta.  It  meets  every  year 
to  celebrate  the  anniversary  of  Hahnemann’s  birthday  on  the  10th 
of  April.  Special  meetings  may  be  called  when  required. 

Two  or  three  days  before  my  departure  from  Calcutta,  there  was 
a meeting  of  Homoeopathic  physicians  and  students  of  our  school  to 
accord  to  me  a farewell  address.  In  that  meeting  one  of  our  col- 
leagues remarked  that  though  our  country  was  poor  and  dependent 
and  we  had  nothing  brilliant  to  offer  to  the  members  of  the  World’s 
Homoeopathic  Congress  and  to  our  American  colleagues,  yet  we 


158 


world’s  homoeopathic  congress. 


possess  warm  hearts  and  I believe  Dr.  Majumdar  will  be  able  to 
convey  to  them  our  warm  and  sincere  greetings.  Now,  ladies  and 
gentlemen,  allow  me  to  perform  that  pleasant  duty  of  greeting  you 
for  myself  and  on  behalf  of  my  colleagues  in  India. 

The  Chairman  : Dr.  Talbot,  in  this  connection  has  a word  to 
say  from  Dr.  D.  N.  Banerjee,  of  Calcutta,  India.  He  has  received 
some  communications,  in  the  way  of  journals  and  otherwise  for  dis- 
tribution, which  can  be  obtained  at  the  close  of  the  session  this 
morning.  He  is  not  here,  so  I will  next  call  upon  Dr.  Fischer,  of 
New  South  Wales. 

Dr.  Fischer,  of  Sidney : It  is  very  little  I have  to  say  about  our 
southern  hemisphere  of  Australia,  but  I have  prepared  a few  words 
which  I will  read  to  you. 


HOMOEOPATHY  IN  AUSTRALIA. 


159 


ADDRESS. 

HOMCEOPATHY  IN  AUSTRALIA. 

By  Charles  F.  Fischer,  Sydney,  N.  S.  W. 


In  presenting  you  with  a report  of  the  present  state  and  progress 
of  Homoeopathy  in  Australasia,  I must  refer  to  its  past  history.  It 
was  forty  years  ago,  in  1853,  when  I went  to  New  Zealand,  and  had 
the  fortune  and  honor  of  being  the  first  practitioner  wTho  introduced 
Homoeopathy  in  the  Southern  Hemisphere,  which,  thanks  to  the 
usual  and  bitter  opposition  our  doctrine  received  from  the  Old  School, 
gave  me  pluck  and  energy  to  work  hard,  and  soon  I succeeded  in 
establishing  a hospital  of  twenty  beds,  and  published  a periodical 
called  the  Homoeopathic  Echo  in  1854,  which  formed  a useful  domes- 
tic guide  to  the  settler  in  the  remote  bush  where  no  doctor  was 
obtainable,  and  the  success  of  Homoeopathy  gained  the  affections  of 
the  people. 

A few  successful  surgical  operations  created  respect,  and  several 
practitioners  of  the  Old  School  became  converts  to  our  ranks,  and 
have  been  and  are  still  enthusiasts  in  promoting  the  progress  of  our 
law  of  similia  similibus  curantur , and  every  city  in  New  Zealand 
was  and  is  supplied  with  practitioners  of  our  school,  who  are  flour- 
ishing and  doing  good  work  in  those  islands. 

Australia,  in  1854,  followed  with  Dr.  Shervin  and  Dr.  Bellamy, 
and,  in  Melbourne,  Dr.  Barigni,  as  the  pioneers.  This  latter  city 
can  boast  of  a splendid  hospital  of  one  hundred  and  twenty  beds, 
which  has  gained  the  admission  of  the  Allopathic  School  that  typhoid 
fever,  which  is  endemic  in  Melbourne,  is  more  successfully  treated 
in  that  hospital  than  in  any  hospital  of  the  Old  School. 

Adelaide  has  a Children’s  Homoeopathic  Hospital,  established  by 
Dr.  Chambers,  and  several  graduates  of  our  school  enjoy  the  con- 
fidence of  the  people. 

In  Queensland,  our  school  is  well  represented,  and  in  Sydney, 


160 


world’s  homoeopathic  congress. 


where  I practiced  during  the  last  twenty  years,  Homoeopathy  has 
gained  great  success,  and  is  held  in  some  esteem  by  the  Old  School, 
Though  not  possessing  a hospital,  soon  we  will  have  wards  in  a 
splendid  building  now  in  course  of  erection  for  incurables. 

Tasmania,  in  all  its  cities,  has  Homoeopathic  practitioners,  who  are 
doing  good  work.  All  the  Australasian  colonies  want  is  the  enthu- 
siasm, the  energy,  the  talent  and  genius  which  is  fostered  here  in 
America,  and  which  has  filled  my  heart  with  admiration,  and  which 
I have  nowhere  else  found  in  the  world  where  I have  travelled. 

The  Chairman  : I have  now  the  pleasure  of  presenting  Dr.  E. 
Vernon,  President  of  the  Canadian  Institute  of  Homoeopathy. 

Dr.  Vernon  addressed  the  Congress  as  follows : 


PROGRESS  OF  HOMCEOPA1 HY  IN  ONTARIO. 


161 


ADDRESS. 

PROGRESS  OF  HOMOEOPATHY  IN  ONTARIO. 

By  E.  Vernon,  M.D.,  of  Toronto,  Canada. 


In  presenting  a report  of  the  progress  of  Homoeopathy  in  Ontario 
for  the  last  few  years  to  this  world-wide  assembly  of  Homoeopathic 
physicians,  I am  confronted  at  the  very  outset  with  a humiliating 
confession  which  I am  compelled  to  make,  and  that  is,  that  our  num- 
bers have  not  increased  as  fast  as  our  popularity  with  the  general 
public,  or  our  legal  and  professional  standing  in  the  country  would 
lead  us  to  expect.  And  still  our  numbers  have  increased.  I am 
unable  to  give  you  the  exact  number,  but  so  far  as  I can  learn  we 
are  between  60  and  70.  Of  these,  16  are  in  Toronto,  where  our 
largest  representation  in  Ontario  is.  Many  of  the  most  wealthy  and 
influential  people  of  that  city  are  firm  adherents  to  our  principles, 
and  have  assisted  liberally  with  their  means  and  influence  towards 
securing  a large  and  magnificent  hospital,  which  has  been  moved 
into  within  the  last  few  months.  It  is  capable  of  accommodating 
about  200  patients,  and  has  at  present  about  100.  They  have  per- 
formed many  of  the  principal  surgical  operations  successfully,  and 
are  gaining  not  only  a city  but  a provincial  reputation  for  skill  and 
success. 

Our  secretary  of  the  Canadian  Institute,  Dr.  Robinson,  as  well  as 
Dr.  Emory,  the  gynaecologist  of  the  hospital,  are  placing  their  names 
in  deserving  prominence  as  surgeons,  and,  before  leaving  this  imper- 
fect notice  of  our  Canadian  hospital,  I would  like  to  call  attention 
to  the  brilliant  example  of  toleration  and  unbiassed  fairness  they 
have  given  the  Old-School  hospitals  of  our  country.  All  the  Allo- 
pathic hospitals  of  Canada  compel  the  patient  to  submit  to  the  treat- 
ment of  the  doctor  who  may  be  in  attendance  that  month,  and  it  has 
happened  that  a pay  patient  has  been  under  the  care  of  three  dif- 
ferent doctors  in  the  same  illness.  But  in  the  Homoeopathic  hos- 

11 


162 


world’s  homoeopathic  congress. 


pital  the  patient  takes  his  doctor  from  whatever  school  he  chooses, 
and  can  keep  him  as  long  as  he  wishes,  and  that  one  act  of  fair  deal- 
ing with  the  sick  has  done  very  much  to  make  our  system  popular 
with  most  right-thinking  people. 

But  the  one  thing  that  has  placed  Homoeopathy  in  a better  light 
in  Canada  than  any  other  is  the  fact  that  all  our  medical  matters  are 
governed  by  a Medical  Council,  composed  of  26  members,  5 of  which 
are  Homoeopaths,  12  Allopaths,  and  9 college  men.  This  council 
is  presided  over  by  a president,  and  at  three  different  times  this 
president  has  been  a Homoeopathist.  On  the  Medical  Board  of  Ex- 
aminers, which  grants  the  privilege  to  practice  medicine  in  our 
province,  there  is  one  Homoeopathic  examiner  on  general  subjects, 
so  that  every  practitioner  of  our  country  has  to  have  his  diploma 
ornamented  with  the  name  of  a Homoeopathic  doctor. 

Me  have,  besides,  an  examiner  on  our  special  branches,  so  you 
will  see  that  we  stand  so  high  that  the  most  bigoted  crank  cannot 
point  at  us  as  being  inferior  in  any  medical  attainment,  and  most  of 
the  general  public  think  we  know  the  Allopathic  branches  of  study 
with  Homoeopathy  added. 

The  great  cause  of  our  lack  of  numerical  success  is  the  fact  of 
having  to  educate  our  students  on  this  side  of  the  border;  and  you 
people  are  so  seductive  that  by  the  time  they  get  to  be  a credit  to  us 
you  have  enticed  them  to  stay,  or  they  have  enticed  you  to  permit 
them  to  remain,  I don’t  know  which,  but  they  stay.  Now  what  we 
hope  to  do  shortly  is,  to  have  a college  of  our  own  in  connection 
with  the  hospital  in  Toronto ; and  although  it  has  not  been  opened 
yet,  and  may  not  properly  be  considered  as  a fixed  fact  in  the  progress 
of  Homoeopathy,  still  its  incubation  has  so  far  progressed  that  we 
can  almost  hear  the  chick  peep,  and  when  that  event  matures  we 
hope  to  educate  and  keep  our  boys  at  home,  and  at  the  next  Colum- 
bian Exhibition  make  a better  showing  than  we  are  doing  now. 


HOMOEOPATHY  IN  LONDON,  ENGLAND. 


163 


ADDRESS. 

HOMCEOPATHY  IN  LONDON , ENGLAND . 

By  J.  Cavendish  Molson,  M.D.,  London,  Eng. 


The  Chairman  : Dr.  J.  Cavendish  Molson,  of  the  London 
Hospital,  will  now  be  presented. 

Dr.  Molson,  of  London,  Eng.  Ladies  and  Gentlemen  ; I think 
I have  imbibed  a little  of  the  spirit  of  the  Queen  of  Sheba  this 
morning.  The  question  before  my  mind  is:  “ What  shall  the  man 
do  who  cometh  after  the  king  ?”  in  view  of  the  splendid  addresses 
to  which  we  have  listened  this  morning,  for  there  is  very  little  to 
add.  I am  here  without  my  brief.  I can  give  you  as  my  reason 
for  not  giving  you  exact  particulars  as  to  the  state  of  Homoeopathy  in 
London  as  a mayor  of  one  of  our  western  towns  is  said  to  have  given 
to  Queen  Elizabeth  for  not  ringing  the  bells.  This  mayor  had  eight 
reasons  why  the  city  bells  were  not  rung  in  honor  of  her  majesty’s 
coming  to  town.  Said  he : “ May  it  please  your  majesty,  the  first 
reason  is  that  we  have  no  bells, ” and  Queen  Elizabeth  was  so  sat- 
isfied with  the  first  reason  that  she  dispensed  with  the  other  seven. 
Now,  perhaps  you  will  be  satisfied  with  my  reason  for  not  reading 
a paper  this  morning,  which  is  because  our  president  faithfully 
promised  to  mail  these  necessary  and  precise  particulars  to  me,  and 
day  after  day  I have  gone  full  of  hope  to  the  letter-box,  and  this 
morning  last  of  all,  and  have  found  no  paper.  But  the  paper  shall 
be  forthcoming.  It  would  be  a sin  that  London  should  not  furnish 
you  with  those  particulars  which  you  desire. 

There  are  just  a few  remarks  which  I would  like  to  make  bearing 
on  the  progress  of  Homoeopathy  in  England  and  America.  And, 
by  the  way,  I believe  if  Columbus  were  here  he  would  be  occupying 
the  presidential  chair.  It  would  be  impossible  for  that  man  who 
had  that  veni,  vidi,  vici  spirit  not  to  be  the  pioneer  of  Homoeopathy 
in  this  land.  But  we  have  great  men  in  our  time,  and  among  them 
I desire  to  mention  the  name  of  our  late  lamented  Major  Vaughan 


164 


world’s  homoeopathic  congress. 


Morgan.  This  gentleman  made  an  offer  of  a £1000  per  annum  for 
five  consecutive  years  to  St.  George’s  Hospital  in  London,  the 
offer  being  made  on  these  lines,  that  the  endowed  ward  should  be 
opened  for  the  reception  of  patients  who  should  be  treated  on 
Homoeopathic  principles.  The  offer  was  not  accepted.  I desire  to 
draw  attention  to  two  points  in  connection  with  this  mistake  on  the 
part  of  our  Allopathic  friends.  First  of  all,  the  Allopathic  loss. 
We  are  told  that  Homoeopathy  and  humbug  are  synonymous  or 
equivalent  terms.  What  a splendid  opportunity  was  here  presented 
to  the  dominant  school  to  demonstrate  the  absurdity  and  hum- 
buggery  of  our  method.  But  it  may  be  said,  in  the  language  of 
our  illustrious  bard  : 

“ There  is  a tide  in  the  affairs  of  men 
Which,  taken  at  the  flood,  leads  on  to  fortune: 

Omitted,  all  the  voyage  of  their  life  is  bound 
In  shallows  and  in  miseries.” 

We  have  considered  the  Allopathic  loss;  now  for  the  Homoeo- 
pathic gain.  The  conduct  of  the  hospital  authorities  was  such  that 
the  public  indignation  which  it  aroused  can  be  viewed  in  no  ether 
light  than  a Homoeopathic  gain. 

I would  like  to  call  your  particular  attention  to  the  following 
words,  for  they  embody  in  the  most  logical  manner  the  reasons  for 
the  non-acceptance  of  Major  Morgan’s  magnanimous  offer.  Now 
listen  with  both  ears,  if  you  please : 

“ I do  not  love  you,  Dr.  Fell, 

The  reason  why  I cannot  tell ; 

But  this,  indeed,  I know  full  well, 

I do  not  love  you,  Dr.  Fell.” 

I have  the  fact  noted  in  my  note-book  here,  that  of  755  cases 
treated  in  our  hospital  in  the  past  year,  including  220  operations  of 
all  degrees  of  severity,  we  had  only  11  deaths.  Mr.  Nugshore 
recognizes  the  value  of  the  principle  that  “ In  union  there  is 
strength,”  and  has  been  going  through  our  provinces  and  endeavor- 
ing to  conciliate  the  British  Homoeopathic  Society  on  the  one 
hand  and  to  merge  within  its  fostering  care  branch  societies  on  the 
other  hand.  I believe  I am  correct  in  saying  that  Dr.  Hawkes  be- 
longed to  one  of  these  branch  societies  which  is  now  merged  under 
the  sheltering  wing  of  the  fostering  parent  sister,  the  British  Hom- 
oeopathic Society.  I believe  that  the  future  Homoeopath  will  depend 


HOMOEOPATHY  IN  LONDON,  ENGLAND. 


165 


in  a large  degree  upon  its  representatives.  I have  written  my  notes 
in  shorthand,  and  I cannot  read  them.  That  is  one  of  the  peculi- 
arities of  shorthand  writing.  There  are  men  of  this  stamp  abroad 
who,  when  they  see  a diseased  man  or  woman,  regard  that  individual 
as  a diseased  machine.  That  is  not  the  man  who  is  going  to  set  the 
Thames  on  fire,  as  we  say  in  our  country. 

Then  there  is  another  class  of  practitioners  who  regard  the  dis- 
eased individuals  not  only  as  disorganized  machines,  but  they  recog- 
nize him  as  a human  animal.  And  these  men  are  a step  in  advance 
of  the  others,  but  I think  perhaps  very  often  they  partake  of  the 
spirit  of  the  Chinese  who,  when  the  floods  were  abroad,  bent  all 
their  energies  on  rescuing  a pig  from  the  waters  while  scores  of  their 
fellow-creatures  were  drowned.  What  is  the  highest  type  of  physi- 
cian ? It  is  said  in  the  book  of  books : “ I wish  above  all  things 
that  thou  mayest  prosper  and  be  in  health.”  I would  like  to  in- 
quire who  is  meant  by  “ thou  ?”  “ Thy  whole  spirit  and  soul  and 

body.”  Now,  the  man  who  has  before  him  spirit,  soul  and  body  in 
a diseased  organism  will  be  the  successful  man  and  the  highest  type 
of  physician. 

Sometime  ago  I was  in  a place  called  Bromley,  in  Kent,  and 
there  had  been  a very  able  exponent  of  our  school  of  medicine,  the 
lamented  Dr.  Phillips,  to  whose  memory  there  is  a hospital  erected 
in  that  town.  It  was  said  of  him  when  he  went  to  Bromley,  by  the 
Old-School  men,  “ What  is  this  young  shaver  going  to  do  ?”  Now, 
he  was  a man  that  had  a kind  word  for  every  person  with  whom  he 
came  in  contact;  he  was  a gentlemen,  and  he  was  so  successful  in 
that  district  that  when  I was  there  there  were  seven  horses  in  the 
stable  which  had  to  carry  him  hither  and  thither.  He  died  I be- 
lieve at  the  early  age  of  35,  but  such  was  his  devotion  to  duty,  such 
his  moral  rectitude,  such  his  affection  for  his  patients  that  in  a dying 
state  he  was  literally  carried  into  their  houses  to  prescribe  for  them. 
These  are  the  men  who  are  the  ornaments  of  our  profession,  and  our 
literature  teems  with  the  names  of  such. 

Without  trespassing  on  your  time  any  further,  let  me  draw  your 
attention  to  these  words  in  honor  of  the  illustrious  founder  of  Ho- 
moeopathy : 

There  lived  a man,  a man  of  men, 

A king  on  fancy’s  throne  ; 

We  ne’er  shall  see  his  alike  again. 

The  globe  is  all  his  own. 


166 


world’s  homoeopathic  congress. 


And  if  we  claim  him  of  our  clan 
He  half  belongs  to  you, 

For  Hahnemann,  Friend  Jonathan,  is  yours 
And  also  Europe’s,  too. 

The  Chairman  : Ladies  and  Gentlemen : I am  sure  that  I voice 
the  sentiment  of  every  member  of  the  Congress  when  I extend  to 
our  distinguished  foreign  confreres  our  most  cordial  greetings.  And 
also  our  thanks  for  their  interest  in  Homoeopathy  and  the  success  of 
the  Congress  shown  by  their  presence  with  us.  Our  distinguished 
friend,  Dr.  Bojanus,  of  Russia,  tells  me  that  it  has  been  the  dream 
of  his  life  to  see  his  American  confreres.  Those  of  us  who  can  re- 
member how  few  in  number  in  some  countries  are  Homoeopaths  can 
realize  the  pleasure  afforded  this  gentleman  by  seeing  so  large  a 
delegation  of  believers  in  their  faith  collected  together.  Those  who 
are  here  simply  indicate  to  us  the  intense  interest  in  Homoeopathy 
throughout  the  world. 

I wish  there  was  time  to  read  to  you  all  the  telegrams  and  letters 
that  have  been  received  from  our  illustrious  associates  in  all  other 
lands.  Time,  however,  is  wanting  for  that,  but  to  all  of  them,  in 
every  clime,  we  extend  our  most  sincere  and  cordial  greeting  and 
our  thanks. 

The  hour  for  adjournment  has  now  arrived.  We  shall  be  obliged 
to  make  the  paper  of  Dr.  D.  A.  Strickler,  of  St.  Paul,  Minnesota, 
the  first  order  of  business  to-morrow  morning.  The  meeting  is  now 
adjourned. 

(The  Sections  in  Materia  Medica  and  in  Obstetrics,  held  sessions 
at  3 o’clock  p.m.,  at  each  of  which  several  important  papers  were 
presented  and  discussed  (see  “ Sectional  Meetings  ” in  each  of  those 
subjects). 


FOURTH  DAY’S  SESSION. 

June  2, 1893. 

The  Congress  was  called  to  order  at  11.30  o’clock  by  the  Presi- 
dent, Dr.  J.  S.  Mitchell,  who  announced  that  the  first  address  would 
be  by  Dr.  D.  A.  Strickler,  of  St  Paul,  Minnesota,  which  was  made 
the  special  order  for  this  session. 

Dr.  Strickler’s  address  is  as  follows : 


COMPARATIVE  VITAL  STATISTICS. 


167 


ADDRESS. 

COMPARATIVE  VITAL  STATISTICS—  HOMOE- 
OPATHY vs.  ALLOPATHY. 

By  David  A.  Strickler,  M.D.,  St.  Paul,  Minnesota. 


Ladies  and  Gentlemen : The  young  man  or  the  young  woman  who 
intends  to  read  medicine,  if  not  too  greatly  prejudiced  in  favor  of 
one  or  the  other  school,  naturally  asks  of  each  “ in  what  particulars 
does  it  excel  ?”  The  answer  to  this  question,  however,  interests  not 
only  the  young  man  or  the  young  woman  intending  to  read  medi- 
cine, but  all  mankind. 

We  believe  that  the  Homoeopathic  system  excels  in  many  fea- 
tures, but  it  is  my  purpose  to  speak  of  but  one — the  one  which 
should  interest  all — namely,  the  cure  of  the  sick.  This  belief  is 
founded  partly  on  our  own  individual  experiences  and  successes  in 
the  treatment  of  the  sick.  But  a similar  belief,  similarly  based, 
exists  in  the  minds  of  practitioners  of  all  schools,  hence  counts  for 
naught  with  unprejudiced  investigators. 

Next  comes  our  faith  based  on  recorded  results,  i.e.}  comparative 
vital  statistics.  On  these  the  Homoeopath  places  his  reliance,  and 
well  may  he  do  so. 

It  is  not  my  province  at  this  time  to  give  statistics  of  earlier  days, 
but  I trust  you  will  pardon  me  for  briefly  calling  your  attention  to 
the  comparative  results  in  a few  diseases  which  have  had  much  to  do 
with  creating  and  sustaining  the  faith  that  is  in  us. 

Of  these  take  (1)  Cockburne’s  cholera  statistics,  of  dates  prior  to 
1850.  (See  page  168.) 

Again — the  total  (1)  cholera  statistics  by  Dr.  Jal,  St.  Petersburg, 
Russia,  1840,  were — Allopaths  reported  901,413  cases,  with  462,581 
deaths,  mortality  per  cent.,  51.3  ; Homoeopaths  reported  16,436  cases 
with  1448  deaths,  jnortality  per  cent.,  8.8. 

In  (2)  yellow  fever  in  1878  the  Allopaths  reported  a total  of 
96,187  cases  with  22,296  deaths,  mortality  per  cent.,  23.6;  the 
Homoeopaths  reported  3914  cases  with  261  deaths,  mortality  per 
cent.,  6.6. 


168 


world’s  homceopathic  congress. 


Allopathic. 

Homceopathic. 

Cases. 

Deaths. 

Death 
Rate ; pr.  c. 

Cases. 

Deaths. 

Death 
Rate ; pr.ct. 

Bavaria 

12,703 

6,163 

48.5 

1,269 

85 

:e.7 

Paris 

6,543 

3,374 

51.5 

175 

45 

24.7 

Dundee 

157 

87 

55.5 

173 

48 

27.7 

Stockholm  

4,143 

2,447 

59.7 

76 

6 

8.0 

Christiana 

2,318 

1,506 

65.0 

380 

49 

12.5 

Helsingfors 

3,328 

1,607 

48.2 

1,093 

95 

8.7. 

Copenhagen  

7,515 

4,047 

55.2 

3,016 

264 

8.7 

Paris  Hospitals 

4,203 

3,144 

74.7 

1,270 

108 

8.5 

Sweden  

1,165 

735 

63.0 

1,116 

35 

3.0 

Totals 

42,125 

23,110 

54.8 

8,568 

735 

8.5 

And  so  I might  add  the  statistics  in  pneumonia,  in  typhoid  fever 
and  dysentery.  If  time  permitted  it  could  also  be  shown  that  pri- 
vate and  public  records,  and  records  of  (3)  insane  hospitals  all  tell 
one  and  the  same  story.  Some  of  these  statistics  have  been  assailed 
with  all  the  force  and  bitterness  that  the  ablest  writers  of  the  oppos- 
ing school  could  command,  but  they  stand  to-day,  and  will  ever 
stand,  as  proud  monuments  of  what  Homoeopathy  did  in  its  earlier 
days. 

Dr.  Horatio  C.  Wood  (4)  admits  our  early  comparative  success 
but  accounts  for  it  by  charging  his  predecessors  with  doing  u much 
more  harm  than  good  ” — a charge  which  no  longer  holds  good, 
according  to  the  same  authority.  Our  young  friend  may  here  inter- 
pose “ granting  that  this  was  true  in  an  earlier  day,  the  Allopaths 
claim  to  have  made  wonderful  advances  since  then  ; what  have  you 
to  show  that  you  are  still  ahead  of  them  ?” 

In  answer  to  this  query  we  would  say  that  in  the  (5)  cholera  epi- 
demic of  1873,  statistics  from  eighteen  states  gave  7356  cases  with 
3800  deaths,  mortality  per  cent.,  52;  while  the  recent  European  epi- 
demic of  cholera  served  to  show  that  in  the  treatment  of  this  disease 
the  Allopaths  are  no  more  successful  than  they  \yere  fifty  years  ago 
— the  mortality  per  cent,  being  between  50  and  60;  that  the  records 
in  public  institutions,  such  as  city  hospitals,  (3)  insane  hospitals, 
penitentiaries,  etc.,  where  we  have  been  given  an  opportunity  show 
decidedly  in  our  favor.  Unfortunately  we  have  too  few  public  in- 


COMPARATIVE  VITAL  STATISTICS.  1.69 

stitutions  under  our  control,  and  recent  statistics  are,  consequently, 
somewhat  fragmentary  and  limited. 

It  is  a fact  worthy  of  note  that  our  friends  of  the  Old  School  are 
not  given  to  gathering  statistics  showing  comparative  results  of 
treatment  under  the  two  dominant  schools  of  medicine.  I have  been 
a pretty  general  reader  of  medical  literature  for  the  past  twelve 
years  or  more,  and  have  aimed  to  read  all  that  I could  find  said 
against  us,  but  I do  not  recall  a single  instance  in  which  the  writer 
gave  statistics  claiming  superior  results  in  treatment  over  us.  The 
apparent  need  of  recent  full  and  reliable  comparative  vital  statistics 
led  me  to  commence  an  investigation  of  the  health  offices  in  the 
three  largest  cities  in  the  State  of  my  adoption,  Minnesota,  in  June 
of  1891.  The  results  of  this  investigation  were  given  in  an  address 
(6)  before  the  Minnesota  State  Institute  of  Homoeopathy  in  May, 
1892,  and  the  State  Institute  was  urged  to  instruct  its  delegates  to 
the  American  Institute  of  Homoeopathy  to  bring  the  matter  before 
that  body,  and  see  whether  it  would  not  take  up  the  work  of  collect- 
ing comparative  results  from  the  Boards  of  Health  in  all  of  the  more 
important  cities  throughout  the  United  States.  Suffice  it  to  say  that 
the  American  Institute  of  Homoeopathy  assumed  charge  of  the  work, 
and  by  the  Chairman  of  the  Bureau  of  Organization,  Registration 
and  Statistics,  the  collection  of  these  statistics  was  placed  in  my 
hands. 

It  was  decided  to  have  blank  forms  printed  and  sent  to  the  dif- 
ferent cities  where  statistics  were  to  be  collected,  so  that  the  work  in 
all  cities  should  be  made  in  accordance  with  one  general  plan.  After 
consultation  with  different  persons  interested  in  and  familiar  with 
the  character  of  the  work,  it  was  thought  best  to  have  five  forms 
printed  for  distribution.  Form  No.  1 calling  for  the  number  of 
cases  of  and  deaths  from  small-pox,  typhoid  fever,  scarlet  fever, 
measles,  diphtheria  and  mumps,  reported  by  physicians  of  the  Allo- 
pathic and  Homoeopathic  schools  respectively. 

Form  No.  2 calling  for  the  number  of  births  reported  by  members 
of  each  of  the  two  schools,  together  with  the  number  of  deaths  re- 
ported from  puerperal  causes  under  the  various  headings  of  puer- 
peral septicaemia,  puerperal  fever,  puerperal  eclampsia,  affections  of 
pregnancy,  uterine  haemorrhage,  and  dystocia,  reported  by  each 
school.  This  form  further  calling  for  the  premature  and  still  births 
reported  by  each  school. 

Form  No.  3 calling  for  the  deaths  from  acute  stomach  and  bowel 


170 


WORLD  S HOMCEOPATHIC  CONGRESS. 


diseases,  from  acute  respiratory  diseases,  from  violence,  and  from  all 
causes,  reported  by  members  of  each  of  the  two  schools. 

Form  No.  4 calling  for  a tabulated  list  of  the  deaths  reported  by 
the  Coroner,  and  the  number  of  cases  and  deaths  reported  by  the 
physicians  having  charge  of  the  city  poor — city  physicians’  cases 
and  deaths. 

Form  No.  5 calling  for  cases  of  and  deaths  from  typhus  fever, 
cerebro-spinal  meningitis,  varicelli,  pertussis,  erysipelas  and  leprosy, 
reported  by  members  of  each  school. 

Form  No.  5 is  readily  seen  to  be  of  limited  application.  The 
forms  are  based  on  the  requirements  of  the  Board  of  Health  in  New 
York  City,  which  requires  the  maximum  number  of  diseases  re- 
ported, and  as  the  greater  includes  the  less,  it  is  believed  that  the 
forms  include  all  that  is  reported  in  any  city. 

The  next  thing  in  order  was  to  find  some  suitable  person  or  per- 
sons in  each  city  to  fill  these  blanks.  That  we  were  successful  in 
this  I think  the  following  names  of  well-known  physicians  and  sur- 
geons will  attest. 

Philadelphia  reported  by  Dr.  H.  L.  Northrop  under  auspices  of 
the  Homoeopathic  Medical  Society  of  Philadelphia  County ; St. 
Louis,  by  Dr.  C.  M.  Ustick  ; Baltimore,  by  Dr.  W.  Dulaney  Thomas 
(7);  San  Francisco,  by  Dr.  Hayes  C.  French  under  auspices  of  Ho- 
moeopathic Medical  Society  of  San  Francisco;  Cincinnati,  by  Dr. 
A.  E.  Goldsmith,  of  Home  City,  O. ; Detroit,  by  Dr.  Rollin  H. 
Stevens;  Minneapolis,  by  Dr.  William  E.  Leonard  under  auspices 
of  the  Minneapolis  Homoeopathic  Medical  Society ; Rochester,  by 
Dr.  H.  M.  Hoyt;  St.  Paul,  by  myself ; Kansas  City,  by  Dr.  S.  C. 
Delap,  in  behalf  of  faculty  of  Kansas  City  Homoeopathic  Medical 
College ; Providence,  by  Dr.  George  B.  Peck  ; Denver,  by  Dr.  J.  M. 
Walker;  Indianapolis,  by  Dr.  O.  S.  and  Solis  Runnels;  Allegheny, 
by  Dr.  J.  Ritchey  Horner ; Syracuse,  by  Dr.  E.  E.  Keeler ; Nash- 
ville, by  Dr.  B.  H.  Enloe;  Dayton,  by  Dr.  Frank  D.  Bittinger; 
Duluth,  by  Dr.  F.  C.  Bowman ; Seattle,  by  Dr.  E.  Weldon  Young; 
and  Lincoln,  by  Dr.  Benjamin  F.  Bailey  (work  done  by  health  offi- 
cers) (8). 

The  work  of  nearly  all  of  these  shows  evidence  of  much  pains- 
taking care,  and  if  the  reports  are  not  full,  it  is  because  the  cases 
are  poorly  reported  in  a large  number  of  cities  and  in  many  in- 
stances the  records  are  very  indifferently  kept.  It  is  a source  of 
great  disappointment  to  me,  and  I know  it  will  be  to  all  of  you,  to 


COMPARATIVE  VITAL  STATISTICS. 


171 


know  that  so  little  attention  and  care  are  given  to  the  reporting  of 
contagious  diseases  by  physicians  all  over  the  country — and  I seri- 
ously question  whether  we  are  not  the  greater  sinners  in  this  direc- 
tion— that,  with  a few  exceptions,  the  records  of  cases  of  contagious 
diseases  are  of  little  value.  I shall  not,  however,  deviate  from  my 
original  plan,  but  shall  present  to  you  all  the  facts  learned  by  this 
investigation  so  that  you  may  see  for  yourselves  not  only  that  there 
is  no  effort  to  hide  anything,  but  also  that  there  is  a crying  need  of 
reform  in  the  matter  of  reporting  cases  of  contagious  diseases  and 
births  in  nearly  every  city  in  the  United  States. 

The  results  obtained  are  given  in  a series  of  tables  which  I now 
submit  (9). 

Table  No.  1. — Measles. 


Cities. 

Year. 

Allopathic. 

Homceopathic. 

Cases. 

Deaths. 

Mortality 
per  ct. 

Cases. 

Deaths. 

Mortality 
per  ct. 

1892 

70 

5 

St.  Louis 

1891 

742 

49 

6.6 

162 

0 

0 

Baltimore 

1891 

227 

16 

7.05 

8 

0 

0 

Baltimore 

1892 

3451 

119 

3.45 

291 

1 

0.34 

San  Francisco 

1892 

26 

0 

0 

Cincinnati 

1892 

664 

17 

2.55 

57 

0 

0 

Detroit 

1892 

21 

1 

Minneapolis 

1891 

845 

14 

1.66 

186 

3 

1.61 

Minneapolis 

1892 

926 

31 

3.35 

254 

1 

0.39 

Kansas  City 

1891 

14 

2 

14.3 

0 

o 

Kansas  City... 

1892 

80 

0 

0 

17 

0 

0 

Providence 

1891 

2 

1 

Providence 

1892 

9 

0 

Denver 

1891 

29 

11 

37.93 

6 

1 

16.66 

Denver 

1892 

61 

2 

3.28 

6 

0 

0 

Indianapolis 

1891 

1064 

9 

0.85 

51 

0 

0 

Indianapolis 

1892 

396 

4 

1 

0 

0 

0 

Allegheny 

1892 

21 

o 

Syracuse 

1892 

9 

o 

Nashville 

1890 

3 

Nashville 

1891 

95 

23 

34.21 

60 

1 

1.66 

Nashville 

1892 

2 

Duluth 

1891 

3 

o 

Lincoln 

1892 

5 

0 

The  blanks  ( ) indicate  cases  not  reported. 


172 


WORLD  S HOMOEOPATHIC  CONGRESS. 


Table  No.  2. — Typhoid  Fever. 


Cities. 

Year. 

Allopathic. 

Homoeopathic. 

Death 

Ratio. 

Physicians’ 

Ratio. 

Cases. 

Deaths. 

Mortality 
pr.  ct. 

Cases. 

Deaths. 

Mortality 
per  ct.  I 

A. 

H. 

A. 

H. 

1892 

2022 

365 

18.05 

333 

60 

18.01 

6.08 

1 

1 

St.  Louis 

1892 

2928 

339 

11.58 

407 

40 

9.83 

8.47 

1 

6.5 

1 

St.  Louis 

1891 

236 

168 

71.18 

42 

14 

33.33 

12. 

1 

6.5 

1 

Baltimore 

1891 

224 

189 

84.37 

5 

8 

? 

24.87 

1 

15.12 

1 

1892 

262 

217 

82.82 

7 

? 

31. 

1 

15.12 

1 

1892 

99 

4 

24.75 

1 

7.45 

1 

Cincinnati 

1892 

222 

130 

58.55 

3 

8 

? 

16.25 

1 

7.5 

1 

19 

5 

3.8 

1 

7.12 

1 

Minneapolis 

1891 

522 

76 

14.65 

60 

17 

28.33 

4.47 

1 

5.23 

1 

Minneapolis 

1892 

436 

60 

16. 

25 

5 

20. 

12. 

1 

5.23 

1 

Rochester 

257 

57 

22.19 

51 

22 

43.13 

2.59 

1 

4.25 

1 

St.  Pa.nl 

1890 

58 

7 

8.29 

1 

6.36 

1 

St  Pa.nl 

1891 

54 

4 

13.5 

1 

1 

St.  Pa.nl  

1892 

58 

4 

14.5 

1 

6.36 

1 

Transas  C!ity 

1891 

51 

5 

10.2 

1 

7.22 

1 

Transas  C!ity 

1892 

41 

4 

10.25 

1 

7.22 

1 

Providence 

1891 

154 

41 

26.62 

22 

11 

50. 

3.73 

1 

3.57 

1 

Providence 

1892 

104 

28 

26.92 

21 

6 

28.57 

4.66 

1 

3.57 

1 

Denver 

1891 

54 

94 

? 

18 

5 

27.77 

18.8 

1 

5.66 

1 

Denver 

1892 

64 

58 

90.63 

13 

6 

46.15 

9.66 

1 

5.66 

1 

Tnrlia.na.pnlis  .... 

1891 

32 

2 

16. 

1 

2.8 

1 

Tn  ri  i an  a.pnl  is 

1892 

61 

3 

20. 

1 

21.8 

1 

Allegheny 

1892 

119 

7 

17. 

1 

7.61 

1 

Syracuse 

1892 

33 

1 

33. 

1 

8.47 

1 

"Washyillft 

1390 

74 

2 

37. 

1 

18.91 

1 

"Nasi1  viBft 

1891 

21 

79 

? 

2 

39.5 

1 

18.91 

1 

"Was?)  vUift 

1892 

69 

0 

69. 

0 

18.91 

1 

Dayton 

1892 

58 

33 

56.89 

52 

2 

3.85 

16.5 

1 

8.58 

1 

Blanks  ( ) indicate  cases  not  reported. 


COMPARATIVE  VITAL  STATISTICS. 


173 


Table  No.  3. — Diphtheria. 


Cities. 

Year. 

Allopathic. 

Homoeopathic. 

Death 

Ratio. 

Physician’s 

Ratio. 

Cases. 

Deaths. 

Mortality 
per  ct. 

Cases. 

Deaths. 

Mortality 
per  ct. 

A. 

H. 

A.. 

H. 

St,  Louis 

1892 

636 

265 

41.67 

101 

28 

27.72 

9.15 

1 

6.5 

1 

Baltimore 

1891 

779 

350 

44.91 

38 

17 

43.65 

20.6 

1 

15.12 

1 

Baltimore 

1892 

753 

358 

47.54 

41 

30 

73.17 

11.93 

1 

15.12 

1 

1892 

248 

11 

22.55 

1 

7.45 

1 

Cincinnati 

1892 

1063 

290 

27. 28 

71 

31 

43.22 

9.36 

1 

7.50 

1 

Detroit 

1892 

980 

212 

21.63 

171 

42 

24.56 

5. 

1 

7.12 

1 

Minneapolis 

1891 

285 

91 

31.93 

62 

13 

20.97 

7. 

1 

5.23 

1 

Minneapolis 

1892 

246 

57 

23.17 

53 

12 

22.65 

4.75 

1 

5.23 

1 

Rochester 

420 

198 

47.14 

150 

56 

36. 

5.5 

1 

4.25 

1 

St.  Paul 

1890 

332 

111 

33.33 

25 

9 

36. 

12.33 

1 

6.37 

1 

St.  Paul 

1891 

289 

99 

30.8 

11 

2 

18.18 

49.5 

1 

6.37 

1 

St.  Paul 

1892 

346 

148 

42.77 

25 

4 

16. 

37. 

1 

6.37 

1 

Kansas  City 

1891 

80 

43 

53.75 

26 

2 

7.69 

21.5 

1 

7.22 

1 

Kansas  City 

1892 

74 

13 

17.57 

13 

4 

30.76 

3.25 

1 

7.22 

1 

Providence 

1891 

116 

30 

25.86 

19 

4 

21.05 

7.5 

1 

3.57 

1 

Providence 

1892 

89 

19 

21.35 

14 

3 

21.43 

6.33 

1 

3.57 

1 

Denver 

1891 

339 

123 

36.58 

73 

21 

28.77 

5.86 

1 

5.66 

1 

Denver , 

1892 

241 

75 

31.12 

46 

10 

21.74 

7.5 

1 

5.66 

1 

Indianapolis  .... 

1891 

612 

164 

26.8 

46 

9 

19.57 

18.22 

1 

21.8 

1 

Indianapolis  .... 

1892 

500 

155 

31. 

25 

11 

44. 

14.1 

1 

21.8 

1 

Allpghpny 

1892 

86 

7 

12.29 

1 

7.61 

1 

Syracuse  

1892 

100 

52 

52. 

5 

2 

40. 

26. 

1 

8.47 

1 

Nashville 

1890 

22 

4 

18.18 

7 

1 

14.3 

4. 

1 

18.91 

1 

Nashville 

1891 

5 

10 

20.  ? 

0 

0 

0. 

10. 

0 

18.91 

1 

Nashville 

1892 

18 

7 

39. 

2 

2 

100. 

3.5 

1 

18.91 

1 

Dayton 

1892 

70 

33 

47.14 

56 

5 

8.91 

6.6 

1 

8.58 

1 

Duluth 

1891 

158 

26 

16.46 

22 

7 

31.82 

3.7 

1 

7.93 

1 

Duluth 

1892 

96 

32 

33.33 

14 

6 

42.83 

5.33 

1 

7.93 

1 

Lincoln 

1892 

116 

31 

26.72 

35 

9 

25.71 

3.44 

1 

4.13 

1 

174 


world’s  homoeopathic  congress. 


Table  No.  4. — Scarlet  Fever. 


Cities. 

Year. 

Allopathic. 

Homoeopathic. 

Cases. 

Deaths. 

Mortality 
per  ct. 

Cases. 

Deaths. 

Mortality 
per  ct. 

Philadelphia 

1892 

5213 

395 

7.58 

1053 

71 

6.74 

St.  Louis 

1891 

813 

95 

10.46 

138 

5 

3.62 

Baltimore 

1891 

1311 

128 

9.76 

71 

8 

11.26 

Baltimore 

1892 

2495 

250 

10. 

168 

9 

5.36 

1892 

96 

1 

Cincinnati 

1892 

688 

43 

6.25 

66 

1 

1.61 

Detroit 

1892 

705 

106 

4 15.03 

149 

12 

8.05 

Detroit 

1891 

706 

56 

7.93 

130 

2 

1.54 

Minneapolis 

1891 

531 

34 

6.4 

191 

5 

2.63 

Minneapolis 

1892 

636 

52 

8.18 

193 

5 

2.59 

Rochester 

1892 

679 

57 

8.54 

209 

16 

7.65 

St.  Paul 

1890 

334 

26 

7.78 

56 

1 

1.79 

St.  Paul 

1891 

359 

22 

6.13 

93 

2 

2.15 

St.  Paul 

1892 

307 

20 

6.51 

71 

0 

0 

Kansas  City 

1891 

185 

6 

3.24 

26 

0 

0 

Kansas  City 

1892 

168 

7 

4.17 

44 

2 

4.54 

Proyidence 

1891 

190 

14 

7.37 

45 

0 

0 

Providence 

1892 

199 

23 

11.56 

48 

4 

8.33 

Denver 

1891 

189 

13 

6.87 

56 

4 

7.14 

Denver 

1892 

689 

52 

7.55 

114 

5 

4.39 

Indianapolis 

1891 

355 

12 

3.38 

51 

1 

1.96 

Indianapolis 

1892 

258 

7 

2.7 

12 

0 

0 

Allpghpny 

1892 

38 

o 

Syracuse 

1892 

61 

1 

1.64 

13 

0 

0 

Nashville 

1890 

13 

2 

15.4 

4 

0 

0 

Nashville 

1891 

43 

3 

7. 

3 

0 

0 

Nashville 

1892 

32 

0 

0. 

8 

0 

0 

Dayton 

1892 

6 

3 

5.0 

7 

0 

0 

COMPARATIVE  VITAL  STATISTICS, 


175 


Table  No.  5. — Obstetrical , No.  1. 


Cities. 

Year. 

Allopathic. 

Homoeopathic. 

Cases. 

Deaths. 

Mortality 
per  ct. 

Cases. 

[Deaths.  1 

Mortality 
per  ct.* 

St.  Louis 

1892 

3101 

99 

3.13 

740 

15 

2.03 

Baltimore 

1891 

2935 

97 

3.30 

229 

2 

0.87 

Baltimore 

1892 

3124 

107 

3.42 

172 

0 

0 

1892 

168 

5 

Cincinnati 

1892 

2619 

131 

5. 

280 

6 

2.14 

1892 

26 

2 

Minneapolis 

1891 

1304 

30 

2.3 

386 

1 

0.26 

Minneapolis 

1892 

1557 

30 

1.93 

460 

4 

0.87 

Rochester 

1892 

1076 

20 

1.36 

420 

6 

1.43 

St.  Paul 

1890 

1068 

25 

2.34 

166 

5 

3. 

St.  Paul 

1891 

1559 

19 

1.22 

185 

1 

0.54 

St.  Paul 

1892 

2068 

23 

1.11 

227 

0 

0 

Kansas  City 

1891 

1971 

42f 

2.13 

152 

1 

0.66 

Kansas  City 

1892 

2102 

25f 

1.19 

145 

0 

0 

Providence 

1891 

13 

1 

Providence 

1892 

15 

7 

Denver 

1891 

20 

1 

Denver 

1892 

Indianapolis 

1891 

19 

0 

Indianapolis 

1892 

1888 

8 

0.42 

56  • 

0 

0 

Allegheny 

1892 

28 

1 

Syracuse  

1892 

1179 

4 

0.35 

189 

0 

0 

Nashville 

1890 

618 

7 

1.13 

47 

0 

0 

Nashville 

1891 

801 

16 

2. 

66 

0 

0 

Nashville 

1892 

848 

7 

0.82 

71 

0 

0 

Duluth 

1891 

726 

4 

0.55 

71 

1 

1.41 

Duluth 

1892 

540 

3 

0.56 

62 

0 

0 

Seattle 

1892 

404 

5 

1.21 

96 

o 

o 

T4nn.nl n 

1892 

26 

6 

The  blanks  ( ) indicate  cases  not  reported. 

f Includes  “ Peritonitis,”  “ Septicsemia  ” of  females  between  14  and  45  years  of  age. 


176 


world’s  homoeopathic  congress. 


Table  No.  6. — Obstetrical  No.  2. 


Cities. 

Yr. 

Puerperal 

Septicsemia 

Puerperal 

Fever. 

Puerperal . 
Eclampsia. 

Affect’ ns  of 
Pregnancy. 

Uterine 

Bsemor'age 

Dystocia. 

Alio. 

Horn. 

Alio. 

Horn. 

Alio. 

Horn. 

Alio.  Horn. 

Alio. 

Horn. 

Alio. 

Horn. 

St.  Louis 

1892 

36 

4 

28 

3 

8 

3 

13 

4 

2 

12 

2 

Baltimore  

91 

23 

28 

11 

4 

1 

5 

1 

26 

Baltimore  

92 

17 

38 

15 

23 

3 

11 

San  Francisco 

92 

29 

1 

87 

3 

7 

28 

1 

8 

9 

Cincinnati 

92 

84t 

5f 

16 

26 

5 

1 

Detroit 

92 

20 

0 

6 

2 

Minneapolis  ... 

91 

13 

13 

1 

1 

2 

1 

Minneapolis ... 

92 

8 

1 

13 

3 

1 

2 

1 

2 

3 

Rochester  

92 

3 

1 

7 

2 

5 

1 

4 

2 

1 

St.  Paul 

90 

8 

1 

11 

1 

0 

2 

3 

3 

1 

St.  Paul 

91 

8 

7 

3 

1 

1 

St.  Paul 

92 

5 

10 

1 

1 

6 

Kansas  City.... 

91 

34: 

1 

3 

0 

0 

0 

1 

0 

0 

0 

Kansas  City.... 

92 

19| 

0 

3 

0 

1 

0 

0 

0 

2 

0 

Providence 

91 

5 

2 

2 

2 

1 

2 

Providence 

92 

1 

5 

3 

2 

1 

1 

2 

2 

2 

1 

Denver 

91 

10 

1 

17 

3 

Denver 

92 

Indianapolis... 

91 

4 . 

7 

2 

4 

2 

Indianapolis... 

92 

i 

1 

5 

Allegheny  

92 

6 

0 

12 

0 

2 

3 

5 

1 

Syracuse 

92 

2 

1 

1 

Nashville 

90 

2 

4 

1 

Nashville 

91 

4 

3 

4 

4 

1 

Nashville 

92 

2 

3 

1 

1 

Duluth 

91 

3 

1 

1 

Duluth 

92 

2 

1 

Seattle 

92 

2 

3 

Lincoln 

92 

1 

1 

4 

18 

3 

4 

2 

Blanks  ( ) indicate  cases  not  reported. 

t Includes  Puerperal  Septicsemia. 

j Includes  Peritonitis  and  Septicsemia  of  females  between  14  and  45  years  of  age. 


Table  No.  7. — From,  Form 


COMPARATIVE  VITAL  STATISTICS. 


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Under  head  of  “ Cerebro-Spinal  Meningitis  ” are  classed  all  acute  non-tubercular  diseases  of  Brain  and  Chord  and  Meninges. 


178 


WORLD  S HOMOEOPATHIC  CONGRESS. 


Table  No.  8. — Ratio  of  Work  Reported , and  of  Physicians. 


Cases  Reported. 

Philadelphia. 

1892. 

St.  Louis. 
1891  and  1892. 

Baltimore. 
1891  and  1892. 

San  Francisco. 
1892. 

Allop. 

Horn. 

All  op. 

Horn. 

Allop. 

Horn. 

a liop. 

Horn. 

Typhoid  Fever 

2022 

333 

236 

42 

484 

5 

Scarlet  Fever 

5213 

1053 

813 

138 

3,806 

239 

742 

162 

3,678 

299 

Diphtheria 

636 

101 

1,531 

79 

3101 

740 

6,059 

407 

7235 

1386 

3456 

1590 

15,559 

1023 

Ratio,  cases  reported 

5.22 

1 

5.31 

1 

15.21 

1 

Physicians  reporting 

2036 

(3)  394 

(1)  637 

98 

(1)  771 

51 

(1)  700 

94 

Ratio  physicians 

5.17 

1 

6.5 

1 1 

15.12 

1 

7.45 

1 

Cincinnati. 

Detroit. 

Minneapolis. 

Rochester. 

(First  >2  of  1892.) 

1892. 

1891  and  1892. 

1891  and  1892  * 

1892. 

Cases  Reported. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Typhoid  Fever 

222 

3 

958 

85 

257 

51 

Scarlet  Fever 

688 

66 

1411 

279 

1167 

384 

679 

209 

Measles 

664 

57 

1771 

440 

Diphtheria 

1063 

71 

980 

171 

531 

115 

420 

150 

Births 

2619 

280 

2861 

846 

1076 

420 

Totals 

5256 

477 

2391 

450 

7288 

1870 

2432 

830 

Ratio,  cases  reported 

11.02 

1 

5.31 

1 

3.89 

1 

2.93 

1 

Physicians  reporting 

450 

60 

(1)  349 

49 

(3)  277 

53 

(1)  234 

55 

Ratio,  Physicians 

7.5 

1 

712 

1 

5.23 

1 

4.25 

1 

St.  Paul. 

Kansas  City. 

Providence. 

Denver. 

1890,  ’91  & ’92. 

1891  and  1892. 

1891  and  1892. 

1891  and  1892. 

Cases  Reported. 

* 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Tvphoid  Fever 

258 

43 

118 

31  1 

Scarlet  Fever 

1000 

220 

353 

70 

389 

93 

878 

170 

Measles 

90 

12  ! 

Diphtheria 

967 

61 

154 

39 

214 

33 

580 

119 

Births 

4695 

578 

4073 

299 

Totals 

6662 

859 

4580 

408 

861 

169 

1666 

332 

Ratio,  cases  reported 

7.75 

1 

11.2 

1 

5.09 

1 

5 

i i 

Physicians  reporting 

(1)  172 

27 

(1)  267 

37 

(2)  107 

30 

(1)340 

60 

Ratio,  Physicians 

6.37 

1 

7.22 

1 

3.57 

1 

5.66 

1 

COMPARATIVE  VITAL  STATISTICS. 


179 


Table  8. — (Concluded). 


Cases  Reported. 

Indianapolis. 
1891  and  1892. 

Allegheny. 

1892. 

Nashville. 
1890,  ’91  & ’92. 

Syracuse. 

1892. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

1 

| 

21 

0 

1 



613 

63 

88 

17 

61 

13 

1460 

51 

95 

60 

1112 

71 

45 

9 

100 

5 

2267 

184 

1179 

189 

Totals 

3185 

185 

0 

0 

2516 

270 

1340 

207 

17.22 

1 

9.32 

1 

6.47 

1 

Physicians  reporting 

(3)  305 

14 

(1)  137 

18 

(3)  208 

(3)11 

166 

19 

Ratio,  physicians 

21.8 

1 

7.61 

1 

18.91 

1 

3.74 

1 

Dayton. 

Duluth. 

Seattle. 

Lincoln. 

1892. 

1891  and  1892. 

1892. 

1892. 

Cases  reported. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Allop. 

Horn. 

Typh  nid  Foyor 

58 

52 

701 

59 

Scarlet  Fever 

6 

7 

109 

11 

66 

9 

Measles 

Diphtheria 

70 

56 

254 

36 

116 

35 

Births 

1206 

133 

404 

96 

Totals 

134 

115 

2330 

259 

404 

96 

182 

44 

Ratio,  cases  reported 

1.65 

1 

9 

1 

4.21 

1 

3.91 

1 

Physicians  reporting 

(3)  103 

12 

(3)  50 

7 

(3)  115 

16 

(1)  62 

15 

Ratio,  Physicians 

8.58 

1 

7.14 

1 

77.19 

1 

4.13  , 

1 

Blanks  ( ) indicate  cases  not  reported. 

(1)  Physician’s  report. 

(2)  Members  of  two  State  Societies. 

(3)  From  3d  edition  Medical  and  Surgical  Register  (Polk). 


180 


WORLD  S HOMOEOPATHIC  CONGRESS, 


Table  No.  9. — From  Form  No.  3,  “ Deaths 


Cities. 

Year. 

Acute  Stom’ch& 
Bowel  Diseases. 

Death 

Ratio. 

Acute  Respira- 
tory Diseases. 

Death 

Ratio. 

Allop. 

Horn. 

A. 

I H. 

Allop. 

Horn. 

A. 

H. 

St.  Louis 

1892 

808 

67 

12.1 

1 

1415 

83 

17.1 

1 

Baltimore 

1891 

1083 

42 

25.8 

1 

1396 

46 

30.35 

1 

Baltimore 

1892 

1307 

47 

27.8 

1 

1107 

42 

26.35 

1 

San  Francisco 

1892 

563 

12 

47.08 

1 

1966 

49 

40.12 

1 

Cincinnati 

1892 

464 

44 

10.54 

1 

902 

61 

14.78 

1 

Detroit 

1891 

314 

33 

9.52 

1 

328 

41 

8. 

1 

Minneapolis 

1891 

188 

36 

5.22 

1 

279 

41 

6.8 

1 

Minneapolis 

1892 

223 

33 

6.76 

1 

314 

42 

7.47 

1 

Rochester 

1892 

303 

67 

4.52 

1 

541 

95 

5.69 

1 

St.  Paul 

1890 

230 

15 

15.33 

1 

197 

32 

6.13 

1 

St.  Paul 

1891 

167 

19 

8.79 

1 

279 

17 

16.23 

1 

St.  Paul 

1892 

205 

12 

17.1 

1 

256 

32 

8. 

1 

Kansas  City 

1891 

133 

7 

19. 

1 

218 

10 

21.8 

1 

Kansas  City 

1892 

154 

7 

22. 

1 

203 

7 

29. 

1 

Providence 

1891 

169 

19 

8.9 

1 

251 

33 

7.61 

1 

Providence 

1892 

219 

26 

8.42 

1 

280 

47 

5.96 

1 

Denver 

1891 

193 

23 

8.39 

1 

391 

37 

10.57 

1 

Denver 

1892 

179 

9 

19.9 

1 

175 

19 

9.21 

1 

Indianapolis 

1891 

178 

4 

44.5 

1 

285 

1 

285. 

1 

Indianapolis 

1892 

140 

7 

20.1 

1 

183 

2 

91.5 

1 

Allegheny 

1892 

349 

15 

25.27 

1 

387 

24 

16.12 

1 

Syracuse 

1892 

223 

27 

8.28 

1 

415 

35 

12.57 

1 

Nashville 

1890 

229 

12 

19. 

1 

125 

6 

20.8 

1 

Nashville 

1891 

193 

9 

21.44 

1 

229 

9 

23.1 

1 

Nashville 

1892 

183 

7 

26.14 

1 

175 

13 

18.5 

1 

Dayton 

1892 

124 

5 

24.8 

1 

116 

13 

9. 

1 

Duluth 

1891 

79 

2 

39.5 

1 

65 

2 

32.5 

1 

Duluth 

1892 

66 

3 

22. 

1 

35 

4 

8.75 

1 

Seattle 

1892 

39 

3 

13. 

1 

63 

9 

7. 

1 

Lincoln 

1892 

79 

6 

16.2 

1 

105 

16 

5.56 

1 

From  all 

Ratio  of  cases 

Ratio  of 

causes. 

Reported. 

Physicians. 

St.  Louis 

1892 

3197 

237 

13.47 

1 

5.32 

1 

6.5 

1 

Baltimore 

1891 

9501 

356 

26.69 

1 

15.21 

1 

15.12 

1 

Baltimore 

1892 

9513 

481 

19.78 

1 

15.21 

1 

15.12 

1 

COMPARATIVE  VITAL  STATISTICS, 


181 


Table  9. — (Concluded). 


Cities. 

Year. 

From  all 
Causes. 

, Death 
Ratio. 

Ratio  of  Cases 
Reported. 

Ratio  of 
Physicians. 

Allop. 

Horn. 

A. 

H. 

Allop. 

Horn. 

A. 

II. 

1892 

6674 

198 

33.71 

1 

1 

7.45 

1 

Cincinnati 

1892 

5150 

381 

13.52 

1 

11.02 

1 

7.5 

1 

Detroit 

1891 

1057 

137 

7.79 

1 

5.31 

1 

7.12 

1 

Minneapolis 

1891 

1601 

295 

5.42 

1 

3.89 

1 

5.23 

1 

Minneapolis 

1892 

1690 

305 

5.54 

1 

3.89 

1 

4.25 

1 

Rochester 

1892 

2068 

460 

4.5 

1 

2.93 

1 

4.25 

1 

St.  Paul 

1890 

1440 

154 

9.35 

1 

7.75 

1 

6.37 

1 

St.  Paul 

1891 

1628 

141 

11.54 

1 

7.75 

1 

6.37 

1 

St.  Paul 

1892 

1464 

137 

10.6 

1 

7.75 

1 

6.37 

1 

Kansas  City 

1891 

1620 

82 

19.75 

1 

11. 

1 

7.22 

1 

Kansas  City 

1892 

1526 

90 

16.96 

1 

11. 

1 

7.22 

1 

Providence 

1891 

1692 

273 

6.2 

1 

5.09 

1 

3.57 

1 

Providence 

1892 

1734 

302 

5.14 

1 

5.09 

1 

3.57 

1 

"Dpnypr  

1891 

1 

5. 

1 

5.66 

1 

Denver 

1892 

1 

5. 

1 

5.66 

1 

Indianapolis 

1891 

1874 

1873 

25.66 

1 

17.43 

1 

21.8 

1 

Indianapolis 

1892 

2116 

53 

39.92 

1 

17.43 

1 

21.8 

1 

Allegheny 

1892 

1921 

137 

14.08 

1 

0. 

1 

7.61 

1 

Syracuse 

1892 

1505 

155 

9.71 

1 

6.47 

1 

8.47 

1 

Nashville 

1890 

1152 

78 

14.77 

1 

9.32 

1 

18.91 

1 

Nashville.. 

1891 

1445 

74 

19.52 

1 

9.32 

1 

18.91 

1 

Nashvillf* 

1892 

1263 

85 

14.86 

1 

9.32 

1 

18.91 

1 

Dayton 

1892 

687 

52 

13.21 

1 

9. 

1 

8.58 

1 

Duluth 

1891 

1 

9. 

1 

7.93 

1 

Duluth 

1892 

1 

9. 

1 

7.93 

1 

Seattle 

1892 

346 

51 

6.8 

1 

4.21 

1 

7.19 

1 

Lincoln 

1892 

428 

67 

6.39 

1 

4.14 

1 

4.13 

1 

These  tables,  showing  as  they  do  the  results  of  a very  large 
amount  of  labor  in  many  different  cities,  cannot  be  studied  with  any- 
thing like  the  care  they  deserve  in  the  few  minutes  now  at  our  dis- 
posal. It  is  out  of  the  question  for  me  to  go  into  details,  or  to  con- 
sider the  cities  separately  in  the  short  time  allotted  me.  I will, 
therefore,  simply  call  your  attention  to  some  general  features  of  the 


182 


world’s  homceopathic  congress. 


different  tables,  leaving  it  for  you  to  study  them  more  in  detail  at 
your  leisure.  I invite  you  to  make  such  study,  as  I believe  you  will 
find  it  both  interesting  and  profitable. 

Taking  the  tables  up  in  the  order  given,  we  have  first,  Measles. 
The  only  cities  in  which  there  is  any  pretence  of  reporting  cases,  are 
St.  Louis,  Baltimore;  Cincinnati,  Minneapolis,  Kansas  City,  Denver, 
Indianapolis,  and  Nashville  in  1891.  These  cities  report  totals  as 
follows  : Allopaths,  8656  cases  with  297  deaths,  mortality  per  cent., 
3.43 ; Homoeopaths,  1098  cases  with  7 deaths,  mortality  per  cent., 
0.64. 

It  is  questionable  whether  in  Baltimore  in  1891,  Kansas  City, 
Denver,  Indianapolis,  in  1892,  and  Nashville  with  an  Allopathic 
total  of  568  cases  reported  and  54  deaths,  mortality  per  cent.,  9.5; 
and  a Homoeopathic  total  of  97  cases  with  2 deaths,  mortality  per 
cent.,  2.06  ; there  is  anything  more  than  a pretence  of  reporting 
cases.  In  the  rest  of  the  cities  named  the  reports  may  be  approxi- 
mately correct.  They  show  that  the  Allopaths  reported  8088  cases 
with  243  deaths,  mortality  per  cent.,  3.04;  while  the  Homoeopaths 
reported  1001  cases  with  5 deaths,  mortality  per  cent.,  0.5. 

Of  the  cities  reporting  deaths  alone  we  have  reports  from  Phila- 
delphia, San  Francisco,  Detroit,  Providence,  Allegheny,  Syracuse, 
Nashville,  Duluth,  and  Lincoln  giving  total  deaths,  Allopaths  171 
to  the  Homoeopaths’  7.  Ratio,  24.43  to  1.  These  cities  report  of 
other  diseases  and  births — Allopaths  16,855  cases  to  the  Homoeo- 
paths’, 2785  ; ratio,  6 to  1 and  have  of  physicians;  Allopaths,  3815  ; 
Homoeopaths,  637 ; ratio,  6 to  1. 

In  no  city  is  the  Homoeopathic  mortality  as  high  as  the  Allo- 
pathic, and  in  only  one  of  the  cities  named  as  perhaps  approximately 
correct  is  our  maximum  mortality  as  high  as  their  minimum. 

Table  No.  2 deals  with  Typhoid  Fever.  Here  we  find  a larger 
number  of  cities  pretending  to  report  cases.  That  it  is  largely  a 
matter  of  pretence  with  many,  a glance  at  the  table  will  readily  con- 
vince any  one  familiar  with  the  facts,  and  the  results  in  typhoid,  but 
following  the  order  laid  down  we  find  that  Philadelphia,  St.  Louis, 
Baltimore,  Cincinnati,  Minneapolis,  Rochester,  Providence,  Denver, 
Nashville,  in  1891,  Dayton  and  Duluth  report — Allopaths,  8265 
cases  with  2037  deaths,  mortality  per  cent.,  24.65 ; Homoeopaths, 
1131  cases  with  224  deaths,  mortality  per  cent.,  19.71. 

Of  these  cities,  Philadelphia,  St.  Louis,  in  1892,  Minneapolis, 


COMPARATIVE  VITAL  STATISTICS. 


183 


Dayton,  and  Duluth,  in  1891,  have  apparently  the  fullest  reports  of 
cases  attended.  They  report — Allopaths,  6502  cases  with  940 
deaths,  mortality,  per  cent.,  14.46 ; Homoeopaths,  941  cases  with  131 
deaths,  mortality  per  cent.,  13.92.  The  rest  of  the  cities  in  the  list 
report — Allopaths,  1763  cases,  with  1097  deaths,  mortality  per 
cent.,  62.22;  Homoeopaths,  190  cases  with  93  deaths,  mortality  per 
cent.,  48.95.  The  cities  reporting  deaths  alone,  are  San  Francisco, 
Detroit,  St.  Paul,  Kansas  City,  Indianapolis,  Allegheny,  Syracuse, 
Nashville  in  1890  and  1892,  and  Lincoln.  They  report — Allo- 
paths, 801 ; Homoeopaths,  55;  ratio,  14.56  to  1.  These  cities  report 
of  other  diseases  and  births,  Allopaths,  20,756;  Homoeopaths,  2423  • 
ratio,  8.15  to  1,  and  have  of  physicians,  Allopaths,  2336;  Homoeo- 
paths, 284;  ratio,  8.33  to  1. 

Table  No.  3 deals  with  Diphtheria.  The  cities  reporting  cases  of 
diphtheria  are  St.  Louis,  Baltimore,  Cincinnati,  Detroit,  Minneapolis, 
Rochester,  St.  Paul,  Kansas  City,  Providence,  Denver,  Indianapolis, 
Syracuse,  Nashville,  Dayton,  Duluth  and  Lincoln.  They  report — 
Allopaths,  8765  cases,  with  2996  deaths,  mortality  per  cent.,  34.07 ; 
Homoeopaths,  1141  cases,  with  347  deaths,  mortality  per  cent., 
30.41.  Cities  in  which  both  schools  report  40  per  cent,  or  less  are 
St.  Louis,  Detroit,  Minneapolis,  St.  Paul,  in  1890  and  1891,  Kansas 
City,  Providence,  Denver,  Nashville,  in  1890,  Duluth  in  1891  and 
Lincoln.  They  report — Allopaths,  4615  cases  with  1356  deaths, 
mortality  per  cent.,  39.37  ; Homoeopaths,  724  cases  with  176  deaths, 
mortality  per  cent.,  24.31.  The  rest  of  the  cities  reporting  but,  on 
account  of  high  death-rates,  not  believed  to  be  fully  reported,  give 
Allopaths,  4150  cases  with  1630  deaths,  mortality  percent.,  39.3; 
Homoeopaths,  417  cases  with  171  deaths,  mortality  per  cent.,  41. 
Cities  not  reporting  cases  are  San  Francisco  and  Allegheny.  They 
report  deaths,  Allopaths  334;  Homoeopaths  18;  ratio,  18.55  to  1. 
There  are  of  physicians,  Allopaths,  837  ; Homoeopaths,  112;  ratio, 
7.47  to  1. 

Table  No.  4 treats  of  Scarlet  Fever.  Scarlet  fever  is  without 
doubt  the  best  reported  disease,  in  nearly,  if  not  quite  every  city 
represented  in  this  report.  I am  sorry  to  have  to  say  that  there  is 
plenty  of  evidence  that  it  is  not  well  reported  in  a vast  majority  of 
cities.  The  cities  reporting  cases  of  scarlet  fever  are  Philadelphia, 
St.  Louis,  Baltimore,  Cincinnati,  Detroit,  Minneapolis,  Rochester, 
St.  Paul,  Kansas  City,  Providence,  Denver,  Indianapolis,  Syracuse, 


184 


world’s  homoeopathic  congress. 


Nashville,  Dayton,  Duluth  and  Lincoln.  They  report  totals  as  fol- 
lows— Allopaths,  17,340  cases  with  1466  deaths,  mortality  per  cent., 
8.45  ; Homoeopaths,  3039  cases,  with  157  deaths,  mortality  per  cent., 
5.16.  Cities  with  12  per  cent,  or  less  mortality  report — Allopaths, 
16,463  cases  with  1317  deaths,  mortality  of  8 per  cent.;  Homoeo- 
paths, 2862  cases  with  141  deaths,  mortality  per  cent.,  4.93.  Detroit 
in  1892,  Nashville  in  1890,  Dayton,  Duluth  in  1892,  and  Lincoln 
all  report  more  than  12  per  cent,  mortality,  and  are  probably  not 
worthy  of  credence.  They  report  — Allopaths,  877  cases  with  149 
deaths,  mortality  per  cent.,  17;  Homoeopaths,  177  cases  with  16 
deaths,  mortality  per  cent.,  9.  Cities  reporting  deaths  alone  are 
San  Francisco  and  Allegheny.  They  report — Allopaths,  134  to 
the  Homoeopaths  1.  Physicians  reporting  are  Allopaths,  837  ; Ho- 
moeopaths, 112;  ratio,  7.47  to  1. 

Table  No.  5,  Obstetrical  No.  1,  deals  with  the  number  of  cases  of 
labor  attended  by  members  of  the  two  schools,  and  the  number  of 
deaths  from  puerperal  causes. 

In  studying  this  table  I would  call  your  attention  to  the  fact  that 
it  does  not  include  the  cases  attended  by  midwives,  and  consequently 
if  the  number  of  cases  here  given  seems  small  for  the  number  of 
deaths  given  in  Table  9,  it  is  in  part  due  to  the  large  number  of 
cases  of  labor  attended  by  mid  wives  in  every  city  reported.  There 
is,  however,  good  evidence  that  labors  are  not  fully  reported  in  a 
large  number  of  cities. 

Of  the  cities  reporting  cases,  we  find  that  St.  Louis,  Baltimore, 
Cincinnati,  Minneapolis,  Rochester,  St.  Paul,  Kansas  City,  Indian- 
apolis in  1892,  Syracuse,  Nashville,  Duluth  and  Seattle  report — 
Allopaths,  31,488  cases  with  702  deaths,  mortality  per  cent.,  2.23; 
Homoeopaths,  4219  cases  with  42  deaths,  mortality  per  cent.,  1. 

Of  cities  not  reporting  cases  we  find  San  Francisco,  Detroit, 
Providence,  Denver,  Indianapolis,  in  1891,  Allegheny  and  Lincoln 
reporting — Allopaths,  315  deaths  to  the  Homoeopaths,  23;  ratio, 
17  to  1,  while  the  physicians  are — Allopaths,  2000;  Homoeopaths, 
280 ; ratio,  7.14  to  1. 

Table  No.  6,  Obstetrical  No.  2. — This  table  deals  with  the  num- 
ber of  deaths  from  the  different  puerperal  causes  reported  by  physi- 
cians of  the  two  schools  and  should  be  studied  in  connection  with 
the  preceding  table,  Table  No.  5,  to  be  properly  comprehended. 

Taking  the  cities  mentioned  as  reporting  cases  of  labor,  we  have 


COMPARATIVE  VITAL  STATISTICS. 


185 


seen  that  they  report — Allopaths,  31,488  cases  to  the  Homoeopaths’ 
4219,  or  7.46  to  our  1. 

They  report  deaths  as  follows  : from  puerperal  septicaemia,  190  to 
our  9 ; ratio,  21  to  1 ; from  puerperal  fever,  258  to  our  11  ; ratio, 
23.45  to  1 ; from  puerperal  eclampsia,  79  to  our  9 ; ratio,  8.77  to  1 ; 
from  affections  of  pregnancy,  97  to  our  8;  ratio,  12.12  to  1;  from 
uterine  haemorrhage,  27  to  our  6 ; ratio,  4.5  to  1 ; and  from  dystocia, 
67  to  our  3;  ratio,  22.33  to  1. 

Cities  not  reporting  cases  of  labor  are  San  Francisco,  Detroit, 
Providence,  Denver,  Indianapolis,  in  1891,  Allegheny  and  Lincoln. 
They  have  of  physicians:  Allopaths,  2000;  Homoeopaths,  280; 
ratio,  7.14  to  1 ; and  report  deaths  as  follows  : puerperal  septicaemia, 
55  to  our  2;  ratio,  27.5  to  1 ; puerperal  fever,  151  to  our  7 ; ratio, 
21.6  to  1 ; puerperal  eclampsia,  26  to  our  3 ; ratio,  8.66  to  1 ; affec- 
tions of  pregnancy,  54  to  our  6 ; ratio,  9 to  1 ; uterine  haemorrhage, 
21  to  our  3 ; ratio,  7 to  1 ; and  from  dystocia,  11  to  our  1. 

Table  No.  7 (from  Form  No.  5). — This  table  gives  the  number  of 
cases  of  pertussis  reported,  and  deaths  from  the  same.  It  gives  also 
the  number  of  deaths  from  cerebro-spinal  meningitis  and  from  ery- 
sipelas. Under  the  head  of  pertussis  we  find  that  St.  Louis,  Balti- 
more, and  Cincinnati  report — Allopaths,  675  cases  with  230  deaths, 
mortality  per  cent.,  34.1  ; Homoeopaths,  49  cases  with  14  deaths, 
mortality  per  cent.,  28.6.  It  is  scarcely  necessary  to  say  that  the 
reports  of  cases  of  pertussis  are  utterly  useless.  The  cities  reporting 
deaths  alone  are  Detroit,  Minneapolis,  1892,  Providence,  Indianapo- 
lis, in  1892,  Allegheny  and  Nashville.  They  report  deaths,  Allo- 
paths, 117;  Homoeopaths,  18;  ratio,  6.5  to  1.  St.  Louis,  Balti- 
more, Cincinnati,  Detroit,  Minneapolis,  in  1892,  Providence,  Alle- 
gheny, Syracuse  and  Nashville  report  deaths  from  cerebro-spinal 
meningitis:  Allopaths,  1064;  Homoeopaths,  81;  ratio,  13.13  to  1. 
The  same  cities  report  deaths  from  erysipelas:  Allopaths,  165  ; Ho- 
moeopaths, 12  ; ratio,  13.75  to  1 ; and  have  of  physicians:  Allopaths, 
3107 ; Homoeopaths,  403;  ratio,  8.43  to  1. 

Table  No.  8,  Ratio  of  Work  Reported  and  of  Physicians. — This 
table  is  designed  to  show  the  relation  between  the  number  of  cases 
of  different  diseases  reported  by  the  two  schools,  and  also  the  rela- 
tive number  of  physicians  of  the  two  schools  reporting  work.  From 
it,  we  learn  that  Philadelphia,  St.  Louis,  Baltimore,  Cincinnati, 
Detroit,  Minneapolis,  Rochester,  St.  Paul,  Kansas  City,  Providence, 


186 


world’s  homoeopathic  congress. 


Denver,  Indianapolis,  Syracuse,  Nashville,  Dayton,  Duluth,  Seattle 
and  Lincoln  report  from  all  causes:  Allopaths,  72,477  cases  to  the 
Homoeopaths’  10,570;  ratio,  6.86  to  1.  There  are  in  these  cities: 
Allopaths,  6649;  Homoeopaths,  1008;  ratio,  6.59  to  1. 

Cities  reporting  typhoid  fever  cases  give  cases  reported  : Allo- 
paths, 8265;  Homoeopaths,  1131  ; ratio,  7.31  to  1. 

Physicians  in  the  same  cities  are:  Allopaths,  4979,  Homoeopaths, 
776;  ration,  6.42  to  1. 

Cities  reporting  scarlet  fever  give  cases  reported : Allopaths, 
17,340;  Homoeopaths,  3039  ; ratio,  5.71  to  1.  Physicians  in  the 
same  cities  are:  Allopaths,  6534;  Homoeopaths,  992;  ratio,  6.59 
to  1. 

Cities  reporting  measles  give  cases  reported  : Allopaths,  8656  ; 
Homoeopaths,  1098 ; ratio,  7.88  to  1.  Physicians  in  the  same  cities 
are:  Allopaths,  2988;  Homoeopaths,  347 ; ratio,  8.61  to  1. 

Cities  reporting  diphtheria  give  cases  reported:  Allopaths,  8765; 
Homoeopaths,  1141  ; ratio,  7.68  to  1.  Physicians  in  same  cities  are : 
Allopaths,  4498  ; Homoeopaths,  598  ; ratio,  7.52  to  1. 

Cities  reporting  cases  of  labor  give  cases  reported:  “ Allopaths, 
31,488;  Homoeopaths,  4219;  ratio,  7.46  to  1.  The  same  cities 
have  of  physicians:  Allopaths,  3347;  Homoeopaths,  434;  ratio, 
7.71  to  1. 

Table  No.  9 (from  Form  No.  3). — This  table  deals  with  deaths 
alone  as  reported  by  the  two  schools,  and  for  the  reason  that  in  all 
the  larger  cities  a death  certificate  must  be  given  before  a body  is 
permitted  to  be  buried,  this  is  the  most  reliable  table  given. 

The  deaths  are  given  under  the  headings  of  “ Deaths  from  Acute 
Stomach  and  Bowrel  Diseases,”  from  “ Acute  Respiratory  Diseases,” 
and  from  “All  Causes”  (exclusive  of  deaths  from  violence,  suicide, 
and  coroners’  cases).  Under  the  heading  of  “ Death  from  Acute 
Stomach  and  Bowel  Diseases,”  we  find  St.  Louis,  Baltimore,  San 
Francisco,  Cincinnati,  Detroit,  Minneapolis,  Rochester,  St.  Paul, 
Kansas  City,  Providence,  Denver,  Indianapolis,  Allegheny,  Syra- 
cuse, Nashville,  Dayton,  Duluth,  Seattle,  and  Lincoln  report:  Allo- 
paths, 8786;  Homoeopaths,  618;  ratio,  14.22  to  1.  Under  the 
heading  of  “ Deaths  from  Acute  Respiratory  Diseases,”  we  find  the 
same  cities  report:  Allopaths,  12,678;  Homoeopaths,  866;  ratio, 
14.63  to  1.  Under  the  head  of  “Deaths  from  All  Causes:”  Allo- 
paths, 64,287;  Homoeopaths,  4854;  ratio,  13.24  to  1.  Compare 


COMPARATIVE  VITAL  STATISTICS. 


187 


the  ratios  with  the  ratios  of  cases  reported  in  the  same  cities,  7.1  to 
1,  and  of  physicians  reporting  7.5  to  1,  and  judge  for  yourself  who 
are  signing  death  certificates. 

Taking  a general  survey  of  the  tables,  there  are  a few  points  which 
seem  to  me  to  especially  merit  our  attention.  And  of  these  I would 
place  first  the  fact  that  with  the  exception  of  measles,  our  best  showing 
is  made  on  tables  of  the  greatest  apparent  reliability,  and  the  worst  on 
those  which,  from  their  extremely  high  mortality  per  cent.,  we  be- 
lieve to  be  the  most  imperfectly  reported.  It  is  a fact  that  any  one 
who  will  make  some  inquiries  can  readily  verify  that  typhoid  fever 
cases  are  not  recorded  with  anything  like  the  care  they  should  be. 
This  is  astonishingly  true  of  our  men  in  many  cities,  as  note  Balti- 
more, in  1891,  reporting  five  cases  and  eight  deaths;  in  1892,  re- 
porting no  cases  and  seven  deaths ; also  note  Cincinnati,  with  its 
three  cases  and  eight  deaths, — all  reporting  more  deaths  than  cases. 
Different  reporters  stated  that  the  Homoeopaths  reported  more  cases 
after  death  than  did  the  Allopaths.  Diphtheria  is  almost  an  exact 
parallel  of  typhoid  fever,  both  in  relation  to  the  number  of  cases  re- 
ported and  to  the  comparative  results  between  the  two  schools.  It 
should  be  noted  in  this  connection  that  these  are  the  only  diseases  in 
which  the  Homoeopaths  do  not  report  more  cases  per  physician.  If 
the  death  ratios  are  compared  with  the  number  of  physicians  report- 
ing, we  make  a much  better  showing  than  through  percentages,  as 
witness : All  cities  reporting  cases  of  typhoid  give  death  ratio  9.1  to 
our  1,  while  the  ratio  of  physicians  in  the  same  cities  is  6.4  to  1. 
In  diphtheria,  the  ratios  are:  Deaths,  8.7  to  1 ; of  physicians,  7.5 
to  1.  These  two  diseases  will  bear  some  study  which  we  do  not 
have  time  to  give.  It  would  be  interesting  to  know  something  of 
the  comparative  success  of  men  of  our  own  school.  This  was  out 
of  the  question,  and  at  best  would  be  very  difficult  to  get  at.  It 
has  incidentally  come  to  my  knowledge  that  in  two  cities  with  325 
Allopaths  and  60  Homoeopaths,  in  one,  one  physician  changed  our 
mortality  per  cent,  in  typhoid  from  16  to  28,  and  in  the  other  city 
one  physician  changed  our  mortality  in  diphtheria  from  13  to  43  per 
cent.  In  both  instances  the  men  are  noted  among  their  medical 
brethren  for  their  crude  and  un-Homoeopathic  methods  of  prac- 
tice, but  they  sail  under  the  flag,  and  their  work  is  included  in  these 
tables,  as  is  the  work  of  all  physicians  who  claim  to  be  Homoeo- 
paths. 


188  world’s  homceopathic  congress. 

In  Table  No.  6,  Obstetrical  No.  2,  it  is  interesting  to  note  that  our 
best  relative  showing  is  in  connection  with  puerperal  septicaemia, 
where  the  ratio  is  21  to  1,  and  with  puerperal  fever  wdth  the  ratio 
23.45  to  1,  while  the  ratio  of  cases  treated  is  7.46  to  1,  or,  in  other 
words,  their  loss  from  the  same  number  of  cases  of  labor  attended  is 
3 to  our  1. 

In  Table  No.  9 we  have  seen  that  the  Allopaths  lost,  from  acute 
stomach  and  bowel  diseases,  8786  to  the  Homoeopaths  618;  from 
acute  respiratory  diseases,  12,678  to  our  866;  and  from  all  causes, 
64,287  to  our  4854 ; while  they  reported  of  all  diseases  treated,  7.1 
cases  to  our  1.  At  the  same  rate  they  have  to  account  for  4396  or  a 
little  over  50  per  cent,  of  their  deaths  from  acute  stomach  and  bowel 
diseases,  for  6529  or  54  per  cent,  of  their  deaths  from  acute  respira- 
tory diseases,  and  for  29,824  or  46  per  cent,  of  their  deaths  from  all 
causes.  The  population  represented  in  this  table  is  4,607,066,  or 
about  j1^  of  the  population  of  the  United  States.  Those  of  a specu- 
lative turn  of  mind  may  find  it  interesting  to  figure  what  this  means 
if  applied  to  the  whole  of  the  United  States,  and  what  it  means  in 
dollars  and  cents  at  the  average  value  of  a human  life  as  fixed  by  the 
United  States  courts — between  $5000  and  $6000. 

In  conclusion,  permit  me  to  say,  that  while  the  elements  of  unre- 
liability in  the  health  office  records  cannot  be  laid  at  our  door,  the 
records  being  almost  wholly  in  the  hands  of  our  opponents,  there  is 
a work  in  this  connection  which  we  can  and  should  do.  We  should 
individually  and  collectively  report  all  of  our  cases,  and  insist  that 
all  others,  irrespective  of  school,  shall  do  likewise.  We  should  also 
insist  that  these  cases  be  properly  recorded.  Then  will  such  investi- 
gations as  this  be  valuable. 

Let  us  speed  the  day. 

Notes  for  Appendix. 

1.  Medical  Reform , Cockburne.  See  Boericke  & Tafel’s  Catalogue, 
1890,  p.  128. 

2.  From  Hardenstein’s  work.  See  Boericke  & Tafel’s  Catalogue, 
1890,  p.  129. 

3.  Comparative  Results  in  the  Treatment  of  the  Insane.  See 
“ Homoeopathy  and  the  Insane,”  by  N.  Emmons  Paine,  A.M.,  M.D., 
New  England  Medical  Gazette , 1892.  Also  reprint. 

4.  Hare’s  System  of  Practical  Therapeutics , vol.  i. 


COMPARATIVE  VITAL  STATISTICS. 


189 


5.  “Cholera  Epidemic  of  1873  in  the  United  States.”  Second  Ses- 
sion Forty-third  Congress,  p.  35. 

6.  See  Minneapolis  Homoeopathic  Magazine , June,  1892.  Also 
reprint. 

7.  To  Eld  ridge  C.  Price  is  due  the  credit  of  interesting  Dr. 
Thomas  in  this  work. 

8.  The  New  York  County  Homoeopathic  Medical  Society  took  up 
the  work  of  filling  Form  No.  1,  was  at  first  refused  permission  to 
see  the  records;  was  upon  further  demands  permitted  to  see  the 
records,  but  cases  were  found  to  be  so  indifferently  reported  that  the 
committee  appointed  to  do  the  work  decided  that  the  report  would, 
of  necessity,  be  not  worth  the  labor.  Dr.  William  Watts,  of  Toledo, 
Ohio,  promised  to  report  that  city,  but  was  positively  refused  per- 
mission to  see  the  records  of  the  Old-School  health  officer,  and  living 
outside  of  the  city  limits,  could  not  gain  access  by  recourse  to  legal 
courses.  Philadelphia  was  at  first  granted  the  privilege,  but  later 
was  refused,  and  up  to  this  writing  is  debarred  from  the  records. 
Chicago,  Boston,  and  Cleveland  commenced  the  wTork  too  late  to  be 
completed  for  this  report.  Washington,  D.  C.,  reported  records 
hard  to  get  at  and  not  reliable.  Omaha,  Buffalo,  Louisville,  and 
Memphis  promised  reports  but  forgot  to  fulfill  their  promises.  Owing 
to  circumstances  not  in  our  control,  the  reports  in  many  of  the  cities 
are  far  from  full.  In  some  instances  men  who  promised  to  do  the 
work  delayed  until  it  was  too  late  for  them  or  any  other  to  make 
full  reports.  The  reports  received  are  given  in  the  different  tables, 
and  what  any  particular  city  reported,  can  be  seen  by  examining  the 
different  tables. 

9.  In  all  tables  the  coroner’s  cases  are  not  included.  City  physi- 
cians are  left  out  when  ascertainable. 

10.  Cases  are  reported,  but  Dr.  Keeler  says,  in  such  manner  that 
he  could  not  ascertain  who  reported  them. 

Discuss  ton. 

Dr.  Beckwith  : May  I ask  why  Boston,  New  York,  and  Chicago 
were  omitted  from  the  table? 

Dr.  Strickler  : The  Boston  Homoeopathic  Medical  Society  took 
up  the  subject  in  January,  I think.  The  man  who  was  to  report 
was  Dr.  Porter,  I believe.  He  wrote  me  long  ago  that  he  would 
send  in  a report.  The  report  has  not  been  received. 

New  York  attempted  to  get  into  the  Health  Office  sometime  in 


190 


world’s  homoeopathic  congress. 


January  or  February,  and  were  at  first  refused  permission  to  examine 
the  records,  but  on  further  demand  were  given  the  privilege,  but 
found  them  so  imperfectly  reported  that  it  was  not  worth  the  time 
and  trouble. 

There  is  somebody  in  this  hall  1 presume  who  can  answer  about 
Chicago,  but  I had  a definite  promise  that  Chicago  would  be  reported 
last  June.  I depended  upon  that  promise  until  it  was  too  late  to 
find  a^y  one  to  report  it. 

Dr.  Beckwith  : Cleveland  ? 

Dr.  Strickler:  The  same  with  Cleveland. 

Dr.  Beckwjth  : I was  consulted  by  the  committee,  and  I said, 
“ If  we  present  papers,  we  want  some  authority.”  Consequently 
they  hired  a clerk  in  the  health  office  and  she  is  at  work  on  that 
now,  and  when  it  comes  out  it  will  be  signed  by  the  health  officer. 

Dr.  Peck  : The  importance  of  this  subject  no  one  will  gainsay,  but 
few  have  any  idea  of  the  amount  of  labor  involved  in  the  preparation 
of  the  paper  to  which  you  have  just  listened.  I myself  would  not 
undertake  it  for  any  consideration.  In  compiling  the  statistics  of 
Providence  which  had  135,000  in  1891  and  138,000  inhabitants  in 
1892,  it  took  my  copyist  at  least  one  month  of  working  hours  in 
order  to  prepare  the  returns  simply  for  the  chairman  of  the  com- 
mittee. The  difficulties  I found  in  the  health  office  and  in  the  pre- 
paration of  such  a report  were,  that  the  facts  are  not  to  be  found 
ordinarily  in  the  health  office.  I had  no  trouble  at  all  in  getting 
the  documents  in  my  own  city,  but  the  trouble  was  the  different 
systems  of  registration.  I wonder  at  the  table  we  have  here.  I never 
should  have  arranged  such  a scheme,  but  since  the  Empire  City  has 
decreed  it,  of  course,  I had  to  accept.  To  illustrate  : The  paper 
called  for  statistics  on  diphtheria,  including  membranous  croup.  I 
flatly  refused  to  include  membranous  croup  death  certificates  in  those 
of  diphtheria,  because  I do  not  believe  the  two  diseases  are  any  more 
alike  than  a rose  and  a cabbage.  Both  grow  on  a stalk,  both  have 
leaves,  and  both  may  be  eaten ; therefore,  they  are  identical. 

Furthermore,  the  cases  of  croup  are  not  reported ; the  cases  of 
diphtheria  are  pretended  to  be.  One  of  my  particular  friends  who 
is  a rising  surgeon  in  my  city,  gives  a number  of  deaths  equal  to  the 
number  of  cases.  His  death-rate  for  typhoid  fever  for  the  year 
1891  is  100  per  cent.  I think  that  he  would  feel  very  happy  to 
have  that  statement  publicly  made.  It  simply  shows  how  doctors 
generally  neglect  to  comply  with  the  law.  There  were  two  or  three 
such  cases.  I found  in  one  year  that  I continued  the  examination, 
that  the  Allopaths  were  fully  as  delinquent  as  the  Homoeopaths, 
frequently  not  mailing  their  certificates  of  the  disease  until  they  had 
made  out  the  death  certificates. 

With  regard  to  infectious  diseases,  this  heavy  mortality  record  is 
due  to  that  fact.  Ido  not  believe  myself,  while  recognizing  the  fact 


COMPARATIVE  VITAL  STATISTICS. 


191 


that  a person  may  be  taken  so  ill  with  scarlatina  that  he  is  as  dead 
the  day  he  is  taken  sick  as  he  ever  subsequently  becomes,  that  that 
disease  is  productive  of  serious  results  except  from  sheer  neglect  or 
carelessness.  That  is  my  experience. 

With  regard  to  obstetrics  in  our  State,  the  showing  is  very  good, 
and  I think  it  will  be  found  so  in  every  State,  and  I ascribe  that  to 
extra  care  that  is  undertaken  from  personal  observation  and  knowl- 
edge of  the  practice  of  leading  members  of  both  schools.  We  live 
on  terms  of  comparative  harmony  in  our  city,  and  while  we  have  as 
poor  specimens  of  doctors  as  the  other  school  can  show,  yet  the  in- 
creased care  and  attention  and  fidelity  to  duty  which  characterizes 
the  Homoeopath  who  is  a Homoeopath  from  principle  shows  itself 
in  the  lying-in  chamber,  and  that  is  the  cause  of  our  small  mortality. 

Our  showing  is  very  good  also  in  croup  and  in  respiratory  and 
bowel  troubles. 

The  reports  of  death  certificates  from  our  city  are  all  taken  only 
from  members  of  the  Rhode  Island  Medical  Society,  and  Rhode 
Island  Homoeopathic  Society.  Anybody  can  practice  medicine  in 
our  state  who  wishes,  and  I thought  the  only  fair  way  was  to  take 
the  certificates  of  those  who  were  recognized  officially  as  members  of 
their  respective  societies. 

The  practical  lessons  to  be  derived  from  this  paper  are  as  follows  : 
First,  comply  with  the  laws  of  the  cities  in  which  you  reside;  show 
yourself  a good  citizen,  else  you  cannot  expect  to  be  rated  as  a good 
doctor.  You  don’t  know  who  is  going  to  examine  your  death  cer- 
tificates, nor  for  what  purpose  they  will  be  used;  make  them  out, 
then,  in  this  manner:  If  you  are  not  sure,  and  you  know  we  are  not 
always  sure  of  the  cause  of  diseases;  if  there  is  any  doubt — some- 
times, of  course,  the  manner  of  death  determines  the  diagnosis — 
always  make  it  out  for  that  cause  which  is  considered  incurable,  un- 
less that  diagnosis  impairs  the  prospects  of  the  family  with  regard  to 
life  insurance.  Protect  the  interest  of  your  school  as  you  would 
your  own  interest. 

The  Chairman  : Further  discussion  will  be  by  Dr.  Beckwith, 
of  Cleveland,  Ohio. 

Dr.  Beckwith,  of  Ohio  : The  State  Board  of  Ohio,  of  which  I 
was  a member  for  five  years,  spent  much  of  their  time  trying  to 
gather  statistics,  and  we  found  it  impossible.  I don’t  believe  there 
is  a State  in  the  United  States  that  has  statistics,  neither  do  I believe 
that  that  report  is  correct.  Details  are  reported  which  are  not  cor- 
rect. While  this  paper  has  required  a vast  amount  of  labor,  I do 
not  believe  half  of  it  is  correct.  I will  admit  that  our  school  is 
much  more  successful,  and  why  ? Because  we  have  a better  class  of 
patients ; we  have  better  nurses,  and  we  have  a better  class  of  society 
to  treat.  We  have  every  advantage  that  we  possibly  can  have,  con- 
sequently I look  upon  the  statistics  as  rather  unfair  to  the  Old 


192 


world’s  homoeopathic  congress. 


School  because  they  give  but  little  medicine  now.  I think  they  are 
giving  very  little  more  medicine  than  our  school,  and  their  success 
is  much  better  now  than  it  was  before. 

The  mortality  in  those  cases  it  seems  to  me  is  enormous  and  why? 
Because  it  is  down  among  the  lower  classes — the  Norwegians,  Danish 
and  Swedes  that  have  no  care  or  attention  whatever. 

The  only  way  to  make  the  world  and  the  Allopaths  believe  this 
is  to  get  it  from  the  health  authorities.  None  of  you  would  take 
my  statement  or  that  of  any  other  physician  in  regard  to  such  figures, 
especially  when  their  views  are  different.  Dr.  Wilson,  of  Cleveland, 
spent  one  week  with  an  assistant  getting  statistics  ; then  gave  it  up 
and  wrote,  as  many  others  have  done,  to  Dr.  Strickler,  that  he  would 
send  it  later.  Then  they  got  a clerk  in  the  health  office  who  is 
doing  it  correctly,  taking  every  physician  and  his  certificate. 

The  Chairman:  The  paper  will  be  further  discussed  by  Dr. 
Edgerton,  of  Kansas  City. 

Dr.  Edgerton,  of  Kansas  City : We  have  spent  a great  deal  of 
time  on  this  work  in  Kansas  City.  I got  a lady  to  go  to  the  health 
officers  who  very  kindly  allowed  her  the  use  of  the  books,  but  we 
found  it  very  difficult  work  to  make  any  creditable  statement  in 
puerperal  cases,  deaths  due  to  confinement.  The  death  was  simply 
reported,  giving  the  name  of  the  disease  from  which  the  patient  died, 
but  saying  nothing  as  to  whether  it  was  immediately  following  con- 
finement. I found  a tendency,  and  I noticed  it  more  among  the 
Allopaths,  to  put  down  a disease  which  had  the  most  dangerous  form. 
For  instance,  a short  time  ago  I was  called  to  a case  that  an  Allo- 
path had  seen  and  he  pronounced  it  cerebro-spinal  meningitis,  and  I 
found  a little  rheumatism  there.  Cases  that  are  simply  German 
measles  are  called  scarlatina  and  the  ho-use  is  placarded.  I believe 
the  Homoeopaths  are  more  careful  about  these  things. 

The  Chairman  : The  discussion  will  now  be  closed  by  Dr. 
Strickler. 

Dr.  Strickler  : I don’t  know  as  I have  much  to  say  in  closing 
this  discussion.  The  conclusion  of  my  paper  will  be  ample. 

The  Chairman  : The  next  business  is  the  paper  by  Dr.  Martha 
A.  Canfield,  of  Cleveland,  Ohio,  on  “The  Development  of  Medical 
Science  through  Homoeopathy.” 

Dr.  Canfield  addressed  the  Congress  as  follows  : 


THE  DEVELOPMENT  OF  MEDICAL  SCIENCE. 


193 


ADDRESS. 

THE  DEVELOPMENT  OF  MEDICAL  SCIENCE 
THROUGH  HOMOEOPATHY. 

By  Martha  A.  Canfield,  M.D.,  Cleveland,  Ohio. 


The  true  scope  of  medical  science  is  the  healing  of  the  sick,  the 
relief  of  human  misery.  Tried  by  this  test,  there  was  no  real 
medical  science  in  the  world  until  it  was  evolved  from  the  law — 
similia  similibus  curantur.  Before  this  all  was  blind  experiment,  all 
disorder  and  confusion,  and  to  the  pangs  of  disease  were  added  the 
tortures  of  the  damned.  Disease  was  regarded  as  some  evil  spirit 
which  had  possessed  the  body.  Some  infarct,  which  had  lodged  in 
the  bowels  and  must  be  driven  out  by  purging  or  let  out  by  the 
lancet.  The  wildest  and  most  absurd  definitions  were  given,  e.g 
an  infarct  was  defined  by  Kampf,  in  1726,  as  an  unnatural  condition 
of  the  bloodvessels,  which  are  plugged  in  various  places  by  ill  com 
cocted,  variously  degenerated,  fluid  bereft  inspissated,  viscid,  bilious 
polypus  and  coagulated  blood.  Heinrech  Speffens,  who,  in  Oken’s 
periodical,  1822,  is  put  on  a level  with  Aristotle,  Goethe,  and  Hum- 
boldt, thus  defines  hearing.  It  is  the  identity  of  the  inorganic  of  the 
organization  and  its  internal  being,  consequently  identity  of  the  ner- 
vous and  osseous  systems.  Hunger  is  internal  tension  of  the  assimi- 
lation under  the  influence  of  the  mass  opposed  external. — Ameke’s 
History  of  Homoeopathy. 

In  1803  physiological  chemistry  taught  that  blood  consisted  of 
nine  ingredients : odoriferous  matter,  fibrinous  parts,  albumen,  sul- 
phur, gelatine,  iron,  potash,  soda,  and  water.  The  medical  history 
of  the  times  down  to  the  date  of  Samuel  Hahnemann’s  appearance 
upon  the  field  of  action  is  a whirligig  of  theories,  one  following  upon 
the  other  with  astonishing  rapidity. 

Stoll  taught  that  disease  was  caused  by  gastric  impurities,  bilious 
conditions,  and  intestinal  obstructions;  therefore,  vomit  and  purge 
was  his  watchword. 


13 


194 


world’s  homoeopath rc  congress. 


Brown  that  sthenia  and  asthenia  caused  all  disease,  and  “ allay 
irritation  ” was  his  war  cry.  The  antiphlogistic  treatment  contended 
for  supremacy,  but,  whatever  theory  was  uppermost,  poor  old 
humanity  was  blistered  and  bled  and  salivated  and  purged  with  in- 
tent to  drive  out  some  unseen,  unknown  evil  thing  which  was  sup- 
posed to  be  its  enemy. 

All  experiments  of  the  actions  of  drugs  were  made  upon  the 
sick.  Drugs  were  compounded  in  mixtures  of  from  eight  to  fifty 
remedies,  so  that  it  was  impossible  to  separate  the  action  of  one 
drug  from  the  other  or  from  the  symptoms  of  the  disease.  In  this 
absence  of  law  and  order,  in  this  extremity  of  the  human  race,  the 
phenomenon  which  always  appears  at  such  a crisis  was  repeated.  A 
man  was  raised  up  who  was  equal  to  the  emergency,  Samuel  Hahn- 
emann. He  established  a system  of  perfect  law  and  order.  The 
fact  that  the  poisonous  effect  of  drugs  can  be  used  as  the  determining 
indication  for  their  selection  in  the  treatment  of  disease  was  dimly 
seen  by  the  ancients,  but  Hahnemann  seized  upon  the  fact  and 
dragged  it  into  the  light t)f  perfect  day.  He  demonstrated  that  it 
was  the  foundation  rock  of  medical  science;  that  it  was  a fixed  and 
perfect  law  which  never  can  be  altered  or  improved,  though  its 
methods  of  application  may  be  almost  endless.  Upon  this  rock  he 
built  a Materia  Medica. 

He  was  no  common  man  who,  in  the  error  of  his  age,  could  see 
so  clearly.  It  is  true  he  partook  somewhat  of  the  color  of  his  times, 
but  illumined  the  age  with  a wondrous  light.  He  adopted  an  entirely 
new  method  of  determining  the  curative  power  of  drugs,  viz.,  prov- 
ing them  upon  healthy  organisms, — the  method  now  approved  of 
and  practiced  by  all  scientists. 

He  discovered  that  certain  remedies  had  specific  action  upon  cer- 
tain tissues  and  curative  action  in  certain  diseases.  As  a chemist,  he 
far  surpassed  the  age  in  which  he  lived.  He  discovered  a test  for 
metals  which  has  stood  the  test  of  time,  and  is  used  in  every  labora- 
tory in  the  world  to-day.  He  discovered  several  new  products, 
among  them  the  black  oxide  of  Mer.,  our  Mer.  sol.  He  was  the 
first  physician  in  the  world  to  advocate  single  remedies  and  small 
doses,  to  regard  diet  and  hygiene  as  important  in  the  treatment  of 
the  sick.  Was  not  this  a legacy  to  medical  science?  Was  not  this 
the  birth  of  medical  science? 

My  second  proposition  is  that  there  has  been  no  progress  in  the 


THE  DEVELOPMENT  OF  MEDICAL  SCIENCE. 


195 


therapeutics  of  the  dominant  school  since  the  glorious  truth  of  Hom- 
oeopathy burst  upon  the  world,  except  as  it  has  been  developed  upon 
Hahnemannian  principles  or  stolen  outright  from  our  system  with- 
out credit  being  given. 

It  is  quite  possible  to  set  the  world  agog  with  some  wonderful  dis- 
covery, as  did  Brown-Sequard’s  Elixir  of  life,  and  yet  contribute 
nothing  to  medical  progress,  because  it  is  soon  proven  to  be  not  only 
worthless  but  harmful.  All  the  so-called  scientific  discoveries,  as 
Brown  Sequard’s  Elixir,  the  coal-tar  compounds,  and  the  late  Dr. 
Hammond’s  vital  energizer,  may  be  classed  among  the  harmful  dis- 
coveries, and  therefore  have  no  weight  in  the  argument.  Hahne- 
mann built  the  tramway  upon  which  all  great  lines  of  thought 
have  been  projected  in  both  the  Allopathic  School  and  our  own. 
Rokitansky,  Virchow,  Klebs,  and  Koch  are  indebted  to  him  for  the 
principle  upon  which  they  elaborated  their  thought. 

Hahnemann  had  discovered,  as  before  mentioned,  that  certain 
remedies  had  a specific  action  upon  certain  organs  and  tissues,  as 
Digitalis  upon  the  heart. 

And  it  was  upon  this  basis  that  Virchow  wrought  out  his  locali- 
zation theory.  Hahnemann  anticipated  the  germ  theory  when  he 
discovered  the  essential  germ  cause  of  cholera.  Koch  even  wrought 
in  the  self-same  methods  as  Hahnemann.  He  tested  the  poisonous 
matter  upon  healthy  organisms,  then  diluting  the  poison  infinitesi- 
mally, he  tested  it  upon  diseased  organisms,  differing  only  in  the 
method  of  administration,  using  injection  aided  by  the  mechanical 
improvement  of  his  day.  The  most  recent  discoveries  of  Koch  re- 
garding the  blood  of  diphtheria  and  typhoid  containing  elements 
which  are  curative  in  each  of  the  diseases  referred  to  show  that  the 
gleaner  is  going  on  in  the  fields  already  harvested  by  our  school. 
Hering  had  proved  the  worth  of  Tuberculinum  when  Koch  was  in 
pinafores.  He  also  advocated  the  use  of  Hydrophobin  sixty  years 
before  Pasteur  rediscovered  it,  also  Psorinum. 

Homoeopaths  have  enriched  medical  science  by  proving  drugs  of 
commerce,  which  were  before  considered  inert,  to  be  capable  of  curing 
disease.  They  have  antedated  the  use  of  the  diseased  products  of 
the  human  body  as  curative  agents.  And  another  most  wonderful 
development  entirely  due  to  Homoeopaths  is  the  demonstration  of 
the  fact  that  various  animal  viruses  will  heal  the  sick.  This  was 
never  dreamed  of  by  the  Allopathic  School,  and  they  have  not  yet 


196 


world’s  homoeopathic  congress. 


stolen  these  remedies,  to  my  knowledge.  This  enables  the  Homoeo- 
path to  wield  incalculable  vantage  over  them  in  a treatment  of  all 
malignant  diseases,  as  typhoid  fever,  diphtheria,  erysipelas,  etc.  The 
animal  viruses,  as  Apis,  Crotalus,  Lachesis,  Naja,  Tarantula,  Theri- 
dion,  Bufones,  etc.,  have  proven  of  untold  relief  to  human  misery, 
and  are  entirely  due  to  the  heroic  provings  of  Homoeopaths.  Con- 
stantine Hering  enriched  medical  science  by  his  labors  along  this 
line. 

Hering,  like  many  of  Hahnemann’s  followers,  was  a very  learned 
man.  He  was  a wonderful  naturalist.  The  collection  which  he 
made  at  Surinam  is  preserved  with  great  care  in  the  Academy  of 
Natural  Sciences  in  Philadelphia. 

There  are  numbers  of  individual  remedies  which  owe  their  use 
entirely  to  Homoeopaths,  and  are  now  used  by  Allopaths,  no  credit 
being  given  for  their  use,  as  Aconite,  Pulsatilla,  Rhus  tox.,  Mercu- 
rius,  Glonoine,  Hepar  sulphur,  etc.  Many  of  these  remedies  are 
recommended  in  their  text-books — Ringer,  Shoemaker  and  Phillips 
—with  long  paragraphs  of  Homoeopathic  indications  so  plain  that 
you  would  suppose  you  were  reading  Hughes  or  Arndt. 

These  indications  have  been  garbled  from  our  literature  with  the 
most  impudent  kind  of  plagiarism,  viz.,  Chamomilla  is  recommended 
by  Ringer  in  summer  diarrhoea  of  children,  characterized  by  green, 
many-colored  stools,  Podophyllum  in  bilious  morning  diarrhoea.  Dr. 
Aulde,  of  Philadelphia,  recommends  Rhus  tox,  in  rheumatism  in 
doses  of  one  part  to  ten,  but  expresses  diffidence  in  giving  his  opin- 
ion concerning  a remedy  so  altogether  new,  notwithstanding  it  was 
carefully  proven  by  Hahnemann,  as  every  Homoeopath  well  knows. 
They  give  Rhus  tox.  for  rheumatism,  Pulsatilla  for  dysmenorrhoea, 
and  Aconite  for  fever,  but  do  not  differentiate  between  these  reme" 
dies  and  adopt  the  one  which  fits  the  individual  case.  Therefore, 
while  they  acknowledge  the  propriety  of  proving  drugs  upon  the 
healthy,  use  our  remedies  and  our  dose.  (Their  medicine  cases  are 
full  of  semi-potentized  triturate  tablets  and  parvules.)  They  are 
not  making  the  progress  they  would  seem  to  be  making,  because 
they  are  not  using  these  remedies  homoeopathically  but  empirically. 
These  facts  are  too  well  known  to  this  Convention  for  me  to  enlarge 
upon  the  subject. 

In  the  face  of  the  most  unjust  opposition  and  cruel  persecution 
known  in  the  annals  of  history,  we  have  forced  the  dominant  school 


THE  DEVELOPMENT  OF  MEDICAL  SCIENCE. 


197 


to  reform  its  methods  and  adopt  a gentler  and  more  humane  system, 
and  have  won  to  our  belief  such  a majority  of  the  power  and  intel- 
ligence of  the  laity  that  should  the  earth  open  to-day  and  swallow 
up  every  Homoeopath,  public  opinion  would  protect  the  world  from 
the  barbarism  of  the  past. 

Our  school  has  made  wonderful  strides  of  progress  on  its  legiti- 
mate line,  developing  methods  by  which  the  fixed  and  perfect  law 
may  be  perfectly  applied.  We  have  refined  and  regulated  the  dose; 
we  have  proven  new  remedies,  thus  narrowing  down  the  list  of  in- 
curable diseases.  Hundreds  of  volumes  are  monuments  of  the  devo- 
tion and  industry  of  our  pioneers.  See  Bradford’s  Bibliography. 
These  works  form  a vast  pyramid,  with  Hahnemann’s  Organon  and 
Materia  Medica  Pura  as  its  base,  with  Jahr  and  Reckert  and  Teste 
and  Hempel  and  Baehr  and  Carroll  Dunham  and  Farrington  and 
Hughes  and  Drysdale  and  Cowperthwaite  and  Hale  and  Arndt  and 
Lippe  and  Burt  building  upon  them,  with  Allen’s  Encyclopaedia  and 
the  Drug  Pathogenesy  towering  above  them  all.  And  now  Hughes 
is  fashioning  the  capstone,  his  repertory  of  the  Cyclopaedia. 

Our  literature  is  a stupendous  growth.  It  embraces  whole  libra- 
ries of  volumes  which  it  would  require  a lifetime  to  peruse — not 
only  exhaustive  treatises  upon  our  therapeutics,  but  elaborate  dis- 
cussions of  every  phase  of  medical  science,  even  dipping  deeply  into 
psychology  and  spiced  with  poetry.  See  Holcombe’s,  Bane’s  and 
Buck’s  classical  works  and  Crawford’s  Kalevala  and  Bushrod 
James’s  Alaskana.  Bradford’s  Bibliography , itself  a notable  book, 
chronicles  the  long  list  of  authors  too  numerous  for  me  to  mention. 

Our  growth  may  be  compared  to  that  of  a grand  oak,  Hahnemann 
the  central  trunk,  Similia  the  main  root,  his  great  followers  the 
spreading  branches,  and  the  thousands  of  twigs  the  faithful  practi- 
tioners who  are  devoting  their  lives  to  the  application  of  Materia 
Medica  to  disease. 

Seventy  years  ago  there  was  but  one  Homoeopath  physician  in  the 
United  States;  to-day  there  are  twelve  thousand.  We  have  sixteen 
colleges,  graduating  five  hundred  students  annually.  These  colleges 
were  the  first  medical  colleges  in  the  country  to  establish  a four  years’ 
course  of  study  and  demand  a thorough  preparatory  examination. 
The  American  Institute  was  the  first  national  medical  society  to  de- 
mand of  the  colleges  under  its  control  a lengthened  course  and  higher 
grade  of  scholarship.  These  colleges  have  adopted  the  most  ad- 


198 


world’s  homoeopathic  congress. 


vanced  methods  of  clinical  teaching.  They  have  always  been  in  the 
front  rank  of  progress.  Let  me  here  acknowledge  that  it  was  a 
Homoeopathic  college  which  first  opened  the  doors  of  medical  colleges 
to  women. 

We  have  seventy-six  hospitals  and  fifty  dispensaries.  In  these 
hospitals  the  average  mortality  is  only  3.12,  they  are  in  perfect  sani- 
tary condition,  for  Homoeopaths  were  first  to  advise  strict  care  in 
regard  to  hygiene  and  diet,  and  Listerism  is  nothing  more  than  ab- 
solute cleanliness.  Our  pharmacies  have  such  a reputation  for  the 
purity  and  exactness  of  their  preparations  that  they  are  patronized 
largely  by  careful  physicians  in  the  Old  School. 

The  law  of  cure  is  a grand  central  figure  around  which  revolves 
lesser  lights.  Dr.  Edwin  Hale  has  discovered  and  demonstrated  a 
law  of  dose  which  he  deems  a corrollary  to  the  law  of  cure,  viz., 
when  the  primary  symptoms  of  a drug  resemble  the  primary  symp- 
toms of  a disease  the  minimum  dose  should  be  used,  and  when  the 
secondary  symptoms  resemble  the  secondary  symptoms  of  disease, 
large  or  physiological  doses  must  be  used. 

The  late  Dr.  Tessier  placed  on  a firm  basis  the  fact  that  individual 
attacks  of  disease  owe  their  explanation  to  the  definite  predisposition 
wrhich  exists  in  the  individual. 

Dr.  Woodbury,  of  Chicago,  has  elucidated  a system  of  succession 
of  remedies  which  is  about  to  be  given  to  the  medical  world  in  book 
form. 

Dr.  J.  S.  Mitchell  has  given  us  a special  treatment  for  cancer.  He 
is  not  a cancer  specialist,  but  by  scientific  investigation  has  discov- 
ered a method  of  treating  this  loathsome  disease,  which  has  been 
followed  by  wonderful  results.  His  treatment  is  Homoeopathic,  his 
method  of  applying  the  remedies  only  is  original.  See  Medical  Era , 
May,  1889. 

Dr.  Henry  Garey,  of  Baltimore,  Md.,  has  devised  a system  of 
massaging  the  sound-conducting  apparatus  of  the  middle  ear,  by 
which  treatment  he  claims  to  have  produced  marvellous  results  in 
cases  of  deafness  heretofore  considered  hopeless.  — Transactions  of 
American  Institute,  1892. 

Dr.  Pratt  is  the  father  of  the  orificial  philosophy  for  which  he 
claims  that  it  is  the  discovery  of  the  cause  of  chronic  diseases  as  a 
class,  and  that  by  the  aid  of  orificial  surgery  which  it  implies,  it  is 
possible  to  cure  four-fifths  of  all  forms  of  chronic  disease.  If  this 


THE  DEVELOPMENT  OF  MEDICAL  SCIENCE. 


199 


is  true,  and  testimony  pours  in  from  every  quarter,  this  marks  a 
marvellous  progress  in  the  prevention  and  cure  of  disease.  Our 
French  contemporaries  have  stamped  out  anthrax  among  cattle  and 
sheep  by  the  use  of  anthrax. 

Our  Dr.  Dudgeon  has  devoted  much  study  to  optics  and  written 
valuable  works  upon  the  subject.  See  British  Journal  of  Homoeop t 
athy , 1882  to  1893. 

Our  Dr.  Blackley,  Manchester,  Eng.,  is  the  highest  authority  in 
the  world  concerning  hay  fever. 

By  gathering  atmospherical  dust  on  glass  with  glycerine  he  de- 
termined the  pollen  origin  of  this  disease.  His  work  upon  the  same 
is  classical. 

The  late  Dr.  Drysdale,  Liverpool,  Eng.,  was  one  of  the  most  emi- 
nent pathologists,  biologists  and  microscopists  of  the  age,  as  well  as 
one  of  the  most  ardent  lovers  of  Homoeopathy  and  logical  expounders 
of  its  law  (see  British  Journal  of  Homoeopathy ),  during  the  last 
thirty-five  years,  all  of  which  period  he  was  the  senior  editor,  and 
did  a great  amount  of  valuable  work  in  the  study  of  drug  action. 
He  made  a study  of  the  germ  theories  of  infectious  diseases  as  early 
as  1878,  anticipating  much  of  the  work  which  Pasteur  has  since  de- 
veloped. He  gave  eight  years  of  his  life  to  the  study  of  the  life 
histories  of  monads,  now  known  as  saprophytes.  The  words  of  his 
friend  and  fellow-student,  Dr.  Dallinger,  give  us  an  idea  of  this 
work.  “ Our  work  in  this  inquiry,  extending  through  night  and  day 
observations,  occupied  eight  years,  and  during  that  time,  by  use  of 
the  most  powerful  and  perfect  lenses  constructed,  we  were  enabled 
to  study  the  cycles  of  life  in  these  minute  forms,  and  to  show  that 
their  life  history  was  as  definite  and  prescribed  as  the  life  history  of 
a butterfly  or  a daphnia,  although  they  were  so  small  that  a hundred 
million  might  revel  in  the  space  occupied  by  a millet  seed.  And 
this  research  proved  that  abiogenesis,  or  spontaneous  generation, 
has  nothing  to  hope  from  a thorough  knowledge  of  saprophytic  or- 
ganisms.” 

To  show  the  versatility  and  eminently  practical  character  of  his 
genius,  I cite  the  fact  that  he  made  a study  of  the  subject  of  ventila- 
tion, and  jointly  with  Dr.  Hayward,  a deeply  scientific  colleague, 
wrote  a most  valuable  book  on  Health  and  Comfort  in  House  Build- 
ing. No  man  in  our  age  has  added  more  to  the  sum  of  knowledge 
in  medical  art  and  science  than  John  James  Drysdale.  For  a com- 


200 


world’s  homoeopathic  congress. 


plete  study  of  his  work,  see  the  British  Homoeopathic  Review,  Sep- 
tember, 1892. 

Therapeutics  and  pharmacy  will  always  be  the  legitimate  field  for 
Homoeopaths.  The  majority  of  our  ablest  men  will  devote  their 
lives  to  adapting  the  Materia  Medica  to  the  cure  of  disease,  and  this 
is  the  height  of  wisdom,  for,  given  the  certain  law  of  cure,  close  ap- 
plication of  methods  according  to  this  law  will  in  the  majority  of 
cases  prevent  the  necessity  for  surgical  interference,  and  when  the 
surgeon  takes  up  the  scalpel  it  is  an  admission  of  weakness.  He 
practically  says  I cannot  restore  the  body  to  health,  therefore 
it  is  better  that  it  should  lose  one  member  than  that  the  whole 
body  should  be  lost.  Surgery  should  be  the  dernier  ressort  and 
Homoeopathy  has  made  it  so.  It  has  greatly  modified  Allopathic 
surgery.  Mortality  has  greatly  decreased  under  surgery,  aided  by 
our  therapeutics  and  in  our  hospitals  which  are  models  of  hygienic 
perfection. 

Our  surgeons  have  performed  many  brilliant  operations  and  have 
done  much  original  work.  Dr.  G.  D.  Beebe  was  the  first  surgeon  to 
remove  several  feet  of  intestine  (58  inches)  and  get  end-to-end 
union  with  recovery  of  patient. — United  States  Medical  and  Surgi- 
cal Journal,  1869. 

Dr.  I.  T.  Talbot,  of  Boston,  was  the  first  surgeon  in  America  to 
successfully  perform  tracheotomy.  Van  Lennep  of  Philadelphia, 
has  done  great  things  for  intestinal  surgery,  experimenting  on  dogs, 
making  resection  of  gut  with  end-to-end  union,  using  rubber  tubing 
as  splint  instead  of  decalcified  bone,  and  has  tested  the  method  on 
human  cases  with  the  best  results.  He  has  improved  the  operation 
for  fistula  in  ano  and  done  much  good  original  work. 

Dr.  Flagg  the  first  President  of  the  American  Institute,  revolu- 
tionized the  science  of  dentistry  by  his  methods  of  operating  and  in- 
vention of  instruments.  Dr.  Lungren  of  Toledo,  was  the  first  sur- 
geon to  bring  the  peritoneal  surface  together  in  the  closure  of  the 
uterine  incision  in  Caesarian  section  and  published  the  method  several 
years  before  Sanger  made  use  of  it  as  the  basis  of  his  improved 
Caesarian  operation,  which  is  the  approved  method  at  the  present 
time.  Dr.  Lungren  also  first  ligated  the  fallopian  tubes  without 
removal  to  produce  sterility  after  having  twice  peformed  the  Caesa- 
rian section  upon  the  same  patient. 

Biggar,  of  Cleveland,  also  has  witnesses  of  his  great  skill  in  a 


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201 


living  mother  with  two  fine  children  delivered  at  different  births  by 
Caesarian  section.  He  has  a new  method  of  forming  the  flaps  in 
exstrophy  of  the  bladder.  His  method  of  repairing  the  perinaeum  is 
worthy  of  note,  and  an  original  method  of  covering  amputated  bone 
with  periosteal  flaps  for  which  he  claims  three  benefits:  1.  Protec- 
tion. 2.  Medium  of  nourishment.  3 More  rapid  healing  and  less 
deformity. 

Dr.  Knoll,  of  Chicago,  has  made  several  advances  in  surgery. 
1.  He  has  an  original  operation  for  radical  cure  of  fistula  in  ano  by 
dissecting  out  all  the  diseased  tissue  which  forms  the  canal  and 
stitching  up  the  parts,  first  advocated  in  1887.  2.  An  operation  for 

the  radical  cure  of  hernia,  consisting  in  opening  up  the  canal  to  the 
peritonaeum,  freshing  the  edges  of  the  whole  ring  and  stitching  the 
parts  together  with  heavy  silver  wire. — Medical  Era , July,  1888. 
This  operation  he  claims  is  in  advance  of  any  other  operation  of  the 
kind  even  up  to  the  present  date.  3d.  His  treatment  of  eccentric 
stricture  of  the  oesophagus  by  the  stylet  and  dilators  method  of  using 
and  cut  of  the  instrument. — Sharp  and  Smith’s  Catalogue , Chicago, 
1893. 

Lee,  of  Rochester,  has  a wonderful  record  in  laparotomies.  See 
Transactions , American  Institute,  91. 

N.  Schneider,  of  Cleveland,  has  the  honor  of  being  the  first  sur- 
geon in  America  to  remove  a tumor  from  the  brain  with  recovery  of 
patient.  This  tumor  was  the  size  of  a walnut,  situated  back  of  the 
orbit.  The  operation  was  reported  in  1860,  in  the  Ohio  Medical 
Reporter , and  was  copied  in  the  New  York  papers  and  acknowledged 
to  be  unique. 

Dr.  Schneider  introduced  to  the  profession  the  use  of  carbolized 
oil  in  the  dressing  of  wounds.  It  used  to  be  known  on  the  road,  in 
his  days  of  railroad  surgery,  as  Schneider’s  oil. 

It  is  probably  true  that  the  modern  treatment  of  wounds  is  a 
growth  which  all  surgeons  have  nourished  and  cultured,  but  the  fol- 
lowing statement  was  made  to  me  by  Dr.  Dudgeon,  of  England,  in 
reply  to  recent  inquiries  as  to  the  part  taken  by  our  foreign  brethren 
in  the  development  of  medical  science,  viz.,  that  Dr.  Bolle,  a Homoeo- 
pathic physician  of  Aix  la  Chapel le  was  the  father  of  the  modern 
treatment  of  wounds. 

In  a recent  number  of  an  Allopathic  journal,  the  Medical  News , 
there  appears  a Columbian  article  upon  the  work  of  American  sur- 


202 


world’s  homoeopathic  congress. 


geons,  which,  in  the  usual  style,  ignores  the  work  of  Homoeopathic 
surgeons.  Well  might  Helmuth  sound  the  tocsin  ; it  is  time  the 
history  of  Homoeopathic  surgery  was  written.  But  they  cannot  de- 
ceive the  dear  public.  It  well  knows  that  we  have  a galaxy  of  sur- 
geons, with  Helmuth  as  Nestor,  who  have  made  Homoeopathic  sur- 
gery honorable  the  world  over. 

In  mechanical  therapeutics,  our  surgeons  have  invented  many  ap- 
pliances of  recognized  value.  Dr.  Dudgeon’s  sphygraograph  is 
acknowledged  to  be  the  very  best  instrument  of  the  kind  in  the 
world.  Garey,  of  Baltimore,  has  invented  the  instrument  called  the 
vibrinator,  for  massaging  the  sound  apparatus  of  the  inner  ear,  which 
is  destined  to  be  of  incalcuable  value  to  the  afflicted. 

The  protection  sheet  which  is  now  used  in  all  the  hospitals  for 
the  insane,  and  which  has  banished  camisoles,  cribs,  anklets,  strait- 
jackets,  and  all  other  cruel  restraints  of  iron,  wood  and  leather  was 
invented  in  the  Middletown,  New  York,  State  Homoeopathic  Hos- 
pital, under  the  suggestion  of  Dr.  Seldon  H.  Talcott. 

Dr.  Edwin  Hale  has  invented,  a bivalve  expanding  speculum 
which  is  now  used  by  both  schools  in  the  United  States.  Also  the 
pistol- handle  forceps  for  which  he  claims  that  the  line  of  traction 
and  the  curve  of  the  handles  make  it  equal  if  not  superior  to  Tar- 
nier’s. 

Dr.  Griswold  Comstock  has  invented  a pair  of  obstetrical  forceps 
which  are  a great  favorite  with  many  physicians.  Dr.  J.  C.  Mor- 
gan, of  Philadelphia,  has  invented  an  apparatus  for  fracture  of  the 
clavicle  which  is  acknowledged  to  be  the  best  ever  devised.  He 
was  also  in  advance  of  all  others  in  using  and  publishing  the  alumi- 
nium probe  now  in  universal  use.  He  also  invented  a vectus  which 
has  saved  the  lives  of  many  babes  after  uniform  previous  mortality, 
and  many  other  instruments.  Dr.  Campbell,  of  St.  Louis,  has  in- 
vented many  eye  and  ear  instruments.  Dr.  Pratt,  of  Chicago,  whole 
sets  of  orificial  instruments.  The  late  Dr.  Sebold  devised  the  neatest 
and  most  ingenious  speculum  forceps  and  scissors  for  operating  upon 
the  eye  that  ever  was  invented. 

Dr.  Harold  Wilson,  of  Detroit,  has  invented  several  important 
eye  and  ear  instruments. 

Dr.  Knoll  has  invented  several  valuable  instruments  ; 1.  The  large 
bivalve  rectal  speculum,  which  with  slight  modifications  is  now  sold 
everywhere  and  frequently  is  called  the  Pratt  speculum.  2.  An 


THE  DEVELOPMENT  OF  MEDICAL  SCIENCE. 


203 


artery  forceps  which  is  the  strongest,  most  reliable  instrument  of  its 
kind  made.  3.  A punch  forceps  for  skull  operations. — Century , 
January,  1893.  4.  The  stylet  and  dilators  for  stricture  of  oesopha- 

gus and  urethra. 

Dr.  S.  L.  Hall,  of  Cleveland,  has  devised  a very  ingenious  appa- 
ratus for  remedying  a deflected  nasal  septum.  It  is  able  to  meta- 
morphose a badly  deformed  nose  into  one  of  the  purest  Grecian 
type. 

Dr.  George  Gorham,  Albany,  N.  Y.,  has  invented  an  apparatus 
for  treatment  of  Pott’s  disease  which  is  acknowledged  to  be  a valua- 
ble appliance. 

Dr.  E.  D.  Baun,  of  Passaic,  N.  J.,  has  invented  an  attachment 
for  the  bedstead  with  ropes  and  handles  for  the  use  of  women  in 
labor,  which  is  valuable,  also  an  insufflator  for  the  resuscitation  of 
asphyxiated  infants  at  birth  which  is  very  successful. — North  Ameri- 
can Journal  of  Homoeopathy. 

Horace  Ivins,  Philadelphia,  has  a nasal  speculum  which  is  good. 
See  his  recent  book  on  Nose  and  Throat , p.  15. 

Bushrod  W.  James  has  invented  several  good  things. 

Dr.  Edward  Blake,  of  England,  has  introduced  a rhinometer  for 
measuring  the  depth  of  the  nasal  cavity  and  destroying  adenoid 
growths. 

Dr.  Horace  Packard,  of  Boston,  has  improved  and  invented  a 
number  of  surgical  instruments,  but  is  known  of  all  schools  for  his 
appliance  for  administering  ether.  By  his  method  the  same  effect 
is  produced  by  a drachm  which  formally  required  ounces;  thus  he 
became  a benefactor  to  the  thousands  of  suffering  humanity,  who 
must  take  the  risks  of  anaesthetics. 

To  recapitulate,  there  was  no  true  medical  science  until  Homoe- 
opathy was  introduced.  Allopathy  was  not  true  medical  science 
because  it  did  not  cure  the  sick,  or  alleviate  human  misery,  but 
rather  added  to  it  new  tortures. 

Homoeopathy  discovered  a true  law  of  cure,  proved  hundreds  of 
drugs,  animal  viruses,  and  diseased  products  to  be  able  to  relieve 
human  misery.  It  built  up  and  is  constantly  improving  a Materia 
Medica,  which  applied  to  disease,  is  capable  of  restoring  the  sick  to 
health.  Allopathy  has  made  no  progress  except  as  it  has  developed 
Hahnemannian  principles  or  stolen  outright  from  our  system.  Ho- 
moeopathy has  made  wonderful  strides  of  progress  and  greatly  influ- 


204 


world’s  homoeopathic  congress. 


enced  all  medical  practice.  It  has  written  libraries,  founded  colleges 
for  the  teaching  of  its  system,  and  hospitals  for  its  practical  demon- 
stration, and  the  relief  of  human  misery.  It  has  compelled  the 
dominant  school  to  cease  its  vampireism  and  to  adopt  our  methods, 
our  remedies  and  our  dose  ; it  has  educated  the  laity  in  regard  to 
their  own  physical  being  and  the  superior  claims  of  Homoeopathy ; 
it  has  improved  surgical  therapeutics  and  enriched  mechanical  thera- 
peutics; and  in  short  has  been  of  more  benefit  to  humanity  than  all 
other  discoveries  the  world  has  ever  known. 

Discussion. 

The  Chairman  : Dr.  Hawkes,  of  Liverpool,  England,  wishes 
to  speak  on  this  paper. 

Dr.  Hawkes  : I am  exceedingly  sorry  that  I was  away  when  I 
ought  to  have  spoken,  Nothing  illustrates  the  completeness  of  this 
paper  more  than  the  few  touches  our  friend  has  given  of  our  la- 
mented friend’s  work,  which  is  as  complete  as  anything  I could 
have  written.  If  we  were  to  speak  in  our  country  of  lady  doctors 
and  the  work  that  thay  can  do,  or  discuss  that  matter  in  our  medi- 
cal societies  and  tell  them  of  this  paper  to  which  I have  just  lis- 
tened, it  would  be  almost  incredible  to  them.  Not  that  our  friends 
there,  as  a body,  or  as  Englishmen,  do  not  appreciate  the  abilities 
of  women  ; but  it  is  not  yet  conceded  over  yonder  that  medicine  is 
exactly  her  sphere.  If  they  could  have  heard  that  paper  read  that 
argument  would  lose  very  much  of  its  force. 

I am  astonished  to  gather  from  her  paper  what  has  been  done  by 
Homoeopaths  in  this  country,  and,  although  I profess  to  know  a 
little  of  medical  literature,  I must  admit  that  very  little  could  be 
added  to  the  paper  by  anybody  with  whom  I am  acquainted.  Skin- 
ner, as  you  know,  invented  that  apparatus  that  I see  is  used  very 
much  here  for  giving  chloroform,  but  that  was  before  he  became  a 
Homoeopath.  I think  we  must  go  back  to  this  fact  that  what  Hah- 
nemann taught  us  and  what  his  followers  had  insisted  upon  is  this  : 
the  proving  of  medicines  and  the  application  of  those  substances 
that  were  never  employed  as  medicines  at  all  until  Homoeopathy 
came  to  the  front,  which  feature  of  things  they  ought  to  be  most 
thankful  for.  What  Homoeopathy  has  gained  will  go  to  form  a 
monument  to  Hahnemann  which  no  power  can  destroy  and  which 
no  time  can  efface. 

The  Chairman:  The  hour  for  adjournment  has  arrived,  and 
the  Congress  now  stands  adjourned. 

At  three  o’clock  p.m.,  meetings  were  held  by  the  Section  in 
Clinical  Medicine  and  the  Section  in  Mental  and  Nervous  Diseases. 


THE  DEVELOPMENT  OF  MEDICAL  SCIENCE. 


205 


FIFTH  DAY’S  SESSION. 

Saturday  Morning,  June  3,  1893. 

The  final  meeting  of  the  Congress  was  called  to  order  at  10.30  by 
Dr.  J.  S.  Mitchell,  of  Chicago,  President. 

On  motion,  the  following  resolutions  were  unanimously  adopted  : 

Resolved , That  the  thanks  of  the  Congress  be  extended  to  Dr.  J. 
S.  Mitchell,  our  President,  for  his  very  successful  efforts  in  prepar- 
ing for, and  dignity  in  presiding  over,  our  sessions;  also  to  Dr. Wes- 
ley A.  Dunn,  our  Secretary,  for  his  very  efficient  labors. 

Resolved , That  our  thanks  are  due  to  the  editor  and  publishers  of 
the  Daily  Medical  Century  for  their  enterprise  in  the  publication  of 
our  proceedings  and  roster  from  day  to  day. 

Resolved , That  the  thanks  of  the  Congress  be  tendered  Dr.  Emil 
Schlegel  for  copies  of  his  report  on  the  Clinic  at  City  of  Tubin- 
gen ; to  Dr.  C.  Hurtado,  of  Curacoa,  for  copies  of  works  on 
Botany;  to  Dr.  Louis  Paez,  Bogota,  for  copies  of  reports;  to 
Tommaso  Cigliano  for  copies  of  works  on  Materia  Medica;  to  Dr. 
Alexander  Villers  for  copy  of  directory  of  foreign  physicians;  to 
Dr.  B.  N.  Banerjee  for  reports;  to  Dr.  Richard  Hughes,  of  Brighton, 
England,  J.  W.  Hayward,  Liverpool,  Edward  Adams,  of  Toronto, 
for  special  work  to  insure  the  attendance  of  foreign  delegates. 

Dr.  James:  Mr.  Chairman,  it  seems  there  is  very  little  work  for 
this  morning,  and  this  afternoon’s  business  might  as  well  be  included 
in  this  morning’s  session,  so  that  we  can  finish  up  our  work  and  ad- 
journ. I would  move  that  we  go  into  sectional  meeting,  and  take 
up  all  the  unfinished  work,  and  remain  in  session  until  both  the 
morning  and  afternoon’s  work  is  completed. 

The  Congress  so  voted. 

The  Chairman  : The  Section  of  Rhinology  and  Laryngology 
will  meet  in  this  room,  and  the  Section  of  Paedology  will  meet  in 
hall  29. 

The  papers  at  hand  will  be  passed  by  their  titles. 

Dr.  E.  M.  Hale  then  presented  a paper  by  Dr.  Carlos  Plata,  of 
Bogota,  S.  A.  In  introducing  the  subject,  Dr.  Hale  said  : 

Mr.  President  and  Gentlemen:  I have  the  honor  and  the  pleasure 
of  presenting  to  you  a short  paper  prepared  for  your  consideration 
and  sent  to  me  by  Dr.  Carlos  Plata,  of  Bogota,  Colombia  : 

For  many  years,  perhaps  twenty-five,  I have  been  inscribed  an 


206 


world’s  homoeopathic  congress. 


Honorary  member  of  the  Homoeopathic  Institute  of  Colombia,  but, 
I regret  to  say,  that  my  acquaintance  with  the  country  has  scarcely 
gone  farther.  Let  me  remind  you,  as  well  as  myself,  at  this  moment, 
that  the  United  States  of  Colombia  includes  within  its  territory  the 
only  continental  ground  touched  by  the  foot  of  Columbus,  he  having 
given  the  name  of  Veragua  to  what  is  now  the  northwestern  prov- 
ince, on  the  Isthmus  of  Panama,  from  which  province  he  and  his 
descendants  (one  of  whose  distinguished  members  we  have  now  among 
us)  took  their  ducal  title. 

Colombia  is  not  insignificent  in  size,  being  equal  to  our  New  Eng- 
land and  Middle  States,  the  V;rginias,  the  Carolinas,  Ohio,  Tennes- 
see, and  Kentucky ; having  a coast-line  of  a thousand  miles,  an 
enormous  river  system,  and  mountains  rising  to  a height  of  23,000 
feet,  although  under  the  equator.  Consequently,  all  varieties  of  cli- 
mate are  here  exemplified,  although  there  are  no  seasons,  strictly 
speaking,  the  name  of  summer  being  giveij^to  the  dry,  and  winter  to 
the  rainy  periods,  which  alternate  at  intervals  of  sometimes  three 
months,  sometimes  six  months,  while,  sometimes,  summer  is  almost 
unceasing. 

There  are  nine  departments,  or  states;  the  capital,  Bogota,  being 
situated  in  about  the  middle,  at  an  altitude  of  8564  feet,  with  a 
charter  granted  by  Charles  V.,  and  a population  of  140,000.  From 
the  valuable  bulletin  on  Colombia,  issued  by  the  Bureau  of  Ameri- 
can Republics,  at  Washington,  I learn  that,  besides  its  elegant  cathe- 
dral and  one  of  the  handsomest  theatres  in  America,  it  contains  a 
university,  with  faculties  in  medicine,  law,  natural  sciences,  and  en- 
gineering; a large  central  pharmacy,  and  two  Homoeopathic  jour- 
nals; a museum  of  antiquities,  and  an  astronomical  observatory 
founded  by  a celebrated  scientist  named  Mutis.  The  capitol  build- 
ing is  handsome  and  well  kept;  the  dwelling  houses  are  comfortable, 
the  streets  are  paved,  and  there  is  a good  system  of  sewers.  There 
are  three  parks,  in  one  of  which  is  a monument  to  General  Bolivar. 
The  city  is  abundantly  supplied  with  water,  and  the  climate  is  de- 
licious. It  has  a notable  literary  life,  which  is  the  more  remarkable 
as  both  intellectual  and  commercial  communication  with  the  outside 
world  is  most  difficult  and  expensive.  But,  in  spite  of  being  so  in- 
accessible, its  people  seem  to  reach  out  to  the  life  of  the  world,  and 
we  welcome  to  this  Congress  from  Bogota  a message  from  so  earnest 
and  thoughtful  a colleague  as  Dr.  Carlos  Plata. 

Bogota,  Colombia,  March  1,  1893. 

To  the  President  of  the  Congress  of  Homoeopathic  Physician \s  and 
Surgeons  at  Chicago , 

Sir : Through  the  kindness  of  Dr.  E.  M.  Hale,  I present  to  this 
honorable  body  some  remarks  on  Homoeopathic  medicine.  In  doing 
so,  I modestly  beg  your  indulgence  for  my  little  contribution,  which 
I pray  may  be  for  the  good  of  humanity  and  the  service  of  science. 


AXIOMS,  APHORISMS  AND  RULES  OF  HOMOEOPATHY.  207 


ADDRESS. 

OBSERVATIONS  ON  SOME  OF  THE  AXIOMS,  APHO- 
RISMS, AND  RULES  OF  HOMOEOPATHY. 

By  Carlos  Plata,  M.D.,  Bogota,  Colombia,  S.  A. 


“ Life  is  the  result  of  the  incessant  action  of  an  invisible,  imma- 
terial, essential,  and  dynamic  principle,  of  which  the  regularity  and 
harmony  of  the  functions  constitute  health,  while  their  derangement 
and  discord  constitute  disease.” 

This  definition  necessarily  implies  that  if  this  functional  har- 
mony does  not  exist,  in  either  its  organic  or  spiritual  relations,  we 
must  have  discord.  To  me,  this  law  appears  almost  universal.  In 
towns  from  1000  to  100,000  or  more  inhabitants,  and  in  such  a city 
as  Bogota,  where  I live,  which  has  140,000,  I have  investigated  the 
state  of  health  of  many  undoubtedly  robust  persons  with  the  general 
result  that  they  did  not  feel  quite  well ; one  had  a headache,  an- 
other indigestion,  chills,  remittent  pains,  etc. ; apart,  of  course,  from 
mental  complaints  of  melancholy,  forgetfulness,  and  hypochondria; 
all  of  which  investigations  prove  my  proposition. 

A rule  of  logic  teaches  us  to  infer  the  unknown  from  the  known; 
as  by  analogy,  given  the  condition  of  a people  living  in  certain 
climates  and  hygienic  surroundings,  we  may  infer  the  conditions  of 
other  peoples  in  the  same  circumstances,  or  as  we  may  infer  that  pa- 
thological causes  are  more  prolific  in  the  city  than  in  the  country 
with  its  purer  air,  water,  and  food.  What  conclusions  can  be  drawn 
from  these  observations  ? Simply,  that  mankind,  as  a body,  is 
physically  and  mentally  diseased,  although  a good  external  appear- 
ance may  indicate  perfect  health,  just  as  happens  with  fruits  of  good 
color,  the  interior  of  which  is  unsound. 

In  man,  the  two  forces  of  conservation  and  destruction,  health, 
and  disease,  are  in  ceaseless  warfare,  the  end  of  which  is  death.  The 
pathological  state,  whether  latent  or  active,  moral  or  physical,  is  a 
natural  one. 

Can  the  provings  of  medicines  be  obtained  on  a healthy  person, 
since  we  have  demonstrated  that  disease  is  inherent  in  life  itself,  and 


208 


world’s  homoeopathic  congress. 


that  the  very  word  life  is  relative  to  death,  or  merely  a synonym  for 
the  constant  transformation  of  matter? 

Most  probably  until  now,  medicines  have  had  to  be  proved  on  dis- 
eased persons,  and  the  pathogeneses  have  not  been  obtained  from 
healthy  ones,  consequently  the  diseased  state  produced  was  not  artifi- 
cial but  rather  a union  with  an  organic  pathological  state. 

Moreover,  account  must  be  taken  of  the  purity  or  impurity  of 
water,  and  the  chemical  atmospheric  agents  that  may  have  an  influ- 
ence in  producing  new,  or  modifying  old  symptoms,  and  we  must 
especially  consider  the  individual  temperament,  the  climate,  customs, 
etc.  How,  therefore,  shall  we  distinguish  natural  from  induced  dis- 
ease, and  how  shall  we  obtain  an  absolutely  pure  drug  in  every  sense 
of  the  word  ? 

If  two  symptomatologies  are  recorded,  one  before,  the  other  after 
taking  the  drug,  the  result  will  be  particularized  so  as  to  destroy  any 
general  pathogenesis. 

In  the  Organon  of  the  immortal  Hahnemann  occurs  this  statement, 
“ Only  by  means  of  repeatedly  verified  observations  on  a great  num- 
ber of  individuals  of  both  sexes  suitably  selected,  can  we  arrive  at  a 
knowledge  of  the  ensemble  of  morbid  conditions  which  a drug  is  able 
to  produce;  that  is  to  say,  successive  provings  must  give  nearly 
identical  results.”  This  rule  is  very  important,  because  it  necessi- 
tates accuracy  as  to  the  symptoms  produced  by  a medicinal  agent  or 
as  to  the  power  of  a drug  to  alter  and  modify  health. 

The  microscope  has  shown  us  that  earth,  air,  light,  and  water, 
and  even  stones  contain  innumerable  animalculse,  which  chemistry 
can  reduce  to  the  original  elements  of  carbon,  oxygen,  hydrogen, 
and  nitrogen.  How  shall  we  know  for  certain,  when  we  administer 
a drug,  that  it  is  this  drug  which  has  produced  the  cure,  and  not  the 
chemical  atoms  which  the  drug  contains  ? All  that  we  are  sure  of 
is  that  the  drug  was  not  absolutely  pure;  hence  we  may  conclude: 
That  ideal  health  does  not  exist,  and  that  provings  do  not  constitute 
laws ; that  drugs  cannot  be  prepared  pure,  and  that  pathogeneses 
cannot  be  generalized. 

The  vehicles  for  preparing  Homoeopathic  drugs  are  alcohol,  sugar 
of  milk,  starch,  etc.,  because  they  are  considered  inert,  but  as  we  have 
shown  that  they  contain,  or  themselves  may  be,  medicinal  substances, 
they  cease  to  be  inert  and  innocent  to  the  economy,  and  for  that 
reason  they  cannot  serve  as  vehicles  for  pharmaceutical  preparations. 


AXIOMS,  APHORISMS  AND  RULES  OF  HOMOEOPATHY.  209 

According  to  the  definition  of  physics  inertia  is  a purely  negative 
property,  that  is  to  say,  it  does  not  exist.  Inertia  is,  in  a certain 
sense,  activity,  hence  any  combination,  however  weak,  develops  a 
new  body  with  a greater  or  less  amount  of  released  electricity,  as, 
for  example,  the  formation  of  a neutral  salt  by  the  union  of  sulphuric 
acid  and  an  alkali.  It  has  been  likewise  proved  that  each  molecule 
has  its  own  atmosphere ; this  being  so,  it  is  clear  that  each  one  of 
them  is  complex,  although  in  an  infinitesimal  proportion  ; therefore, 
each  molecule  is  an  example  of  polypharmacy,  since  each,  however 
small,  is  divisible  into  its  elements  which  goes  to  prove  that  there  can- 
not be  inert  or  innocent  substances. 

if,  in  spite  of  all  these  obstacles,  Homoeopathy  cures  with  such 
brilliant  and  surprising  results,  its  triumphs  will  be  still  greater  when 
these  defects  are  overcome.  It  will  be  of  immense  advantage  toward 
this  end  to  publish  a Homoeopathic  dictionary,  well  illustrated  in  the 
botanical  and  anatomical  sections,  and  in  at  least  four  languages,  Eng- 
lish, German,  French,  and  Spanish. 

In  conclusion  we  may  state : 

1.  That  man’s  natural  condition  is  that  of  disease. 

2.  The  word  health  is  relative  to  the  greater  or  less  degree  of 
disease. 

3.  An  absolute  proving  is  impossible  where  health  is  only  relative. 

4.  Generalized  pathogeneses  are  inaccurate. 

5.  Drugs  are  never  absolutely  pure,  and  this  prevents  certainty  in 
effects. 

6.  Nevertheless,  Homoeopathy,  the  law  of  similars,  is  the  only 
science  which,  by  reason  of  its  exact  data,  gives  us  more  accurate 
results  than  the  systems  opposed  to  it  have  been  able  to  obtain. 


President  Mitchell  announced  that  the  Section  in  Rhinology  and 
Laryngology,  and  the  Section  in  Paedology  would  hold  their  sessions 
at  once.  He  then  declared  the  World’s  Congress  of  Homoeopathic 
Physicians  and  Surgeons  adjourned  sine  die. 

Wesley  A.  Dunn,  M.D., 

Secretary. 


14 


REPORTS  OF  THE  SECTIONS, 


INCLUDING  THE 


MINUTES  OF  THE  SECTIONAL  MEETINGS, 


TOGETHER  WITH  THE 

SECTIONAL  ADDRESSES, 

SCIENTIFIC  ESSAYS 


AND  DISCUSSIONS. 


. 


' 


REPORT 


OF  THE 

SECTION  IN  SURGERY. 


Chicago,  Ii/l.,  Tuesday,  May  30,  1893. 

The  Surgical  Section  of  the  World’s  Congress  of  Homoeopathic 
Physicians  and  Surgeons  convened  in  the  Hall  of  Washington  at 
two  o’clock  p.m,,  and  was  called  to  order  by  Dr.  J.  S.  Mitchell, 
President  of  the  Congress. 

President  Mitchell  announced  that  Dr.  John  E.  James,  of  Phila- 
delphia, Pa.,  Acting  Chairman  of  the  Section,  was  not  yet  present, 
and  that,  therefore,  it  would  be  necessary  to  elect  a temporary 
chairman. 

Dr.  George  F.  Shears,  of  Chicago,  111.,  was  thereupon  chosen 
temporary  Chairman. 

The  Chair  called  on  Dr.  Horace  Packard,  of  Boston,  Mass.,  to 
read  a paper  on  “ Anaesthesia.” 

(At  this  moment  Dr.  John  E.  James  entered  the  room  and  as- 
sumed the  duties  of  the  chair.) 

Dr.  Packard  gave  a brief  resume  of  his  paper,  and  illustrated  it 
by  anaesthetizing  a patient  before  the  Section.  (For  these  remarks, 
see  the  discussion  following  the  paper.) 

The  subject  was  discussed  by  Drs.  S.  B.  Parsons,  of  St.  Louis,  Mo. ; 
H.  L.  Northrop,  of  Philadelphia,  Pa.,  whose  remarks  were  pre- 
sented by  title ; H.  F.  Biggar,  of  Cleveland,  O. ; N.  Waldo  Emer- 
son, of  Boston,  Mass. ; J.  G.  Gilchrist,  of  Iowa  City,  la. ; G.  F. 
Shears,  of  Chicago,  111.;  Alonzo  Boothby,  of  Boston,  Mass.;  Geo. 
W.  Bowen,  of  Fort  Wayne,  Ind. ; Emory  B.  Johns,  of  Lexington, 
Ky. ; E.  H.  Pratt,  of  Chicago,  111.,  and  Dr.  Packard,  author  of  the 
paper. 

Dr.  Thomas  L.  MacDonald,  of  Washington,  D.  C.,  read  a paper 
entitled  “ Surgical  Shock.”  It  was  discussed  by  Drs.  I.  T.  Talbot, 


214 


world’s  homoeopathic  congress. 


of  Boston,  Mass.;  L.  H.  Willard,  of  Allegheny  City,  Pa.;  A. 
Boothby,  of  Boston,  Mass. ; W.  F.  Knoll,  of  Chicago,  111. ; S.  B. 
Parsons,  of  St.  Louis,  Mo.,  and  by  Dr.  MacDonald,  the  author  of 
the  essay. 

The  Sectional  Address,  by  Dr.  W.  B.  Van  Lennep,  the  Chairman 
of  the  Section,  was  then  presented  by  title. 

Next  followed  a contribution  to  “ Thoracic  Surgery,”  by  Henry  L. 
Obetz,  M.D.,  of  Detroit,  Mich. 

The  meeting  of  the  Section  was  then  adjourned,  subject  to  the 
call  of  the  Secretary. 


Wednesday,  May  31,  1893. 

Pursuant  to  adjournment  and  the  call  of  the  Sectional  Secretary, 
a further  meeting  of  the  Section  in  Surgery  was  called  to  order  by 
Dr.  J.  E.  James,  the  acting  Chairman,  at  8.35  o’clock,  p.m. 

The  first  paper  read  was  by  Dr.  H.  F.  Biggar,  of  Cleveland,  O.? 
entitled  “ Thoracotomy  and  Thoracoplasty.” 

Dr.  W.  F.  Knoll,  of  Chicago,  111.,  was  called  on  to  discuss  the 
paper,  but  obtained  permission,  instead,  to  read  a paper  on  “ Vivi- 
section and  Pulmonary  Surgery.” 

The  whole  subject  of  Thoracic  Surgery  was  then  discussed  by 
Drs.  C.  E.  Walton,  of  Cincinnati,  O. ; Sidney  F.  Wilcox,  of  New 
York,  N.  Y.,  whose  remarks  were  presented  in  writing  and  without 
reading,  and  by  Dr.  H.  F.  Biggar,  of  Cleveland,  O. 

Dr.  Geo.  F.  Shears,  of  Chicago,  111.,  read  an  essay  on  “ The 
Treatment  of  Epilepsy,  Idiocy  and  Allied  Disorders  by  Cranial 
Excision  and  Incision.”  Discussion  on  the  paper  followed,  which 
was  participated  in  by  Drs.  DeWitt  G.  Wilcox,  of  Buffalo,  N.  Y. ; 
Clarence  Bartlett,  of  Philadelphia,  Pa.,  whose  remarks  were  referred 
by  title ; W.  F.  Knoll,  of  Chicago,  111.,  and  by  Dr.  Shears,  the 
essayist. 

Dr.  E.  H.  Pratt,  of  Chicago,  111.,  read  a paper  entitled  “ A Report 
on  Orificial  Surgery,  Including  an  Analysis  of  1000  Cases.”  The 
essay  was  briefly  discussed  by  Dr.  W.  E.  Green,  of  Little  Rock, 
Ark. 


SECTIONAL  ADDRESS  IN  SURGERY. 


215 


SECTIONAL  ADDRESS  IN  SURGERY. 

By  W.  B.  Van  Lennep,  M.D.,  Philadelphia,  Pa.,  Chairman  of  the 

Section. 


The  instructions  of  the  executive  committee  were  that  the  chair- 
men should  give  a review  of  the  literature  of  their  respective  de- 
partments for  the  past  year  or  two.  Such  a review  of  the  surgical 
work,  if  any  justice  were  done  to  the  subject,  would  require  more 
time  than  the  utmost  limits  of  courtesy  could  accord  even  a chair- 
man. We  were  also  instructed  to  give  the  utmost  possible  latitude 
to  the  discussion  of  the  various  papers,  and,  as  far  as  possible,  to 
have  the  latter  of  such  a character  as  to  invite  comment.  The  essays 
were  therefore  to  deal  with  live  subjects,  to  be  suggestive  and  not 
too  exhaustive.  To  further  this  end  a number  of  gentlemen  have 
prepared  themselves  to  discuss  or,  better,  to  enlarge  the  scope  cov- 
ered by  the  different  essays.  In  this  way  practically  two  or  three 
papers  are  assured  on  each  subject,  which  is  viewed  from  as  many 
different  standpoints.  Surgery  in  general  will  be  the  theme  of  an 
address  to  the  Congress  by  our  eminent  colleague,  Dr.  Helmuth, 
who  will  undoubtedly  handle  it  as  he  only  can.  Again,  the  essays 
presented  by  the  bureau  cover  a number  of  the  most  important  di- 
visions of  the  domain  of  surgery:  Anaesthesia,  Shock,  The  Brain, 
The  Thorax,  The  Bladder.  Each  of  them  will  necessarily  review 
the  literature  more  or  less  completely. 

It  has  therefore  been  deemed  advisable  by  your  chairman,  for  the 
sake  of  brevity,  and,  particularly,  with  a view  of  eliciting  discus- 
sion, to  confine  himself  to  one  of  the  subjects  that  has  not  been 
touched  upon  by  the  members  of  the  bureau,  the  Surgery  of  the 
Intestines. 

The  aids  to  intestinal  suture  inaugurated  by  the  work  of  Senn 
have  been  extensively  used  and  modified  in  this  country.  In  Eng- 
land the  decalcified  bone  plates  were  popularized  mainly  by  Dr. 
Jousset,  but,  on  the  Continent  and  particularly  in  Germany,  these 


216 


world’s  homoeopathic  congress. 


devices  were  looked  upon  with  suspicion,  and,  after  considerable  dis- 
cussion and  experience,  there  seems  to  be  a revulsion  of  feeling, 
until  the  ideal  method  is  getting  to  be  one  that  depends  on  the  un- 
aided suture.  This  is  particularly  true  of  lateral  anastomosis  which 
has  come  to  stay  apparently,  the  great  drawback  to  plates  and  rings 
of  any  kind  being  the  small  communicating  opening,  which  in  time 
contracted  to  a dangerous  extent.  To  avoid  this  a four-inch  anasto- 
motic opening  seems  indispensable,  and  the  technique  is  as  follows  : 

The  intestinal  surfaces  are  united  by  two  parallel  rows  of  continu- 
ous Lembert  sutures,  a quarter  of  an  inch  apart  and  an  inch  longer 
than  the  proposed  opening.  The  ends  of  the  threads  are  left  at- 
tached to  their  needles.  The  bowel  is  open  to  the  extent  of  four 
inches,  a quarter-inch  from  the  two  rows  of  sutures.  Bleeding  points 
are  clamped  until  caught  up  by  a whip-stitch  running  around  the 
opening  and  including  all  the  intestinal  coats.  The  two  rows  of 
continuous  sutures  first  applied  are  then  carried  around  this  and  the 
opening  is  complete  (Abbe).  Weir  and  Markoe  report  successful 
cases  by  this  method. 

To  avoid  the  danger  of  infection  from  opening  the  intestinal  canal, 
an  anastomosis  in  two  tempos  has  been  proposed,  the  second,  however, 
being  carried  out  by  nature.  While  intended  particularly  for  gastro- 
enterostomy, the  principle  is  applicable  to  any  portion  of  the  intesti- 
nal tract.  The  serous  surfaces  being  united  by  a linear  suture,  an 
oval  piece  is  cut  out  from  each  intestine  a quarter  of  an  inch  from 
the  suture,  leaving  the  mucosa  intact.  The  free  edges  of  this  open- 
ing are  united  on  one  side,  and  the  bulging  mucous  membranes  are 
drawn  out,  and  a ligature  tied  tightly  around  them.  The  remaining 
free  edges  of  the  opening  are  then  stitched,  and  the  field  of  operation 
enclosed  by  a continuation  of  the  first  serous  suture.  By  sloughing 
of  the  ligated  mucous  membrane  the  anastomosis  is  completed  bv 
the  third  or  fourth  day  (Postnikow). 

The  importance  of  the  firm  fibrous  submucosa  as  an  anchoring 
ground  for  any  suture  is  to  be  particularly  borne  in  mind,  and  prac- 
tice will  teach  the  surgeon  to  recognize  the  resistance  that  shows  it 
has  been  entered.  While  it  is  indispensable  to  the  firmness  of  a su- 
ture that  it  should  include  a few  fibres  of  this  coat,  great  care  should 
also  be  exercised  not  to  perforate  it  and  enter  the  intestinal  lumen,  as 
fatal  leakage  would  result  (Halstead). 

Another  valuable  principle  which  has  a great  range  of  applica- 


SECTIONAL  ADDRESS  IN  SURGERY. 


217 


bility ,e.g.}  pyloric  excisions,  gastro-enterostomy,  intussusception,  end- 
to-end  union,  high  rectal  excisions,  etc.,  consists  of  tacking  together 
the  lumina  to  be  united  by  two  stitches,  one  being  applied  at  the 
mesenteric  junction  when  that  is  to  be  included.  An  opening  is 
made  in  the  bowel  a short  distance  from  the  ends  to  be  united,  which 
are  then  invaginated  and  drawn  out  of  this  opening  by  traction  On 
the  two  sutures  above  mentioned.  By  passing  a dozen  or  more  in- 
terrupted stitches  through  the  tube  that  is  thus  drawn  out,  picking 
them  up  in  the  middle  and  dividing  and  tying  them,  intestinal  ends 
may  be  united  at  twice  as  many  points.  The  sutured  gut  is  then 
drawn  back  and  the  temporary  opening  closed.  In  this  manner  all 
the  sutures  are  passed  from  the  inside  (Maunsell).  A case  of  intus- 
susception with  carcinoma  has  been  successfully  treated  by  this  method 
(Hartley). 

A somewhat  similar  procedure  has  been  practiced  for  irreducible 
intussusceptions.  The  intussusceptum  and  intussuscipiens  are  united 
at  the  point  where  the  former  enters  the  latter  by  a fine  silk  suture 
which  includes  the  mesentery.  The  intussuscipiens  is  opened  two 
inches  below  this  point  and  the  intussusceptum  amputated.  The 
stump  is  sewed  with  a whip-stitch  arresting  all  bleeding,  and  the 
opening  closed  (Barker). 

Another  modification  consists  of  amputation  of  the  intussuscep- 
tum in  the  same  manner,  ligature  en  masse  of  the  stump,  and  an  an- 
astomosis between  the  intestine  above  and  the  opening  made  to  get 
at  the  intussusceptum  (Bier). 

The  principle  of  the  Heineke-Miculicz  method  of  pyloroplasty 
has  been  extended  to  intestinal  constrictions  of  a cicatricial  nature  in 
which  resection  is  not  deemed  necessary  (Pean,  Hacker). 

The  danger  of  leakage  after  intestinal  perforation  or  suture  has 
been  shown,  experimentally,  to  be  obviated  by  closing  the  opening 
or  protecting  the  suture,  by  covering  it  with  a neighboring  loop  of 
intestine  or  omentum.  This  has  been  found  safer,  and,  of  course, 
of  wider  applicability  than  the  omental  grafts  so  extensively  used  of 
late  (Chaput). 

The  same  writer  closed  openings  made  in  the  intestines  of  dogs 
with  five  or  six  thicknesses  of  iodoform  gauze  in  the  shape  of  pads, 
the  edges  of  which  were  stitched  around  the  orifice.  The  gauze 
acted  temporarily,  working  its  way  gradually  into  the  intestine,  the 
opening  being  closed  by  adhesions  to  neighboring  coils  of  intestine 


218 


world’s  homoeopathic  congress. 


or  omentum.  He  also  found  that  strips  of  iodoform  gauze  were  an 
efficient  protective  to  any  intestinal  suture. 

It  has  also  been  shown  experimentally  that  a part  of  the  small 
intestine  could  be  transplanted  between  two  ends  of  the  colon  and 
replace  the  latter  when  extensive  resections  of  it  have  been  made 
(Mitcheli). 

In  resections  for  malignant  disease,  while  one  of  the  several  cases 
may  be  cited  in  which  the  caecum,  ascending  colon,  and  several 
inches  of  the  ileum  were  successfully  removed  (Lowson),  the  ten- 
dency is  toward  an  operation  in  several  stages.  1.  The  growth  is 
first  isolated  by  resection,  the  two  ends  of  its  intestine  being  drawn 
out  of  the  wound.  2.  The  continuity  of  the  intestinal  canal  is  es- 
tablished by  anastomosis  or  end-to-end  union.  3.  The  isolated 
growth  is  excised  (Bloch,  Hochenegg).  This  method  can  often  be 
practiced  when  hitherto  we  only  had  physiological  exclusion  by  an- 
astomosis at  our  disposal;  it  is  a curative  instead  of  a mere  pallia- 
tive measure,  when  primary  excision  is  unsafe. 

Among  the  substitutes  for  the  bone  plates  may  be  mentioned 
plates  of  raw  potatoes  (Dawbarn)  and  raw  Swedish  turnip  (von 
Baraez).  They  have  the  advantage  of  being  obtainable  in  emergen- 
cies and  can  be  cut  to  any  size  desired,  so  as  to  insure  a large  open- 
ing. The  sutures  are  fastened  by  being  knotted  and  drawn  through 
rubber  tabs  cut  from  drainage  tubing,  much  as  carpet  tacks  are 
armed  or  protected. 

The  stomach  has  received  considerable  attention.  Gastrostomy 
appears  to  be  particularly  indicated  in  cicatricial  narrowing  of  the 
oesophagus,  when  tubage  fails,  as  it  offers  a curative  inducement  in 
the  shape  of  retrograde  dilatation.  For  malignant  diseases  it  is 
dangerous  and  prolongs  life  but  a short  time  (Senn).  The  rectus 
muscle  and  the  eighth  intercostal  space  are  the  points  of  election  for 
the  fistula.  In  the  former  location  leakage  is  prevented  by  a sphinc- 
ter-like action  (Allingham).  This  may  also  be  avoided  by  the  use 
of  two  inflatable  rubber  bags,  one  inside  and  one  outside,  connected 
by  a rubber  tube.  The  operation  is  best  done  in  two  tempos.  It  is 
claimed  that  the  movements  of  the  stomach  are  seriously  interfered 
with,  and  considerable  stagnation  occurs ; also,  in  all  probability, 
the  peptic  function  is  impaired  if  not  destroyed,  nutrition  being  car- 
ried on  by  the  intestines  (Ewald). 

Gastro-enterostomy  has  been  quite  extensively  practiced  with 


SECTIONAL  ADDRESS  IN  SURGERY. 


219 


not  altogether  satisfactory  results.  It  is  after  all  but  a palliative 
measure  and  owes  its  popularity  largely  to  the  dangers  of  pylorec- 
tomy.  With  a view  of  lessening  these  it  has  been  combined  with 
excision  and  closure  of  the  opening  in  the  stomach  and  duodenum. 

Another  palliative  plan  has  been  suggested,  i.e.,  jejunostomy.  The 
jejunum  a short  distance  below  the  duodenum  is  drawn  out,  divided, 
and  the  distal  end  sewed  into  the  wound  while  the  proximal  end  is 
implanted  into  the  distal,  a few  inches  from  the  fistula,  to  allow  the 
pancreatic  juice  and  bile  to  flow  into  the  intestine  (Maydl). 

Digital  divulsion  (Loreta)  has  resulted  fatally  from  rupture, 
although  not  carried  to  the  extent  recommended  by  its  originator 
(Swain). 

Pyloroplasty  (Heineke-Miculicz)  has  been  successfully  practiced  a 
number  of  times  for  cicatricial  pyloric  stenosis  (Page,  Kohler,  etc). 

A novel  plan  has  been  followed  for  the  relief  of  dilatation  of  the 
stomach,  i e.,  folding  or  plating  its  walls  inward  by  rows  of  sutures 
which  do  not  include  the  mucous  membrane  (Weir). 

It  is  a generally  acknowledged  fact  that  an  operation  for  bowel 
obstruction  is  not  complete  until  the  intestinal  paresis  is  relieved  by 
puncture  of  the  distended  intestine.  As  a substitute  for  this,  lavage 
of  the  stomach  is  proposed  and  has  been  successfully  used  (Lund). 
Post-operative  obstructions  have  been  in  several  instances  success- 
fully operated  by  section  and  separation  of  adhesions  (Lucas- 
Championneire).  From  the  fact  that  these  are  soft  and  easily  sepa- 
rated within  the  first  few  days,  the  attempt  has  been  made  to  break 
them  up  by  first  washing  out  the  stomach,  and  then  pouring  into  the 
tube  a half  ounce  of  castor  oil.  Flatus  and  then  copious  stools  were 
soon  passed  (Klotz).  Both  lavage  and  opium  are  looked  upon  as 
dangerous  from  their  masking  effect  in  intestinal  obstruction, 
although  the  former  is  of  value  immediately  before  an  operation  to 
relieve  reversed  peristalsis  and  prevent  actual  “ drowning  ” of  the 
patient  (C.  M.  Thomas).  Early  operations  or  exploratory  section  as 
soon  as  the  diagnosis  of  obstruction  is  made,  have  been  more  than 
ever  emphasized.  The  term  “ exploratory  ” is  used  because,  the 
pathognomic  symptom  being  faecal  vomiting,  this  should  not  be 
waited  for,  but  the  section  made  “ on  suspicion.”  Every  condition, 
aside  from  faecal  impaction,  which  can  produce  the  clinical  picture, 
calls  for  a like  treatment. 

In  cases  where  the  cause  of  the  obstruction  is  hard  to  find,  a short 


220 


world’s  homoeopathic  congress. 


circuit  by  lateral  anastomosis  has  given  gratifying  results  (Atkinson). 
Unnecessary  and  often  fatal  delay  and  handling  of  the  intestine  is 
avoided  in  this  manner. 

Nelaton’s  enterostomy  has  also  been  resorted  to  in  desperate  cases. 
A rapid  method  of  forming  the  artificial  anus  consists  of  attaching 
the  intestine  to  the  parietal  peritonaeum  by  8 or  10  haemostats,  which 
are  removed  in  24  hours,  when  adhesions  will  have  formed  (Chaput)- 

In  spite  of  the  fact  that  the  respective  advocates  of  the  clamp  and 
cautery,  and  those  of  the  ligature  in  the  treatment  of  haemorrhoids 
have  partly  ceased  their  invective  against  the  more  surgical  methods 
of  excision  (Pratt  and  Whitehead),  and  directed  their  abuse  to  those 
who  dare  suggest  any  but  the  operation  they  have  recently  learned, 
colotomy,  nevertheless  the  excisions  of  malignant  rectal  neoplasms 
have  increased  their  hold  on  the  profession.  And  justly,  too,  for 
every  physician  should  strive  after  curative  rather  than  palliative 
measures.  The  plan  proposed  by  Kraske  has,  with  certain  modifi- 
cations, been  extensively  and  successfully  practiced  and  advocated 
(McCosh).  The  results  are  as  satisfactory  as  could  be  expected  with 
cancerous  disease.  The  sphere  of  the  operation  has  been  extended 
to  attack  the  uterine  adnexa  (Montgomery)  and  the  terminal  portion 
of  the  ureter  (Cabot). 

In  oonsequence  of  the  incontinence  frequently  resulting,  to  allow 
of  more  extensive  enucleation,  and  to  insure  an  asepsis  of  the 
wound,  the  writer  has  successfully  practiced  the  following  method  : 

1.  The  formation  of  a permanent  anus  by  inguinal  colotomy,  the 
intestine  being  drawn  well  down  to  leave  an  abundance  of  signoid 
flexure  below. 

2.  Complete  and  thorough  extirpation  through  the  anus,  through 
the  sacrum,  or  by  opening  the  peritonaeum  and  drawing  down  the 
gut.  Usually  two  or  all  three  of  these  steps  have  been  combined. 

3.  Closure  of  the  resulting  wound  by  granulation  aided  by 
suture. 

In  cases  where  the  growth  is  not  readily  accessible  from  the  ab- 
domen or  through  the  sacrum,  Maunsell  has  made  use  of  the  prin- 
ciple already  referred  to : the  abdomen  is  opened  and  the  peritonaeum 
around  the  bowel  incised.  The  growth  is  then  drawn  out  of  the 
dilated  anus  by  invaginating  the  gut.  It  is  excised  by  amputating 
the  intussusceptum,  and  the  stump  sutured  in  the  manner  already 
described.  The  intestine  is  drawn  back  into  the  abdomen,  and 


SECTIONAL  ADDRESS  IN  SURGERY. 


221 


the  peritoneal  incision  closed.  The  proposition  is  based  on  experi- 
ment. 

Inguinal  colotomy,  or  colostomy,  or  sigmoidostomy  is  the  opera- 
tion of  election  and  has  been  very  extensively  used,  the  well-known 
methods  of  suspension  with  a rod  or  suture,  together  with  previous 
drawing  down  of  the  intestine  being  followed.  When  no  time  is  to 
be  lost  the  gut  has  been  simply  suspended  with  a rod,  the  wound 
being  stuffed  with  gauze  (Maydl,  Reeves,  etc.).  When  immediate 
opening  was  necessary  a tube  has  been  introduced  and  the  bowel 
tied  around  it  (Jones),  or  the  intestine  has  been  punctured  with  a 
trocar  and  a rubber  drain  attached  to  the  canula  to  carry  off  the 
discharges  (Robson).  In  this  way  contamination  is  prevented  until 
safe  adhesions  take  place. 

The  subject  of  appendicitis  has  naturally  received  considerable  at- 
tention; and,  while  but  little  that  is  new  has  been  published,  what  is 
already  known  has  been  well  emphasized,  and,  better  still,  the  pro- 
fession generally  have  been  aroused  to  realize  the  importance  of  this 
affection.  The  impossibility  of  an  idiopathic  peritonitis,  the  fre- 
quency of  appendical  trouble,  its  fatality,  and  the  importance  of  a 
study  of  each  case  from  its  incipiency  by  the  surgeon  as  well  as  the 
physician  are  becoming  pretty  generally  realized.  It  was  a healthy 
sign  of  the  times  to  the  writer,  when  he  offended  the  physician  and 
disappointed  the  family  by  advising  against  an  operation  between  at- 
tacks in  a recent  case.  The  advisability  of  such  operations  between 
attacks  has  been  strongly  emphasized,  and  the  cases,  which  were  but 
few  and  far  between  when  the  writer  gave  his  experience  on  the  sub- 
ject at  the  last  Congress,  have  been  indefinitely  multiplied  and  have 
shown  most  satisfactory  results  (Morris  and  others).  The  indica- 
tions are : frequency  of  recurrence,  increasing  severity  of  attacks, 
and,  particularly,  continuance  of  pain  and  tumor  between  attacks- 
Persistent  colicky  pains,  with  tenderness  in  the  region  of  the  ap- 
pendix, have  been  relieved  by  excision  of  the  organ,  which  was 
found  to  be  moderately  diseased.  Distinct  attacks  were  absent 
(Hochstetter).  The  writer  has  opened  three  such  cases  and  has  been 
surprised  at  (1)  the  slight  changes  in  the  appendix  ; (2)  the  suffering 
resulting  from  such  lesions,  amounting  at  times  to  complete  invalid- 
ism ; (3)  the  complete  and  permanent  relief  following  excision. 

While  almost  every  case  of  so-called  typhlitis  is  dependent  upon 
a diseased  appendix,  an  occasional  report  is  published  of  lesions  in 


222 


world’s  homoeopathic  congress. 


the  caecum  which  produce  much  the  same  phenomena  and  results. 
In  one  instance  a circumscribed  faecal  abscess  was  found  to  be  due 
to  a perforating  caecal  ulcer.  The  onset  of  the  trouble  was  more 
insidious,  diarrhoea  having  preceded  it  and  being  present;  the  initial 
vomiting  was  also  absent;  the  appendix  was  normal  (Hartley). 

As  to  the  pathology  of  appendical  disease,  catarrh,  beginning  at 
the  caecal  junction,  is  still  considered  the  usual  cause.  This  is  fol- 
lowed by  the  well-known  changes : thickening,  stricture,  ulceration, 
perforation,  or  the  formation  of  faecal  concretions  (Kiimmel). 
Foreign 'bodies  are  rare,  although  occasionally  met  with  (Pinnock). 
Tubercular  disease  has  also  been  known  to  be  a not  infrequent 
cause  of  this  affection  (Delorme),  and  actino-mycosis  may  affect  this 
organ  (Lang). 

The  importance  of  early  operating  has  received  due  attention, 
some  going  so  far  as  to  recommend  it  as  soon  as  a diagnosis  is  made 
(Hurd,  Marshall).  Persistence  or  aggravation  of  the  symptoms 
after  twenty-four  hours,  and,  particularly,  the  characteristic  signs 
of  peritoneal  infection,  are  the  indications  mainly  relied  on.  An 
occasional  cure,  after  general  septic  peritonitis  has  been  lighted  up, 
gives  encouragement  to  try  to  save  life  even  in  this  desperate  con- 
dition. Cocaine  as  an  anaesthetic  (Tachard),  and  rectal  puncture 
without  anaesthesia,  have  been  resorted  to  in  very  weak  patients 
(Richardson). 

That  attacks  that  subside  even  should  be  watched  with  care  and 
suspicion  is  shown  by  a case  of  the  writer’s.  A young  man  got  over 
a severe  attack  so  completely  that  he  was  allowed  to  go  about  the 
house.  A little  exertion  was  followed  by  dangerous  constitutional 
symptoms  and  the  rapid  development  of  a large  tumor.  A small 
well  encysted  abscess  had  ruptured,  and  the  whole  right  side  of  the 
abdomen  was  filled  with  a stinking  fluid,  only  feebly  protected  by 
adhesions.  But  for  these  adhesions  he  would  have  quickly  died  of 
fulminating  septic  peritonitis. 

As  to  the  technique,  Iodoform  gauze  to  protect  the  general  abdomi- 
nal cavity,  together  with  a light  pack  of  the  same  and  a drain  for  the 
abscess,  are  universally  used.  The  appendix,  unless  readily  acces- 
sible, is  usually  left  alone  in  these  abscesses.  Occasional  cases  of 
peritoneal  infection  have  been  met  with  in  which  the  appendix  was 
not  perforated  or  gangrenous  (Poucet). 

The  operations  for  the  radical  cure  of  hernia  have  been  performed 


SECTIONAL  ADDRESS  IN  SURGERY. 


223 


frequently,  and,  on  the  whole,  with  improved  results,  but  the  ten- 
dency is  a revolution  from  the  enthusiasm  that  has  led  to  indiscrimi- 
nate operation  and  early  reports  of  so-called  cures  by  new  methods. 
The  ultimate  results  of  a number  of  procedures  have  been  reported, 
which,  particularly,  show  the  failures  after  the  method  that  claims 
to  substitute  a cicatrix  for  a truss  (McBurney),  and  which  has  been 
very  extensively  practiced  (Bull). 

The  tendency  now  seems  to  be  toward  a restoration  of  the  normal 
relations  of  the  tissues  as  laid  down  in  the  method  of  Bassini.  The 
principles  of  this  procedure  are,  excision  of  the  sac  with  obliter- 
ation of  the  peritoneal  dimple,  closure  of  the  internal  and  ex- 
ternal rings,  and  narrowing  the  canal,  which  has  been  split  by  a 
close  approximation  of  the  different  layers  of  muscle  and  fascia. 
The  narrowing  of  the  external  ring  has  been  still  further  com- 
pleted by  chiselling  a groove  in  the  pubic  bone,  laying  the  cord  in 
this,  and  covering  it  with  the  periosteum,  which  has  been  preserved 
(Frank). 

The  presence  of  the  cord  as  an  invitation  to  recurrence  has  been 
studied  too.  Its  removal  to  prevent  relapse  once  led  to  such  a uni- 
versal practice  of  castration  as  to  call  for  special  legislation.  The 
sac  being  excised  and  sutured  or  tied,  the  ends  of  the  ligature  are 
passed  through  the  muscles  above  the  internal  ring  to  draw  up  and 
smooth  the  peritonaeum.  In  this  connection  it  is  worthy  to  note 
that  Tait’s  proposition  to  reduce  the  hernia  and  close  the  sac  and 
ring  from  the  inside  through  an  abdominal  incision  has  been  prac- 
ticed occasionally.  The  cord  is  hooked  up,  while  the  muscles  and 
fascia  are  closely  united,  obliterating  the  inguinal  canal.  By  fasten- 
ing it  in  the  outer  angle  of  the  wound,  its  direction  of  exit  is 
changed  from  that  of  the  inguinal  canal  to  directly  forward  or  for- 
ward and  outward.  The  cord  is  then  laid  outside  the  muscles,  and 
the  skin  and  fat  closed  over  it  (Halstead).  By  carrying  an  incision 
upward  from  the  internal  ring  the  direction  of  the  cord  may  also  be 
changed  to  an  upward  one,  whence  it  comes  down  into  the  scrotum 
as  above  (Fowler).  To  lessen  the  size  of  the  opening,  all  but  one 
or  two  of  the  spermatic  veins,  which  are  apt  to  be  enlarged,  are  ex- 
cised (Halstead). 

As  aids  to  closure  of  the  opening,  decalcified  bone  has  been  used; 
also  the  outer  pillar  of  the  external  ring  has  been  detached,  together 
with  a bit  of  bone  furming  its  insertion,  and  carried  across  to  the 


224  world’s  homoeopathic  congress. 

inner  pillar  and  nailed  to  the  symphysis.  In  this  way  the  opening 
is  reduced  to  a mere  slit  (Landerer).  The  sac  has  also  been  used  as 
an  external  plug  in  contradistinction  to  Macewen’s  internal  pad. 
After  being  isolated  it  is  drawn  out  of  an  opening  opposite  or  exter- 
nal to  the  inner  ring,  thus  changing  its  direction.  It  is  then  twisted 
to  obliterate  the  peritoneal  dimple  (after  Ball),  and  fastened  outside 
of  the  aponeurosis  of  the  external  oblique  (Kocher). 

Following  the  observation  that  the  mesentery  of  the  protruded  • 
gut  is  usually  lengthened  in  hernia,  and  that  the  presence  of  this 
condition  invites  recurrence,  it  has  been  proposed  that  it  be  short- 
ened by  folding  and  suture  (Shimwell). 

To  avoid  infection  of  the  wound,  particularly  in  children,  the 
urine  has  been  diverted  through  a perineal  wound  (Gerster). 

The  treatment  of  femoral  hernia,  hitherto  either  entirely  ignored, 
or  relegated  to  a hurried  postscript  after  an  elaborate  description  of 
a new  method  for  the  cure  of  inguinal  hernia,  has  received  more  at- 
tention. 

The  stump  of  the  sac  may  be  tacked  well  up  inside  the  abdominal 
wall  through  which  the  suture  ends  are  passed ; or  the  isolated  sac 
may  be  drawn  through  an  opening  above  Poupart’s  ligament,  twisted 
and  incorporated  in  the  lower  wound,  serving  in  this  way  as  a plug  to 
fill  the  femoral  canal  (Kocher).  The  need  of  such  a plug  or  barrier 
has  led  to  the  turning  up  of  a piece  of  the  fascia  of  the  pectineus 
muscle  where  it  is  thick  and  tough  (Salzer),  or  the  fascia  and  a flap 
of  this  muscle  itself  (Cheyne).  In  this  manner'  the  femoral  canal  is 
completely  closed. 

As  the  results  of  operations  for  the  cure  of  inguinal  hernia  have 
been  far  superior  to  those  for  the  femoral  variety,  an  attempt  has 
been  made  to  transform  the  latter  into  the  former.  The  tumor  is 
incised  and  the  sac  freed,  the  inguinal  canal  is  split  and  its  posterior 
wall  incised ; the  sac  is  drawn  into  this  opening,  tied  off,  and  both 
wounds  accurately  sutured  (Ruggi). 

The  indications  for  an  attempt  at  radical  cure  are,  1,  ineffectual, 
partially  effectual,  or  painful  trusses;  2,  irreducible  hernia;  3,  oc- 
cupation tending  to  force  out  the  rupture ; 4,  proposed  occupation 
which  is  precluded  by  hernia  ; 5,  strangulated  hernia  where  the  local 
and  general  condition  permit  of  such  an  undertaking  (Bennett). 
Hernia  in  women,  particularly  when  young,  with  the  child-bearing 
age  before  them,  seem  to  merit  a trial  of  operation  (Lucas-Cham- 
pionniSre). 


SECTIONAL  ADDRESS  IN  SURGERY. 


225 


The  treatment  of  gangrenous  or  suspicious  bowel  still  calls  forth 
a diversity  of  opinion.  Relief  of  the  constriction,  warm  applications, 
or  temporary  replacement  with  an  anchor  thread  attached,  should  be 
tried  in  all  uncertain  cases.  If  a doubt  still  remains,  the  intestine 
is  fastened  outside  the  abdomen,  dressed  warmly  and  antiseptically, 
and  observed.  In  a case  in  which  this  plan  was  followed,  the  gut 
was  found  normal  on  the  fourth  day  and  successfully  replaced  (Rov- 
sing).  In  similar  cases  it  is  suggested  that  the  gut  be  well  drawn 
out,  an  anastomosis  made  above  the  suspicious  area,  and,  after 
sloughing  has  taken  place,  the  two  openings  be  closed  and  the  gut 
replaced  (Helferich). 

In  general,  however,  primary  resection  is  to  be  preferred  to  the 
formation  of  an  artificial  anus,  and  gives,  on  the  whole,  a lower  mor- 
tality. It  is,  of  course,  understood  that  the  patient’s  condition  and 
the  surroundings  permit  such  a procedure,  and  that  the  surgeon  has 
the  requisite  skill. 

As  to  the  method  of  uniting  the  two  ends,  the  weight  of  opinion 
seems  to  be  in  favor  of  the  end-to-end  plan,  with  or  without  aids. 
These  artificial  aids  may  be  in  the  shape  of  rubber  rings  or  splints 
to  hold  the  ends  together;  a rubber  tube  or  decalcified  bone  drains 
to  hold  the  intestine  open  and  prevent  invagination.  When  the  two 
lumina  are  unequal,  several  plans  may  be  followed:  lateral  anasto- 
mosis, lateral  implantation  (the  small  end  into  the  side  of  the  large 
tube),  or  slitting  up  the  smaller  tube  on  the  surface  opposite  the 
mesentery  until  the  openings  are  of  equal  size,  when  they  are  united. 

The  dangers  of  the  persistent  use  of  taxis  have  received  well- 
merited  attention  (Bennett).  Bruising  or  rupture  of  the  bowel  are 
often  produced  and  much  valuable  time  is  lost.  These  two  factors 
are  largely  responsible  for  the  mortality  of  from  32  to  46  per  cent, 
in  the  large  English  hospitals  (Southam).  The  local  application  of 
ether,  followed  by  gentle  and  intelligent  taxis  for  not  more  than  five 
minutes,  and  that  only  when  a true  hernial  impulse  is  perceptible, 
will  obviate  the  above-mentioned  dangers.  Immediate  recourse  to 
operation  after  the  failure  of  such  procedures  cannot  be  too  strongly 
emphasized.  The  persistent  application  of  sulphuric  ether  to  stran- 
gulated hernia  has  brought  about  reduction  when  taxis  under  an 
anaesthetic  has  failed  (Finkelstein). 

Although,  as  a rule,  the  presence  of  an  undescended  testicle  in  a 
hernial  sac  calls  for  castration,  Depage  reports  a case  in  which  it  was 

15  * 


226 


world’s  homoeopathic  congress. 


drawn  down  into  the  scrotum  and  the  hernia  treated  in  the  ordinary 
way. 

Cases  of  strangulation  symptoms  from  the  appendix,  omentum 
and  testicle  are  also  reported. 

Of  the  special  varieties  of  hernia  a number  have  been  published : 

1.  Littre’s  hernia  with  no  tumor,  the  partial  nipping  of  the  bowel 
in  right  femoral  ring  being  found  and  reduced  through  a median 
abdominal  incision  (Keen). 

2.  An  obturator  hernia,  strangulated  and  made  out  by  a tumor, 
was  successfully  operated  by  Wyman.  Anderson  opened  the  abdo- 
men for  persistence  of  obstructive  symptoms  after  an  operation  for 
femoral  hernia,  and  found  a knuckle  of  gut  in  the  left  obturator 
foramen.  Examination  by  the  rectum  or  vagina,  as  well  as  the  dif- 
fuse deep  swelling  and  pain,  are  the  diagnostic  points  (Berger). 

3.  Ischiatic  hernia  has  also  been  accidentally  found  : 

(а) .  Through  an  abdominal  section  after  persistence  of  symptoms 
in  spite  of  a femoral  herniotomy  (Garve). 

(б) .  On  removing  a fibro-lipoma  to  which  two  hernial  sacs  were 
found  attached  (Schwab). 

4.  Hernia  into  the  foramen  of  Winslow  was  made  out  but  not 
reduced  by  abdominal  section,  recovery  following  a large  enema 
(Neve). 

5.  Diaphragmatic  hernia  has  been  met  with  but  only  diagnosed 
after  death. 

6.  The  writer  has  operated  two  cases  of  hernia  of  the  urinary 
bladder  recently.  Pain  was  a prominent  symptom,  but  vesical 
symptoms  were  absent.  No  truss  could  be  worn.  In  one  the  atten- 
uated diverticulum  was  opened  for  the  sac,  the  bladder  drained,  and 
the  wound  allowed  to  heal  by  granulation.  In  the  other  the  viscus 
was  recognized,  and  the  abdominal  wound  was  treated  in  the  ordi- 
nary way.  Both  recovered  and  have  not  had  relapses  so  far. 


ETHER  OR  CHLOROFORM. 


227 


ETHER  OR  CHLOROFORM f 

By  Horace  Packard,  M.D.,  Boston,  Mass. 

Introduction. — It  is  the  purpose  of  this  paper  to  discuss  some 
questions  relative  to  ether  and  chloroform  anaesthesia. 

I need  hardly  refer  to  the  fact  that  at  the  present  time  chloroform, 
or  some  modification  of  it,  is  the  anaesthetic  which  is  used  for  surgi- 
cal purposes  in  nearly  all  European  countries,  and  that  it  is  also  the 
favorite  anaesthetic  in  the  western  portion  of  the  United  States.  On 
the  other  hand  sulphuric  ether  is  used  almost  exclusively  in  New 
England  and  the  Middle  States. 

It  is  my  purpose  to  discuss  : 

First. — The  reasons  for  this  wide  divergence  of  practice. 

Second. — The  reasons  for  the  diverse  opinions  which  are  still  held 
by  the  adherents  to  these  two  forms  of  anaesthetic  preparations. 

Third . — To  place  before  you  an  improved  method  of  Ether  anaes- 
thesia. 

Sulphuric  Ether. — Sulphuric  ether  was  brought  into  use  in  1846 
and  the  first  practical  demonstration  of  it  was  made  October  17th 
of  that  year  at  the  Massachusetts  General  Hospital,  in  the  city  of 
Boston. 

We  need  seek  no  further  reason  for  an  explanation  of  its  preva- 
lent use  in  New  England  and  the  Middle  States.  The  natural 
pride  and  glory  which  a community  shares  in  such  a beneficient  dis- 
covery is  quite  enough  to  give  it  an  impetus,  and  result  in  almost 
universal  adherence  to  it.  The  method  of  administration  of  Sul- 
phuric ether  for  surgical  purposes  has  remained  substantially  the 
same,  during  all  these  fifty  years,  as  that  utilized  by  Morton  on  that 
historic  occasion  in  the  Massachusetts  General  Hospital.  To  this 
day  an  ordinary  cup  sponge  almost  identical  with  the  original,  is 
utilized  at  that  institution. 

Two  to  four  ounces  of  ether  are  poured  at  a time  in  it,  or  upon 
it,  and  an  average  total  of  from  eight  to  sixteen  ounces  of  ether  is 
consumed  at  each  seance.  Every  device  and  every  form  of  inhaler 


228 


world’s  homoeopathic  congress. 


for  ether  administration  has  been  some  simple  or  complex  modifica- 
tion of  the  original  sponge,  i.e.y  the  employment  of  a cap,  hood,  or 
cone  to  cover  the  nose  and  month,  in  which  liquid  ether  is  placed  or 
poured,  and  over  or  through  which  the  tidal  air  of  respiration  passes. 

What  are  the  objectionable  features  to  surgical  anaesthesia  with 
sulphuric  ether? 

Individuals  differ  vastly  in  the  way  they  succumb  to  ether  anaes- 
thesia by  any  method  of  administration,  but  the  following  is  a sum- 
mary of  the  disagreeable  complications  usually  met : 

First. — Immediate  rebellion  by  the  respiratory  tract  to  the  strong 
fumes  of  sulphuric  ether,  such  as  result  from  evaporation  from  a 
sponge  or  any  of  its  modifications,  with  unbearable  feelings  of  suffo- 
cation, and  if  the  patient  be  a child,  an  ignorant  person,  or  one  de- 
void of  great  self-control,  fright  results,  with  effort  to  escape. 

Second. — Ether  vapor  is  an  irritant  to  the  respiratory  mucous 
membrane,  and  in  many  cases  causes  a profuse  secretion  of  mucus, 
with  coughing,  spasm  of  the  glottis,  cataleptic  spasms  of  the  respira- 
tory muscles,  with  cessation  of  respiration  and  cyanosis.  It  is  claimed 
that  anaesthesia  with  ether  is  attended  with  greater  danger  in  infants 
and  the  aged,  on  account  of  the  greater  fatality  of  bronchitis  at  those 
periods  of  life.  This  is  based  on  the  supposition  that  bronchitis  is  a 
frequent  result  of  ether  anaesthesia. 

Third. — As  a rule  ether  anaesthesia  is  followed  by  nausea,  retch- 
ing and  vomiting,  with  headache  and  feeling  of  malaise  for  twenty- 
four  to  thirty-six  hours. 

Fourth. — It  is  claimed,  but  I am  not  sure  that  this  claim  is  well 
substantiated,  that  sulphuric  ether  is  a violent  irritant  to  the  kidneys. 
That  kidneys  which  are  already  crippled  in  their  functional  activity, 
especially  suffering  from  that  form  of  disease  characterized  by  albu- 
minuria, may  be  still  further  crippled  by  the  action  of  sulphuric 
ether  to  such  a degree  as  to  cause  death. 

Fifth. — Ether  anaesthesia  is  said  to  induce  mental  aberration  in 
those  who  have  a special  tendency  to  insanity,  or  who  have  already 
suffered  from  melancholia. 

Sixth. — Sulphuric  ether  is  a dangerous  anaesthetic,  though  in 
skillful  hands,  deaths  are  very  infrequent.  I have  during  the  past 
two  or  three  years  kept  a careful  record  of  reported  deaths  from 
ether  which  I herewith  append. 

A Death  From  Ether. — Death  from  the  administration  of  sul- 


ETHER  OR  CHLOROFORM. 


229 


phuric  ether  is  of  such  rare  occurrence  that  the  case  about  to  be  nar- 
rated seems  to  merit  a place  on  the  records.* 

The  patient  was  a Frenchman,  aged  46.  For  a year  or  more  he 
had  been  suffering  from  tubercular  disease  of  the  tarsus  of  one  foot. 
At  the  time  of  his  admission  to  the  French  Hospital  the  disease 
had  become  widely  diffused.  The  general  appearance  of  the  patient 
was  bad.  There  were  aortic  and  mitral  systolic  murmurs,  and  the 
heart-sounds  were  feeble.  The  urine  contained  a moderate  amount 
of  albumin.  The  patient’s  condition  appeared  not  only  to  justify 
but  to  demand  removal  of  the  tubercular  foot,  and  I prepared, 
therefore,  on  January  25,  1889,  to  do  a Syme’s  amputation  at  the 
ankle-joint. 

In  the  presence  of  the  attending  staff  and  internes,  after  the  ad- 
ministration of  half  an  ounce  of  whisky,  the  etherization  was  com- 
menced. In  a few  minutes  the  respiration  faltered  and  the  patient 
became  deeply  cyanosed  but  this  somewhat  alarmingcondition  quickly 
passed  away.  About  five  minutes  later  the  assistant  having  the 
pulse  under  observation  suddenly  announced  that  it  had  ceased.  Im- 
mediately hypodermatic  injections  of  brandy,  ether  and  sulphate  of 
atropine  were  given;  amyl-nitrite  was  applied  to  the  nostrils,  artifi- 
cial respiration  was  practiced,  and  the  head  and  shoulders  were  de- 
pressed by  elevation  of  the  foot  of  the  table;  but  all  was  in  vain  ; 
the  patient  was  dead. 

The  ether  used  was  the  aether  fortior  manufactured  by  Squibb. 

The  following  is  the  report  of  the  autopsy  made  by  Dr.  G.  G.Van 
Schaick,  pathologist  to  the  French  Hospital,  in  the  presence  of  the 
coroner : 

“ No  rigor  mortis.  Body  well  nourished.  Lungs,  very  small, 
otherwise  normal;  left  pleura,  a few  adhesions,  no  fluid;  right 
pleura,  no  fluid,  many  adhesions.  Lungs  slightly  congested.  Heart, 
hypertrophied;  pericardium  everywhere  adherent ; coronary  arteries 
of  small  calibre;  slight  atheroma  of  the  aorta;  mitral  valve  stenotic. 
Spleen,  enlarged.  Kidneys,  left  atrophied,  capsule  adherent,  mark- 
ings indistinct,  sclerosis  above  the  pyramids ; pelves  filled  with  fat. 
Right  kidney  in  about  same  condition ; both  surrounded  by  a thick 
layer  of  fat.  Stomach,  normal. 

“ The  most  striking  revelation  of  the  autopsy  was  the  complete 

* Paper  by  W.  Duncan  McKim,  M.D.,  New  York  Clinical  Society,  March  26, 
1889. 


230 


world’s  homoeopathic  congress. 


adhesion  of  the  two  surfaces  of  the  pericardium.  The  death  seemed 
due,  then,  to  syncope,  the  heart  being  so  fettered  that  it  could  not 
respond  to  the  unusual  strain  thrown  upon  it.  When  beginning  the 
inhalation  of  ether,  the  patient  seemed  very  nervous,  there  was  rather 
more  struggling  than  usual,  and  a struggle  closely  preceded  the  dis- 
appearance of  the  pulse.  The  heart  was  in  a condition  to  suffer 
permanent  arrest  of  its  function  upon  any  slight  increase  of  labor, 
and  any  occasion  for  unusual  mental  or  physical  excitement 
would,  I think,  have  been  as  fatal  as  the  ether.  Had  much  more 
than  ordinary  care  been  exercised  to  quiet  the  patient’s  nervousness, 
and  to  restrain  his  jactitation  by  moral  suasion  and  the  gentle  and 
gradual  administration  of  the  ether,  I can  readily  believe  that  this 
feeble  heart  might  have  successfully  emerged  from  its  ordeal.” 

A Death  from  Ether.* — A death  from  ether  is  reported  in  a 
patient  undergoing  an  operation  for  haemorrhoids.  The  patient,  a 
man  of  65  years,  healthy  heart,  always  in  good  health  except  the 
haemorrhoids,  temperate  in  habits  except  being  an  inveterate  smoker. 
The  administration  of  ether  was  entrusted  to  a druggist  who  claimed 
to  have  had  experience.  In  the  midst  of  the  operation  the  surgeon 
became  conscious  that  something  was  wrong  and  found  the  patient 
pulseless.  Artificial  respiration,  suspension,  hypodermic  injections 
of  brandy,  etc.,  were  of  no  avail. 

The  Recent  Death  of  Colonel  Elliot  Shepard. — This  death 
from  ether  is  so  widely  known  and  has  gained  such  publicity  through 
the  public  print,  that  I need  but  barely  refer  to  it. 

At  the  present  writing  I have  seen  no  authentic  report  from  the 
physicians  in  charge  of  the  case. 

Unfortunately  no  autopsy  was  made.  It  will  always  be  regretted 
that  such  was  denied,  since  knowledge  of  great  value  might  have 
been  attained  thereby. 

Until  I know  all  the  circumstances  of  the  case,  I shall  be  unable 
to  divest  my  mind  from  the  suspicion  that  there  may  have  been  in- 
competency in  the  administration  of  the  anaesthetic. 

Some  years  ago  a British  medical  journal  reported  as  the  result 
of  statistical  research,  one  death  to  23,203  ether  inhalations. 

Professor  Guerlt  of  the  German  Surgical  Congress  reports  one 
death  in  8431  cases. 

About  three  years  ago  the  Director  of  Public  Assistance  of  Paris 


* New  England  Medical  Gazette,  April,  1892. 


ETHER  OR  CHLOROFORM. 


231 


caused  a report  to  be  made  on  the  surgical  operations  of  the  preced- 
ing ten  years  in  the  hospitals  of  that  city.*  As  a result  of  this 
report  ether  was  shown  to  have  caused  death  once  in  12,581  cases. 

An  editorial  in  the  Medical  Record  of  May  30,  1891,  states  that 
the  prevailing  belief  is,  that  statistics  will  show  about  one  death  in 
25,000  anaesthetizations  for  ether. 

With  this  array  of  disagreeable  and  dangerous  features  of  ether 
anaesthesia  before  us,  let  us  turn  to  its 

Virtues — First. — Its  inhalation  abolishes  memory  of  painful  sen- 
sations, in  a very  short  space  of  time,  two  to  three  minutes. 

Second. — Muscular  relaxation  usually  follows  in  from  five  to  seven 
minutes. 

Third. — The  cautious  anaesthetist  is  always  apprised  of  impend- 
ing danger  from  impeded  respiration,  by  coughing,  labored  action 
of  the  respiratory  muscles,  and  the  first  sign  of  cyanosis,  sufficiently 
early  to  so  modify  the  ether  administration  as  to  stop  the  progress 
of  such  threatening  symptoms. 

Fourth. — The  heart’s  action  does  not  appear  to  suffer  materially 
from  ether  anaesthesia.  In  threatening  and  fatal  cases,  it  continues 
to  pulsate  for  a time  after  all  voluntary  respiratory  efforts  have  ceased. 
It  would  appear  that  labored  action  of  the  heart  in  ether-anaesthesia 
is  a result  of  carbonic  acid  poisoning,  rather  than  any  inhibitory  in- 
fluence of  the  ether  itself. 

Fifth. — The  exigencies  of  the  practice  of  medicine  and  surgery 
frequently  demand  that  the  administration  of  an  anaesthetic  shall  be 
conducted  by  a person  possessing  little  or  no  practical  knowledge  of 
the  matter,  while  the  physician  busies  himself  with  the  operation, 
with  a more  or  less  watchful  eye  over  the  progress  of  the  anaesthesia. 
While  we  must  deplore  the  necessity  of  entrusting  a dangerous  agent 
in  the  hands  of  an  unskilled  person,  yet,  if  such  must  be  done,  all 
experience  thus  far  points  to  sulphuric  ether  as  possessing  the  least 
dangerous  qualities  of  any  anaesthetic  now  known. 

Chloroform. — The  value  of  chloroform  as  a surgical  anaesthetic 
was  placed  before  the  profession  by  Sir  James  Y.  Simpson,  of  Edin- 
burgh, November  10,  1847,  about  one  year  after  the  advent  of  sul- 
phuric ether. 

Here,  the  glory  of  a new  discovery,  the  discovery  of  an  anaesthetic 
agent  which  appeared  to  possess  all  the  desirable  qualities  of  sul- 


* Medical  Record,  April,  1890. 


232 


world’s  homoeopathic  congress. 


phuric  ether,  and,  perhaps,  lack  many  of  its  faults,  was  enough  to 
cause  its  adoption  throughout  Great  Britain  and  on  the  European 
continent,  so  that  sulphuric  ether  fell  into  disuse  ; and,  to  the  present 
day,  chloroform,  or  some  admixture  of  it  with  alcohol  or  ether,  or 
both,  is  the  anaesthetic  most  widely  used  in  all  European  countries; 
and,  I am  prone  to  believe,  in  the  western  part  of  the  United  States. 

The  Dangers  of  Chloroform  Anaesthesia — First. — Chloro- 
form is  a dangerous  anaesthetic.  It  kills  quickly  ; how  quickly  no 
one  realizes  unless  he  has  administered  it  to  an  animal  for  lethal 
purposes.  Two  instances  in  my  personal  experience  have  served  to 
impress  me  with  the  lightning-like  rapidity  that  chloroform  can  get 
in  its  fatal  work. 

Case  I. — In  the  early  part  of  my  career  as  a surgeon,  a child  was 
brought  to  my  office  by  a physician  for  the  reduction  of  a fracture. 
I administered  an  anaesthetic ; and  chose  chloroform  on  account  of 
its  supposed  quicker  action.  The  child  struggled,  the  physician 
held  him,  while  I crowded  the  cone  wet  with  chloroform  close  over 
the  patient’s  face.  After  several  deep  inspirations,  there  was  com- 
plete anaesthesia,  but  with  it  such  syncope  that,  for  several  minutes, 
while  I was  instituting  artificial  respiration  I was  under  stress  of 
groat  anxiety  lest  his  heart  would  never  resume  its  action. 

Case  II. — I was  conducting  some  experimental  operations  upon 
dogs.  A female  bull-terrier  was  being  chloroformed.  In  the  course 
of  her  struggles  the  cone  was  crowded  close  over  her  nose,  and  com- 
plete anaesthesia  promptly  followed,  but  she  was  dead  beyond  all 
efforts  at  resuscitation. 

Once  in  the  course  of  a laparotomy  when  a chloroform  mixture 
was  being  used,  the  progress  of  the  operation  was  interrupted  by  the 
sudden  syncope  of  the  patient.  Respiration  and  pulse  had  ceased 
without  warning. 

Almost  every  accidental  death  during  chloform  anaesthetization 
shows  that  when  danger  comes,  it  comes  without  warning.  During 
the  past  two  or  three  years  I have  kept  a careful  record  of  reported 
deaths  from  chloroform,  the  most  characteristic  of  which  I here 
append. 

Dr.  Sherman’s  case.* — On  July  2,  1889,  a boy,  aged  five  years, 
was  chloroformed  at  the  Children’s  Hospital  for  the  little  operation 

* ‘‘  Report  of  Two  Cases  of  Death  in  Young  Children  During  Administration 
of  Chloroform.” — Medical  Record,  March  15,  1890. 


ETHER  OR  CHLOROFORM. 


233 


of  curetting  some  tuberculous  sinuses.  The  chloroform  was  given  in 
the  usual  way,  on  a towel  held  a short  distance  from  the  face.  An- 
aesthesia was  easily  produced,  and  the  sinuses  curetted.  At  the  bot- 
tom of  these  was  found  a small  patch  of  carious  bone,  and,  as  the 
child  began  to  move,  a little  more  chloroform  was  put  on  a towel, 
and  the  scoop  applied  to  the  bone.  At  this  moment  the  child 
ceased  to  breathe,  and  the  haemorrhage  from  the  wound  also  stopped. 
The  chloroform  was  removed,  the  child  inverted,  artificial  respira- 
tion done  for  a few  moments,  when  the  functions  were  restored. 
Color  returned  to  the  face,  and  the  danger  seemed  past.  It  was  only 
for  a short  time,  however;  after  fifteen  or  twenty  respirations,  they 
again  ceased,  though  no  more  chloroform  was  used.  The  heart 
stopped,  the  face  blanched,  the  pupils  dilated.  Artificial  respiration 
was  again  practiced,  the  child  inverted  ; stimulants,  such  as  whiskey, 
ammonia,  Digitalis,  and  Nux  vomica,  were  given  by  the  hypodermic, 
hot  and  cold  water  alternately  applied  to  the  chest,  and  the  battery 
was  used — but  nothing  had  the  slightest  effect,  and  after  an  hour’s 
work  the  case  was  pronounced  hopeless,  and  further  efforts  aban- 
doned. 

Dr.  Gibney’s  case. — A female  child,  two  years  of  age,  with  a sacral 
spinal  bifida , was  put  under  the  influence  of  chloroform  at  myelinic 
on  June  19,  1889.  The  patient  was  in  excellent  health,  hearty  and 
robust.  The  mother  said  it  had  never  been  sick.  The  chloroform 
was  of  good  quality,  and  was  administered  in  the  usual  way  : that 
is,  a small  towel  was  saturated  with  the  drug  and  held  over  the  nose 
and  mouth,  but  not  in  contact  with  the  face.  Within  five  minutes 
the  child  came  under  its  influence,  the  pulse  and  respiration  good 
The  hypodermic  needle  was  thrust  into  the  base  of  the  tumor,  and 
between  six  and  seven  drachms  of  serum  mixed  with  a little  blood 
were  evacuated.  The  sac  was  injected  with  two  drachms  of  what  is 
known  as  Morton’s  fluid  (iodine,  ten  grains;  potassium  iodidi,  one- 
half  drachm  ; glycerine,  one  ounce).  The  whole  operation  lasted 
about  ten  minutes,  during  which  time  the  child  was  not  profoundly 
anaesthetic,  but  cried  out  occasionally.  The  needle  was  withdrawn, 
and  collodion  on  cotton  placed  over  the  opening,  a flannel  roller  ap- 
plied around  the  body  preparatory  to  a more  snug  dressing.  At 
this  time,  however,  the  lips  became  blanched,  the  pulse  feeble,  and 
three  minims  of  Magendie’s  solution  of  morphia  were  injected  hy- 
podermically. The  breathing  at  once  became  more  regular,  pulse  a 


234 


world’s  homoeopathic  congress. 


little  better.  Very  soon  after  this,  almost  immediately,  the  pulse 
grew  feeble  again,  and  forty  minims  of  brandy  were  injected,  when 
the  patient  ceased  to  breathe ; and  efforts  at  resuscitation,  such  as 
lifting  the  child  by  the  feet,  head  down,  artificial  respiration,  far- 
adism,  etc.,  proved  of  no  avail. 

Deaths  under  Chloroform.* — At  an  inquest  recently  held,  the 
particulars  were  given  of  the  death  of  a child,  about  six  years  of 
age,  who  succumbed  to  chloroform  at  the  Victoria  Hospital  for 
Children.  The  child  was  admitted  for  treatment  of  disease  affect- 
ing the  left  hip-joint.  He  had  taken  chloroform  successfully  upon 
two  previous  occasions,  but  on  the  day  upon  which  the  operation 
was  to  be  performed,  the  boy  died  after  having  inhaled  the  anaes- 
thetic for  fifteen  minutes.  A post-mortem  examination  was  held, 
and  the  medical  officer  is  reported  to  have  said  that  there  was  fatty 
degeneration  of  the  heart,  liver,  spleen,  and  kidneys.  The  death 
recorded  illustrates  the  fallacy  of  two  popular  beliefs : first,  that  a 
person  that  can  take  chloroform  with  impunity  upon  one  occasion 
will  subsequently  enjoy  an  immunity  from  danger ; and  secondly, 
that  children,  who  proverbially  take  chloroform  so  well,  are  less 
liable  to  fatal  accidents  from  its  effects  than  are  adults. 

In  this  same  article,  the  last  paragraph,  we  have  the  following: 

Almost  before  the  ink  is  dry  with  which  we  record  the  above 
fatality,  the  report  arrives  of  the  death  of  a woman  in  a Dublin  hos- 
pital, to  whom  it  was  proposed  to  administer  chloroform  as  a pre- 
liminary to  amputation  of  the  thumb.  It  appears  that  before  she  was 
fully  anaesthetized  she  collapsed  and  died. 

Death  During  Chloroform  Administration. f — The  late  Dr. 
Parkes  reported,  in  the  Journal  of  the  American  Medical  Associa- 
tion for  February  14th,  an  unfortunate  case,  in  which  the  patient,  a 
healthy  girl  about  eleven  years  old,  died  during  an  operation  for 
removal  of  a mole  from  the  face  performed  under  chloroform  anaes- 
thesia. The  operation  was  practically  completed,  and  no  chloroform 
had  been  given  for  at  least  five  minutes,  when  she  was  seized  with 
general  convulsions.  She  ceased  to  brea  he,  and  her  heart  ceased  to 
beat. 

Death  from  Chloroform. J — The  patient  was  a female,  forty-one 

* London  Lancet , October  19,  1889. 

f N.  Y.  Medical  Journal , April  4,  1891. 

J British  Medical  Journal,  December  21,  1889. 


ETHER  OR  CHLOROFORM. 


235 


"years  of  age;  the  operation  was  trachelorrhaphy , and  was  duly  com- 
pleted. On  removing  the  “ face  piece  ” retching  occurred ; more 
chloroform  given.  Suddenly,  breathing  ceased.  The  heart,  ex- 
amined before  the  operation,  was  declared  healthy.  No  autopsy  was 
made. 

Accidental  Death  of  a Physician  from  Chloroform.* — Dr. 
Justus  E.  Gregory,  a well-known  physician  of  Brooklyn,  was  killed 
on  October  25th  by  an  overdose  of  chloroform.  He  had  been  accus- 
tomed to  inhale  this  anaesthetic  for  the  relief  of  facial  neuralgia. 
On  the  evening  of  his  death  he  inhaled  a dose  of  twenty  drops  on 
a handkerchief.  He  felt  some  relief,  but  called  for  another  dose, 
and  five  minutes  later  was  found  dead.  Dr.  Gregory  was  forty-nine 
years  of  age.  He  had  been  a surgeon  in  the  army  during  the  war  of 
the  rebellion. 

Three  deaths  from  chloroform  have  recently  occurred  in  London. 
One  in  a man,  aged  twenty-seven,  about  to  be  operated  upon  for 
cellulitis  of  the  leg ; another  in  a man,  also  young,  with  varico- 
cele; and  the  third  in  a young  girl  with  an  abscess  of  no  great 
size , — all  three  cases  in  which,  without  the  chloroform,  the  young 
people  would  doubtless  be  alive  to-day.  It  does  take  people  a long 
time  to  learn  that  ether,  dangerous  as  it  may  be,  is  a safer  anaesthetic 
than  chloroform. f 

A death  from  the  administration  of  chloroform  is  reported  in  the 
Cincinnati  Lancet-Clinic  by  Dr.  William  L.  Muzzey.  The  patient 
was  an  apparently  healthy  man , thirty  years  of  age.j 

Another  death  from  chloroform  has  been  reported  in  London  at 
the  King’s  College  Hospital.  The  operation  to  be  performed  was 
a trivial  one  for  suppurative  cellulitis  of  the  leg.  The  patient,  a 
male  tramp,  aged  twenty-six,  was  recovering  from  a drinking  bout, 
and  had  not  partaken  of  food  for  three  days.  At  the  autopsy, 
fatty  liver  and  fatty  heart  were  discovered.  Death  was  sudden  and 
without  warning.§ 

Death  During  Anaesthesia. || — An  inquest  on  a case  of  death 
from  chloroform  at  St.  Mary’s  Hospital  is  reported  this  week. 


* Medical  Record , November  1,  1890. 
f Medical  Record,  January  16,  1892. 

X Medical  Record , October  26,  1889. 

\ Medical  Record,  December  5,  1891. 

||  British  Medical  Journal,  December  20,  1890. 


236 


world’s  homceopathic  congress. 


The  operation  was  for  the  removal  of  a crushed  finger.  A mix- 
ture of  ether  and  chloroform  was  administered.  The  patient  gave 
suddenly,  according  to  the  report,  two  deep  inspirations  while  under 
operation,  when  breathing  ceased.  The  verdict  recorded  was  death 
from  syncope. 

A statistical  research  by  Dr.  Lawrence  Turnbull  shows  that  since 
the  work  of  the  Hyderabad  Commission,  held  in  1888,  forty-three 
deaths  have  occurred  in  the  course  of  anaesthesia ; of  these,  thirty- 
nine  were  from  chloroform  and  four  from  ether.* 

I think  no  further  quotations  are  necessary  to  substantiate  the 
statement  made  earlier  in  this  paper,  viz.,  that  chloroform  is  dan- 
gerous; that  it  kills  quickly. 

Second. — Beside  this  immediately  fatal  action  of  chloroform, 
recent  pathological  investigations  seem  to  indicate  that  deaths 
not  infrequently  occur  some  hours,  or  even  days,  after  chloroform 
anaesthesia. 

Effects  of  Prolonged  Chloroform  Anaesthesia. f — Some  obser- 
vations, made  about  two  years  ago  by  Dr.  Ungar,  pointed  to  fatty 
degeneration  of  the  heart  and  liver  as  the  cause  of  death  after  repeated 
prolonged  administration  of  chloroform.  F urther  experiments  on  dogs 
have  recently  been  made  by  Dr.  Strassman,  which  appear  to  confirm 
this  view.  Dr.  Strassman  found  that  the  first  organ  to  be  affected  was 
the  liver,  then  the  heart,  and  after  that  other  viscera.  The  nature  of 
the  morbid  change  was  not  a fatty  degeneration,  but  fatty  infiltration. 
The  actual  cause  of  death  in  fatal  cases  appeared  to  be  the  cardiac 
affection,  as  in  all  such  a very  marked  degree  of  change  was  found  in 
the  heart.  In  non-fatal  cases  the  morbid  change  was  found  to  have 
disappeared  in  a few  weeks’  time.  When  morphine  was  given  previ- 
ous to  the  chloroform,  less  of  the  latter  was  required,  and,  consequently, 
the  changes  produced  were  not  so  considerable  as  when  the  ordinary 
amount  was  given.  Animals  suffering  from  hunger,  loss  of  blood, 
etc.,  were  especially  predisposed  to  the  morbid  changes  due  to  chloro- 
form. 

Death  After  Chloroform. f — Thiem  and  Fischer’s  ZJeber  todliche 


* “On  Deaths  from  Chloroform  and  Ether  since  the  Hyderabad  Commission,” 
by  Lawrence  Turnbull,  M.D. 
f London  Lancet , 1889. 

J British  Medical  Journal , September  13,  1890. 


ETHER  OR  CHLOROFORM. 


237 


Nachivirkung  des  Chloroforms , published  last  year,  tends  to  attribute 
otherwise  unaccountable  deaths  following  a few  days  after  prolonged 
administration  of  chloroform,  to  fatty  degeneration  of  the  heart 
actually  caused  by  the  anaesthetic.  A case  is  described  where  Thiem 
operated  upon  a robust  and  temperate  man,  aged  36,  for  fracture  of 
the  patella.  The  patient  took  just  half  an  hour  to  get  under,  and 
the  lengthening  and  suturing  of  the  opposite  fragments  of  the  bone 
took  seventy  minutes;  150  grammes  of  chloroform  were  inhaled. 
The  patient  was  slightly  delirious  for  two  nights,  on  the  third  day 
the  wound  looked  well ; the  temperature  was  100.5°,  the  pulse  96,  and 
rather  feeble.  In  the  course  of  the  evening  the  pulse  grew  much 
weaker,  the  delirium  increased,  and  the  patient  died.  At  the  necropsy 
the  muscular  walls  of  the  heart  were  found  in  a state  of  extreme 
acute  fatty  degeneration  ; a similar  change  had  attacked  the  hepatic 
cells.  The  patient  was  a miller’s  man,  and  had  been  accustomed  to 
carry  weights  till  the  day  on  which  he  broke  his  patella ; there  was 
no  previous  evidence  of  any  form  of  heart  disease.  Professors  Thiem 
and  Fischer  observed  similar  changes  in  the  heart  and  liver  in  ani- 
mals kept  under  chloroform,  especially  when  the  dose  was  repeated 
for  two  or  three  days.  It  is  to  be  hoped  that  surgeons  will  not  be 
too  ready  to  attribute  their  fatal  cases  to  these  distant  effects  of  chloro- 
form; but  they  will  do  well,  in  these  days  of  long  and  severe  opera- 
tions on  the  abdominal  viscera,  to  bear  in  mind  that  the  prolonged 
administration  of  chloroform  mav  be  in  itself  a source  of  danger  which 
is  not  passed  when  the  patient  is  restored  to  consciousness. 

Third. — Vomiting  usually  occurs  after  chloroform  anaesthesia. 

The  Desirable  Qualities  of  Chloroform.  First. — Chloroform 
has  a sweetish  odor,  not  unpleasant  to  the  respiratory  tract,  and  can 
be  inhaled  without  special  feelings  of  discomfort,  and  rarely  any  in- 
terruption in  breathing  from  spasm  of  the  glottis  or  irritation  of  the 
respiratory  mucous  membrane. 

Second . — It  is  rapid  in  its  action,  complete  anaesthesia  ensuing  in 
from  five  to  seven  minutes. 

Third. — But  a small  quantity  is  required  to  induce  anaesthesia, 
two  to  three  drachms,  and  an  operation  of  an  hour’s  duration  may  be 
conducted  with  less  than  an  ounce. 


238 


world’s  homoeopathic  congress. 


Tabulation, 


Ether. 

1.  A dangerous  anaesthetic. 

2.  Ratio  of  deaths  to  inhalations: 

1 : 23,204  (Andrews). 

1 : 16,542  (Lyman). 

The  ratio  of  deaths  from  ether  is  from 
5 to  -j  as  great  as  from  chloroform. 

Ether  kills  rarely. 

3.  Ether  is  rapid  in  its  action,  inducing 
anaesthesia  in  from  5 to  7 minutes. 

Ether  is  an  irritant  to  the  respiratory 
mucous  membrane,  and  in  susceptible 
subjects  may  cause  violent  and  fatal 
bronchitis. 

Ether  stimulates  the  heart’s  action. 

Ether  is  claimed  to  be  an  irritant  to 
the  renal  tissue,  and  may  produce  fatal 
results  if  the  kidneys  are  already  crip- 
pled by  disease. 

Ether  may  provoke  attacks  of  melan- 
cholia in  susceptible  subjects. 

The  administration  of  ether  is  likely 
to  be  followed  by  nausea  and  vomiting. 


Chloroform. 

1.  A dangerous  anaesthetic. 

2.  Ratio  of  deaths  to  inhalations : 

1 : 5860  (Lyman). 

1 : 2500  to  3000  (Richardson). 

The  ratio  of  deaths  from  chloroform 
is  4 to  5 times  that  from  ether. 

Chloroform  kills  frequently. 

3.  Chloroform  is  rapid  in  its  action, 
inducing  anaesthesia  in  from  5 to  7 min- 
utes. 

Chloroform  is  a bland  anaesthetic  as 
far  as  its  action  on  the  respiratory  mucous 
membrane  is  concerned. 

Chloroform  depresses  the  heart’s  action. 

Chloroform  is  said  to  have  no  per- 
ceptible influence  upon  the  kidneys. 

Chloroform  is  said  to  be  devoid  of  in- 
jurious influence  on  the  mental  faculties. 

The  administration  of  chloroform  is 
likely  to  be  followed  by  nausea  and 
vomiting. 


Conclusion. — It  would  appear  from  the  foregoing,  that  certain 
facts  regarding  surgical  anaesthesia  have  been  established. 

First. — There  is  some  danger  attending  anaesthesia,  whatever 
anaesthetic  or  method  of  administration  be  employed. 

Second. — Sulphuric  ether  is  the  safest  anaesthetic  for  general  sur- 
gical use,  in  all  periods  of  life,  from  infancy  to  old  age. 

Third. — Chloroform  may  be  advantageously  used  in  place  of  ether 
in  cases  of  renal  disease,  characterized  by  albuminuria,  and  in  per- 
sons having  inherited  or  other  tendency  to  melancholia. 

Fourth. — In  cases  of  weak  heart,  with  dilatation  from  valvular 
disease,  or  other  cause,  any  anaesthetic  carries  extreme  danger  with 
it.  Valvular  disease,  with  good  compensation,  does  not  contra- 
indicate the  use  of  ether. 

Fifth. — If  an  anaesthetic  must  be  administered  to  a patient  suffer- 
ing with  bronchitis,  in  the  absence  of  other  contraindications,  chlo- 
roform is  preferable;  but,  in  such  cases,  it  is  better  to  defer  the  ad- 
ministration, if  possible,  until  the  bronchitis  has  been  cured.  * 


ETHER  OR  CHLOROFORM. 


239 


In  closing,  I wish  to  refer  to  one  other  matter,  and  this  I will  in- 
troduce by  quoting  a paragraph  from  a paper  by  H.  C.  Wood,  M.D., 
delivered  before  the  International  Medical  Congress,  in  Berlin,  Au- 
gust, 1890.  Speaking  of  ether  and  chloroform,  he  says: 

“The  comparative  advantages  and  disadvantages  of  the  two  anaes- 
thetics, in  practical  medicine,  are  so  well  known  that  only  one  or 
two  points  seem  to  force  themselves  upon  our  present  attention.  I 
cannot  see  that  the  surgeon  is  justified  in  putting  the  life  of  the  pa- 
tient to  the  unnecessary  risks  of  chloroformization,  except  under 
special  circumstances.  I believe,  moreover,  that  much  of  the  un- 
popularity of  ether  is  due  to  its  improper  administration.  It  is  so 
easy  to  embarrass  the  respiration  seriously  by  the  folded  towel,  as 
commonly  used,  that  not  only  are  the  struggles  of  mechanical  as- 
phyxia almost  invariably  produced,  but  probably  death  itself  is 
sometimes  caused.  Especially,  is  there  danger  of  death  being  thus 
caused  mechanically  in  the  advanced  stages  of  etherization,  when  the 
patient  is  too  thoroughly  etherized  to  struggle,  and  when  the  atten- 
tion of  the  etherizer  is,  it  may  be,  attracted  by  some  novel  and  diffi- 
cult operation.  I,  myself,  confess  to  having  once  nearly  killed  a 
patient  in  this  way.” 

It  will  be  observed  that  I have  underscored  the  portion  of  the 
above  quotation  referring  to  “improper  administration.” 

This  matter  has  so  profoundly  impressed  itself  upon  me,  that  dur- 
ing the  past  few  years  I have  devoted  much  time  and  thought  to  the 
devising  of  an  improved  system  of  ether  administration. 

This  has  resulted  in  the  method  which  I have  been  pleased  to 
term  “Anaesthesia  with  Etherated  Air,”  a full  description  of  which 
was  presented  to  the  American  Institute  one  year  ago,  and  is  now 
printed  in  its  Transactions  for  1892. 

I would  here  emphasize  what  has  been  forced  upon  me  from  prac- 
tical experience,  viz.,  That  surgical  anaesthesia  should  be  conducted 
by  an  expert. 

It  is  an  injustice  to  the  patient,  as  well  as  to  the  operator  him- 
self, to  entrust  so  important  a matter  as  the  administration  of  an 
anaesthetic  to  an  inexperienced  student,  a nurse,  or  other  incompe- 
tent person. 

The  expert  in  anaesthesia  observes  the  first  warning  of  danger, 
and  trouble  is  thus  avoided.  The  ignoramus  sees  nothing,  because 
he  knows  nothing,  and  his  first  consciousness  of  impending  danger 


240 


world’s  homoeopathic  congress. 


is  likely  to  be  after  the  patient  has  ceased  breathing  or  the  heart  is 
pulseless. 

Discussion. 

Dr.  Packard,  of  Boston:  With  the  permission  of  the  Congress 
I will  simply  give  a resume  of  my  paper,  hoping  thereby  for  more 
time  for  simple  experiments  which  I wish  to  show  you,  and  the  anaes- 
thetization  of  a patient. 

My  paper  is  a defence  of  ether  as  a general  surgical  anaesthetic.  At 
the  outset,  I will  make  the  declaration,  which  I hope  to  prove  to  you 
ere  I am  through,  that  sulphuric  ether  is  the  best  surgical  anaesthetic 
which  we  possess,  falling  short  of  the  ideal  in  but  very  few  details. 
Ether’s  only  rival  in  the  field  of  surgical  anaesthesia  is  chloroform. 
In  spite  of  the  virtues  of  ether,  chloroform  is  still  the  anaesthetic  in 
prevailing  use  over  a large  portion  of  the  earth. 

This  seems  a little  strange,  since  the  discovery  of  sulphuric  ether 
as  an  anaesthetic  antedates  chloroform  by  about  one  year.  It  is  still 
in  prevalent  use  in  New  England  and  the  Middle  States,  and  the 
reason  for  this  we  find  in  the  pride  and  glory  of  a community  which 
attends  the  discovery  of  such  a beneficent  material.  With  the  dis- 
covery of  chloroform  in  New  England,  and  the  impetus  which  En- 
glish, French,  and  German  surgery  have  given  to  the  world,  and  the 
adoption  of  chloroform  and  its  subsequent  use  by  those  countries, 
explains  why  chloroform,  or  some  mixture  of  it,  is  still  so  widely  in 
use  in  Great  Britain  and  on  the  Continent,  and  I think  in  the  west- 
ern part  of  the  United  States.  My  belief  is,  that  the  reason  that 
chloroform  has  continued  to  be  the  prevalent  anaesthetic,  and  that 
ether  still  is  used  by  a comparatively  small  number,  is  because  it 
has  not  received  the  scientific  study  which  it  deserves.  To-day, 
forty-seven  years  after  the  discovery  of  sulphuric  ether,  it  is  utilized 
and  applied  in  substantially  the  same  way,  and  by  the  same  method, 
that  it  was  on  that  memorable  occasion  in  the  Massachusetts  General 
Hospital  in  Boston — simply  by  saturating  a sponge  and  placing  it 
over  the  patient’s  face.  To-day,  that  hospital  has  the  very  same 
kind  of  a sponge  as  was  used  forty-seven  years  ago,  and  all  the  forms 
of  inhalers,  which  are  modifications  of  the  simple  sponge  or  towel, 
embodies  the  same  principle  that  was  utilized  in  the  use  of  the 
sponge.  So  I may.  say,  that  there  has  been,  practically,  no  progress 
in  the  method  of  administration  of  sulphuric  ether. 

I will  here  skip  over  a large  portion  of  my  paper,  which  is  de- 
voted to  somewhat  dry  facts  regarding  the  comparison  of  the  anaes- 
thetical  effects  of  ether  and  chloroform,  and  will  briefly  refer  to  a 
tabulation  near  the  close  of  my  paper,  comparing  these  two  rival 
anaesthetics.  •> 

Ether,  a dangerous  anaesthetic,  not  very  dangerous,  but  once  in  a 
while  we  hear  of  a death.  Chloroform,  a dangerous  anaesthetic, 


ETHER  OR  CHLOROFORM. 


241 


much  more  dangerous  than  ether.  The  ratio  of  deaths  by  ether  in- 
halation, by  one  author,  is  1 to  23,204 ; by  another  author,  1 to 
16,542.  The  ratio  of  deaths  by  inhalations  of  chloroform  by  one 
author,  1 to  5860;  by  another  author,  1 to  2500.  The  ratio  of 
deaths  from  ether  is  from  one-quarter  to  one-fifth  as  great  as  chlo- 
roform. The  ratio  of  deaths  from  chloroform  is  from  four  to  five 
times  that  of  ether.  Ether  kills  rarely,  chloroform  kills  frequently, 
and  the  deadly  action  of  chloroform  never  can  be  realized  until  one 
has  seen  a death  from  it.  Try  to  kill  an  animal  with  chloroform.  I 
never  was  so  impressed  with  the  fatal  action  of  chloroform  as  at  one 
time  when,  in  the  course  of  some  experimental  operations,  I was 
chloroforming  a bull  terrier.  In  the  midst  of  the  struggles  I pressed 
the  hole  closely  down  over  her  nose,  excluding  the  air.  In  a moment 
her  struggles  ceased.  She  was  absolutely  dead,  beyond  resuscitation, 
and  that  is  just  what  we  meet  with  every  now  and  then  in  a human 
being — a death  occurs  like  that. 

Ether  is  rapid  in  its  action,  inducing  anesthesia  in  from  five  to 
seven  minutes.  Chloroform  is  rapid  in  its  action,  inducing  anesthe- 
sia in  from  five  to  seven  minutes.  Here  they  stand  equal.  Ether  is 
an  irritant  to  the  respiratory  mucous  membrane,  and  in  susceptible 
subjects  may  cause  violent  and  fatal  bronchitis.  Chloroform  is  a 
bland  anesthetic  as  far  as  its  action  on  the  respiratory  mucous  mem- 
brane is  concerned.  Ether  stimulates  the  heart’s  action  and  chlo- 
roform depresses  it.  Ether  is  claimed  to  be  an  irritant  to  the 
renal  tissue,  and  may  produce  fatal  results  if  the  kidneys  are  already 
crippled  by  disease.  Chloroform,  it  is  said,  has  no  perceptible 
influence  on  the  kidneys.  Chloroform  is  said  to  be  devoid  of 
injurious  influence  on  the  mental  faculties.  The  administration  of 
ether  is  likely  to  be  followed  by  nausea  and  vomiting,  the  same  as 
chloroform. 

Conclusion. — It  will  appear  from  the  foregoing  that  certain 
facts  regarding  surgical  anaesthesia  have  been  established.  First. 
There  is  some  danger  attending  anaesthesia  whatever  method  be  em- 
ployed. Sulphuric  ether  is  the  safest  anaesthetic  for  general  surgical 
use  in  all  periods  of  life  from  infancy  to  old  age.  Chloroform  may  be 
advantageously  used  in  place  of  ether  in  case  of  renal  disease,  or  other 
cases,  characterized  by  albuminuria,  or  those  having  a tendency  to 
melancholia.  In  cases  of  weak  heart,  with  dilatation  from  valvular 
disease  or  other  cause,  any  anaesthetic  carries  extreme  danger  with  it. 
Valvular  disease,  with  good  compensation,  does  not  contraindicate 
the  use  of  ether. 

I will  briefly  refer  to  the  fact  that  for  the  past  six  years  I have 
made  a study  of  ether  which  has  modified  the  notions  originally  pre- 
vailing and  the  method  of  administration.  I would  like,  if  I can 
have  the  time,  to  show  you  one  or  two  little  experiments,  and  then 
to  etherize  a patient.  In  the  first  place,  I throw  into  an  empty  bottle 

16 


242 


world’s  homoeopathic  congress. 

a few  minims  of  sulphuric  ether  like  that,  putting  the  cork  in,  and 
in  a moment  it  disappears.  They  say  it  evaporates.  At  any  rate, 
there  has  been  some  union  of  the  ether  with  the  air  contained  in  the 
bottle.  I don’t  know  just  what  that  change  is,  whether  it  is  a chemical 
or  a mechanical  change,  but  an  explosive  compound  has  been  formed, 
as  you  will  see  in  a moment.  Y ou  observe  that,  with  a slight  explosive 
action,  the  cork  flies  out  of  the  bottle.  It  simply  shows  that  the  combi- 
nation of  ether  and  air  results  in  a compound  which  has  a much 
greater  volume  than  the  air  which  has  been  saturated  with  the 
vapor. 

I found  by  this  experiment  that  the  injection  of  more  than  one 
minim  to  the  cubic  inch  of  air  overcharges  that  air.  This  bottle 
contains  about  fifteen  ounces.  The  injection  of  fifteen  minims  of 
ether  results  in  the  observation  at  once  of  the  disappearance  of  that 
liquid  ether.  If  more  than  that  be  injected,  there  is  a residue  left, 
so  that  we  have  the  fact  established  that  a saturation  of  air 
with  ether  takes  place  at  the  rate  of  one  minim  to  the  cubic  inch 
of  air. 

The  next  thing  was  to  pass  air  through  a column  of  ether  like  this 
(indicating).  It  makes  its  exit  at  this  tube,  and  on  experiment  I 
found  that  the  compound  makes  its  exit  just  the  same  as  it  is  formed 
in  this  body ; that  it  is  a compound  consisting  of  one  minim  of  liquid 
ether  to  one  cubic  inch  of  air.  Now  what  is  the  property  of  that 
compound?  Has  it  an  anaesthetic  property ? The  next  thing  was 
to  accumulate  that  compound  in  a bag  and  apply  it  to  the  human 
respiratory  tract  and  this  was  the  result.  It  was  so  strong  and  power- 
ful, so  pungent,  that  1 he  human  respiratory  tract  would  not  tolerate  it, 
although  I had  been  told  that  previous  experiments  of  this  kind  have 
been  made,  that  the  resulting  compound  from  the  mixture  of  ether 
with  air  would  not  produce  anaesthesia. 

The  next  step  was  to  find  out  how  much  dilution  with  air  it  needed, 
to  be  tolerated  by  the  human  lungs,  and  if  that  would  produce  sur- 
gical anaesthesia ; and  it  was  learned  that  it  would  do  so,  more 
promptly  than  we  ever  conceived  sulphuric  ether  could  do.  In  from 
five  to  seven  minutes  complete  surgical  anaesthesia  is  induced  by  the 
resulting  compound. 

I will  now  anaesthetize  a patient  with  this  compound.  I have  an 
apparatus  different  from  anything  that  has  ever  been  used.  It  com- 
bines some  principles  which  have  existed  heretofore.  This  bottle  is 
just  the  same  as  the  Junker  method,  which  is  used  for  chloroforming. 
This  portion  which  goes  over  the  face  is  similar  to  other  inhalers 
with  the  exception  of  the  compound.  I call  this  “etherateH  air.” 
The  etherated  air  is  pumped  into  this  bag  and  the  strength  of  that 
which  reaches  the  patient’s  lungs  is  graduated  by  this  valve  which 
is  opened  or  closed  according  to  the  circumstances  of  the  case. 

After  all  anaesthesia  is  but  little  more  than  an  abolishment  of 


ETHER  OR  CHLOROFORM. 


243 


memory,  the  memory  of  painful  sensations ; and  the  moment  that 
memory  is  abolished  we  may  say  that  that  patient  is  anesthetized. 

I will  ask  this  patient  to  signal  to  you  so  that  you  may  know  the 
moment  that  memory  is  abolished.  He  will  do  it  by  making  signals 
with  this  “snapper.”  After  the  abolishment  of  memory  there  is 
usually  a moment  or  two  which  ensues  before  complete  surgical 
anesthesia  follows.  By  surgical  anesthesia  I mean  a relaxation  of  the 
muscular  system.  If  some  one  will  kindly  time  the  point  at  which 
memory  fails  from  the  time  that  I begin  to  see  the  ether  pass  through 
we  will  know  the  time  that  anesthesia  begins. 

(After  three  minutes  the  patient  produced  before  the  Section  failed 
to  make  use  of  the  snapping  instrument,  which  he  had  heretofore 
done  in  a rapid  manner,  and  in  seven  minutes  was  apparently 
anaesthetized.  He  was  restored  to  consciousness  by  the  doctor  in  a 
little  over  one  minute,  and  after  acting  in  a bewildered  manner  and 
exhibiting  some  nervousness,  was  removed  from  the  room). 

S.  B.  Parsons,  M.D. : Mr.  Chairman , Ladies  and  Gentlemen : 
When  I was  asked  to  open  the  discussion  on  anaesthesia,  I felt  that 
perhaps  I was  incompetent  to  do  so.  There  were  many  who  were 
better  able  than  myself  to  discuss  this  question,  for  I consider  it  one  of 
the  most  important  of  the  questions  that  can  come  before  a medical 
association.  I do  not  believe,  Mr.  Chairman,  that  in  the  list  of 
surgical  subjects  that  will  come  before  this  body  to-day,  there  will 
be  one  of  so  great  importance  as  that  of  anaesthesia.  We  have  just 
had  a beautiful  illustration  of  how  easily  some  persons  can  be  put 
under  an  anaesthetic.  But  let  me  tell  you  one  thing  that  you  can- 
not always  get  males  and  females  under  an  anaesthetic  as  easily  as 
this  one  was  put  under.  It  is  very  pleasant  when  you  can,  but 
the  majority  of  them  will  require  from  four  to  a dozen  men  to  keep 
them  quiet  during  the  process,  whether  it  be  ether  or  chloroform* 
The  very  fact  of  the  patient  lying  on  the  table  and  quietly  submit- 
ting to  an  anaesthetic,  inhaling  it  regularly  without  fear,  without 
nervous  excitement,  is  one  very  great  advantage,  I can  assure  you. 
But  when  you  go  into  an  operating  room,  whether  it  be  an  old  per- 
son or  young  person  it  makes  no  difference,  and  find  their  hearts 
going  like  a trip-hammer,  their  minds  and  bodies  in  a state  of  agita- 
tion, afraid  of  their  lives,  not  knowing  what  is  going  to  be  done  to 
them — afraid  they  will  die — I tell  you  you  have  got  a subject 
entirely  different  from  the  one  we  have  just  witnessed.  You  will 
find  that  you  have  got  something  to  do  before  you  give  the  anses- 
thetic,  and  it  is  a very  important  point,  I assure  you,  to  determine 
how  to  overcome  that,  and  to  quiet  that  nervous  excitement.  The 
very  first  thing  an  operator  should  do  in  going  into  an  operating 
room  is  to  allay  the  fears  and  quiet  the  nervous  excitement  of 
the  patient.  Before  an  ansesthetic  is  given,  before  an  inhalation  is 
taken,  the  nervous  excitement  should  be  overcome  and  the  fears 
quieted  and  pacified. 


244 


world’s  homceopathic  congress. 


The  paper  that  Dr.  Packard,  of  Boston,  has  presented,  I had  the 
pleasure  of  looking  over,  and  he  has  given  us  the  relative  statistics 
of  the  frequency  of  deaths  under  chloroform  and  ether,  and  he  tells 
us  it  is  from  five  to  ten  times  greater  under  chloroform  than  ether. 
Now  then,  if  that  is  a fact,  chloroform  has  a ten-fold  power  greater 
than  ether  in  paralyzing  the  nervous  system,  for  etherization  is 
simply  paralysis.  First , It  is,  what?  A stage  of  excitement. 

Second , Loss  of  consciousness.  Third , Loss  of  voluntary  movement, 
and  Fourth,  Loss  of  reflex  action.  Your  patient  is  not  in  a fit  con- 
dition for  you  to  go  on  with  a capital  operation  until  these  all  occur. 
It  is  .all  right  if  you  want  to  open  a felon  or  perform  some  minor 
operation,  but  I assure  you  that  the  patient  never  will  submit,  with- 
out a good  deal  of  struggling,  to  an  operation  of  amputation.  This 
case  before  us  was  not  a full  and  complete  anaesthesia  in  my  belief. 

Ether  is  the  safest ; there  is  no  question  about  it.  Ether  is  the 
safest,  but  the  doctor  has  told  you  that  you  cannot  use  it  always. 
There  are  times  and  conditions  when  you  cannot  use  ether.  Now, 
ether  is  not  a good  thing  in  the  obstetric  room,  for  one  thing. 
Chloroform  takes  preference  there.  Then  again,  there  are  organic 
changes  he  told  us ; trouble  with  the  respiratory  tract,  organic 
changes  in  the  heart,  and  in  the  renal  structure,  and  in  the  brain. 
Now  we  cannot  use  ether  with  a degree  of  safety,  or  any  anaesthetic, 
under  these  conditions.  It  is  true,  I will  admit,  any  anaesthetic  is 
an  unsafe  anaesthetic.  Ether  cannot  be  used  at  these  times,  but  you 
can  use  chloroform  where  you  cannot  use  ether. 

Now,  ether  paralyzes  one  set  of  nerves,  you  may  say,  and  chloro- 
form another.  The  symptoms  of  ether  narcosis,  profound  narcosis, 
or  the  incidents  which  accompany  or  attend  ether  narcosis,  almost 
always — ninety-nine  times  out  of  a hundred — will  give  you  warn- 
ing before  the  dangerous  period  has  arrived ; and  those  symptoms 
are  what?  Interference  with  and  obstruction  of  respiration.  With 
chloroform  it  is  the  opposite.  It  does  not  give  you  any  warning;  it 
takes  the  patient  off  as  quick  as  a flash.  On  the  one  hand  it  is 
failure  of  respiration,  as  they  call  it,  causing  death  under  ether,  and 
on  the  other,  it  is  a failure  of  heart  action  under  chloroform.  Those 
are  the  two  conditions,  and  those  are  the  two  symptoms. 

There  are  many  little  things  that  tend  to  make  anaesthesia  very 
unpleasant.  To  give  an  anaesthetic  where  there  is  a very  irritable 
mucous  tract,  or  where  you  are  going  to  operate  upon  the  niouth,  or 
larynx  or  pharynx,  ether  is  not  a good  anaesthetic  to  use.  Chloro- 
form is  by  far  the  best..  If  you  use  ether,  you  will  have  the  throat 
filled  up  with  mucus  in  a very  little  while.  It  seems  to  paralyze, 
I might  say,  the  vaso-motor  nerves,  and  we  have  an  unusual  amount 
of  mucous  flow  which  fills  up  the  throat  and  obstructs  your  view, 
and  you  are  obliged  to  keep  wiping  it  out,  and  the  operation  is  de- 
layed while  your  patient  is  not  benefited.  Oftentimes  you  cannot 
get  along  and  you  have  to  give  it  up.  With  chloroform  it  is  differ- 


ETHER  OR  CHLOROFORM. 


245 


ent ; you  don’t  have  that  abundant  flow.  There  are  other  things 
that  conduce  to  make  anaesthesia  pleasant  or  unpleasant.  Tempera- 
ment sometimes  has  something  to  do  with  it ; and  peculiarities  of 
constitution,  where  they  are  known  to  exist,  should  always  be  done 
away  with  before  the  operation.  Sex  also  has  something  to  do  with 
it.  Women  take  an  ana?sthetic  a great  deal  better  than  men.  They 
are  more  reconciled  to  the  condition,  more  reconciled  to  the  circum- 
stances ; they  have  less  fear  and  nervous  excitement.  They  lie  down 
and  take  it  quietly,  and  they  come  out  from  under  it  a great  deal 
better. 

With  males  we  have  a greater  number  of  deaths  than  with  females. 
It  is  not  all  because  the  operations  are  so  much  more  frequently  had 
on  males  than  on  females,  but  it  is  on  account  of  the  sexual  condi- 
tions, I believe.  Now  as  to  the  question  of  chloroform  being  used 
in  preference  to  ether  in  different  parts  of  the  country,  perhaps  cli- 
matic changes  and  conditions  may  have  something  to  do  with  it. 
We  have  found  one  thing,  that  ether  does  not  produce  that  profound 
relaxation  that  we  sometimes  need. 

(At  this  point,  Dr.  Northrup’s  discussion  of  the  paper  was  pre- 
sented by  the  chairman.  This  part  of  the  discussion  has  not  been 
received  by  the  editor.) 

H.  F.  Bigg  A r,  M.D. : Mr.  Chairman,  Ladies  and  Gentlemen : I 
have  listened  to  this  paper,  and  have  seen  the  clinic  and  also  listened 
to  the  discussion  with  a great  deal  of  edification.  It  has  been  a 
question  with  me  for  years  just  the  proper  thing  to  use — chloroform, 
ether,  or  the  A.  C.  E.  mixture.  For  years  I used  the  A.  C.  E. 
mixture.  I never  have  had  so  good  results  since,  but  I was  com- 
pelled to  give  it  up  because  if  an  accident  should  occur  the  coroner 
was  after  us,  and  we  had  no  person  in  this  country  to  assist  in  get- 
ting us  out  of  the  dilemma.  The  popular  idea  was  then,  ether.  I 
gave  ether  a trial  for  one  year,  determined  to  find  out  its  merits  or 
demerits.  With  the  most  perfect  instruments  and  most  perfect 
appliances,  I had  six  patients  to  go  right  down  almost  to  death 
before  they  were  saved.  I read  up  chloroform,  and  I am  a friend 
of  chloroform.  When  you  can  perform  difficult  operations  with  two 
grammes  of  chloroform,  I am  a friend  of  chloroform. 

There  is  a great  deal  in  statistics,  but  I take  exception  to  the 
statement  that  more  die  from  chloroform  than  ether.  I dispute  it, 
and  challenge  it,  and  I tell  you  why.  When  they  die  from  chloro- 
form they  die  on  the  table.  When  they  die  from  ether  they  die  af- 
terwards in  the  room  where  they  are  taken  from  the  table.  It  may 
be  two  days  before  they  recover  from  it.  I really  think  there  are 
more  dying  from  ether  than  from  chloroform,  for  the  very  reason  I 
gave  you.  One  point  more,  and  that  is  this  : we  ought  to  be  care- 


246 


world’s  homoeopathic  cong-ress. 


ful  and  study  our  cases.  We  cannot  make  a rule  for  every  case  as 
a law  unto  itself,  and  I use  ether  and  I use  chloroform,  and  wish  the 
law  would  protect  us  in  the  use  of  the  A.  C.  E.  mixture,  which  in  my 
estimation  has  been  the  safest  and  quickest,  and  by  all  means  gives  the 
best  satisfaction  ; but  there  is  this  difficulty  about  it:  when  you  pre- 
pare it,  prepare  it  fresh.  Dr.  Tait  uses  it,  and  he  asks  nothing  better 
than  that  mixture.  I know  there  is  a diversity  of  opinion  about  it, 
but  as  long  as  I am  practicing  I shall  use  my  own  judgment  as  to 
what  I give,  whether  it  shall  be  ether  or  chloroform.  I dare  not 
give  the  A.  C.  E.  mixture  in  this  country,  because  I wouldn’t  get 
any  support  if  the  patient  should  die.  I have  been  a victim  of  this. 
I have  been  accused  of  losing  two  patients,  one  was  by  chloroform, 
which  was  never  inhaled,  and  the  other  was  by  chloroform  which 
she  did  inhale.  I would  not  let  the  patient  get  up  and  sit  up  after 
an  anaesthetic  so  soon  as  this  one  did.  I would  be  afraid  of  paralysis. 
Keep  your  patient  quiet,  get  him  in  good  condition,  and  if  there  is 
any  likelihood  of  vomiting,  get  a large  dose  of  some  cathartic  down 
him  as  soon  as  possible.  You  want  it  to  work  down,  and  as  soon  as 
you  get  it  down  you  will  have  no  vomiting. 

Question  by  Physician  in  audience  : Where  do  you  get  your 

theory  of  vomiting  ? 

Dr.  Biggar  : I am  indebted  to  Dr.  Thayer.  He  says  he  has  no 
trouble  about  vomiting.  He  gives  them  a good  dose  of  citrate  of 
magnesia.  I don’t  want  to  exceed  my  time ; but  one  moment,  if 
you  will  allow  me.  The  reason  I lost  a patient  from  chloroform 
was  this,  and  it  was  a lesson  to  me,  and  will  be  a lesson  to  you,  per- 
haps : after  the  operation  had  been  completed,  the  patient  com- 
menced vomiting,  and  the  vomiting  was  so  severe  that  she  had  stasis 
in  different  parts  of  the  brain  from  undue  pressure  caused  by  the 
vomiting.  That  was  why  she  lost  her  life.  I think  we  ought  to 
carefully  study  that  point  and  prevent  vomiting,  and  by  all  means 
get  a movement  of  the  bowels  if  possible  before  the  person  really 
comes  out  of  the  anaesthesia. 

They  want  to  know  what  the  A.  C.  E.  mixture  is  ? It  is  one 
part  alcohol,  one  part  chloroform,  and  one  part  ether. 

Dr.  Emerson  : I am  here  to  say  a word  for  Dr.  Packard’s  ap- 
paratus. I am  very  familiar  with  the  working  of  it,  and  could  say 
some  things  he  wouldn’t  feel  like  saying.  I will  say  that  the  patient 
he  has  had  to-day  is  the  worst  one  I have  ever  seen  him  experiment 
with.  It  took  seven  and  a half  minutes  to  etherize  the  patient.  As 
to  Dr.  Packard  allowing  his  patient  to  sit  up  so  soon,  I would  also 
say  it  is  entirely  safe  for  him  to  do  so,  for  the  reason  the  patient  had 
taken  so  small  a quantity  of  the  ether.  His  patient  was  entirely 
etherized.  One  could  have  performed  amputation  or  any  other  op- 
eration. I simply  take  this  opportunity  to  speak  in  behalf  of  Dr. 
Packard. 


ETHER  OR  CHLOROFORM. 


247 


Dr.  Gilchrist,  of  Iowa  City  : I have  one  word  to  say  on  the 
subject  of  anaesthetics.  We  have  been  using  the  A.  C.  E.  mixture 
entirely  for  a number  of  years,  and  find  it  a very  satisfactory  agent. 
There  is  one  point  we  haven’t  brought  out  in  the  testimonials.  Isn’t 
it  possible  that  ether  and  chloroform  and  all  anaesthetic  agents  are 
to  be  looked  upon  as  remedies  ? Is  any  anaesthetic  agency  univer- 
sally to  be  approved  ? There  are  many  cases,  I think,  where  we 
dare  not  use  ether.  There  are  many  cases,  I think,  where  we  would 
hardly  dare  to  use  chloroform.  It  certainly  appears  to  me  that  there 
will  be  a time  when  we  will  cometo  understand  anaesthetics  perfectly. 
With  reference  to  the  rapidity  with  which  anaesthesia  can  be  pro- 
duced, we  have  been  keeping  some  records,  and  we  find  that  the  av- 
erage from  the  A.  C.  E.  mixture  is  about  eight  and  three-quarter 
minutes  for  complete  anaesthesia. 

I want  to  give  another  remedy  to  add  to  the  one  that  Dr.  Biggar 
gave,  and  one  I think  of  even  greater  value,  and  that  is  Bismuth, 
given  in  the  third  and  higher  attenuations.  I have  had  one  or  two 
cases  where  Bismuth  has  acted  wonderfully.  One  case  occurred 
but  two  or  three  weeks  ago,  of  abdominal  complication.  I want  to 
call  attention  to  that  as  one  of  the  remedies  we  have  not  given 
special  attention  to  in  abdominal  complications.  I have  used  it  in 
the  third  attenuation. 

Dr.  Shears:  I want  to  take  exception  to  the  statement  that 
ether  is  the  best  general  anaesthetic.  I don’t  think  it  is  an  anaes- 
thetic that  should  be  most  generally  used.  It  should  be  confined  to 
a very  limited  number  of  cases.  It  is  not  applicable  where  there  is 
any  disease  of  the  rectum,  or  taken  in  an  operation  on  the  larynx, 
the  mouth  or  the  nose.  It  is  very  difficult  to  use  ether  with  any 
degree  of  satisfaction.  It  is  not  applicable  to  the  treatment  of  ure- 
thral inflammation,  or  inflammation  of  the  kidneys,  or  stone  in  the 
bladder.  In  all  those  cases  I think  ether  is  not  a safe  anaesthetic. 
It  is  not  a good  anaesthetic  in  operations  on  the  brain  ; it  induces 
greater  congestion,  and  is  more  difficult  to  control.  I find,  in  a large 
number  of  instances  of  operations  upon  the  brain  and  head  that  ether 
is  not  of  service,  and  is  not  useful  as  an  anaesthetic  in  operations  on 
the  abdomen.  It  is  the  cause  of  very  frequent  vomiting.  It  is  very 
difficult  to  control  the  patient  for  a long  period  of  time.  I believe 
it  is  the  more  dangerous  anaesthetic  in  the  long  run.  Pneumonia 
follows  in  two  or  three  days,  or  what  is  supposed  to  be  pneumonia, 
or  some  other  trouble,  will  show  its  effects  from  ether.  I say  this, 
because  there  is  a general  feeling  among  experts  that  if  the  patient 
dies  after  chloroform,  the  physician  has  not  used  the  safest  anaes- 
thetic. I think  we  should  be  assertive  of  the  idea  that  we  are  using 
safe  anaesthetics.  I believe  much  danger  from  chloroform  arises 
from  its  improper  administration.  It  has  been  shown  that  danger 
arises  from  interrupting  respiration.  The  physician  pays  all  his  at- 


248 


world’s  homceopathic  congress. 


tention  to  the  pulse,  and  if  he  would  pay  his  attention  to  respiration 
and  see  that  the  patient  does  not  take  in  too  large  an  amount  of  the 
anaesthetic,  then  I believe  there  would  be  fewer  cases  of  death  from 
chloroform.  Chloroform  has  been  put  over  the  face  in  the  same 
careless  way  that  ether  is  applied.  I believe  it  is  a rare  case  in 
which  you  find  the  heart  cease  to  beat  before  the  patient  ceases  to 
breathe.  If  we  paid  more  attention  to  respiration  there  would  be 
fewer  cases  of  death  from  chloroform. 

Dr.  Boothby:  I wish  to  say  a word  in  favor  of  ether.  I am 
induced  to  do  this  because  of  the  remark  of  the  gentleman  who  has 
just  spoken.  The  inference  would  be  that  we  have  many  deaths 
after  our  operations — some  time  afterwards.  That  was  intimated  by 
Dr.  Biggar’s  remark  ; but  if  you  will  consider  that  matter  more 
carefully  and  consider  the  results  of  those  who  use  ether  you  will 
find  it  is  entirely  erroneous;  that  it  is  an  assumption;  that  they 
haven’t  the  slightest  evidence  to  base  it  upon.  It  is  a positive  fact 
that  ether  can  be  used  in  almost  every  kind  of  operation.  I know 
from  my  own  experience  and  from  the  experience  of  my  Brother 
Packard  and  many  others.  I always  use  ether  myself,  and  I believe 
the  remarks  here  have  been  intended  to  discredit  ether.  The  appa- 
ratus that  has  been  shown  has  given  very  satisfactory  results  with 
the  use  of  ether  in  small  quantities  in  a large  number  of  cases  that 
it  has  been  used  in.  There  has  never  been  an  accident  that  could 
possibly  be  referred  to  ether,  either  at  the  time  of  the  administration 
of  it  or  later. 

Dr.  Bowen,  of  Indiana:  I kept  one  patient  under  the  influence 
of  chloroform  continuously  for  two  nights  and  a day.  I was  called 
to  treat  a gentleman  who  hadn’t  swallowed  a particle  of  food  for 
three  days  and  nights.  He  had  terrible  pains,  and  his  brother  came 
and  placed  himself  under  bond  that  if  I killed  him  he  would  guar- 
antee me  against  damage,  and  told  me  to  give  him  chloroform.  I 
gave  him  two  pounds  of  chloroform  and  kept  him  under  the  influ- 
ence of  chloroform  two  nights  and  a day.  His  respiration  was  five 
or  six  in  a minute  and  his  pulse  kept  up.  When  I let  him  out  from 
under  the  chloroform  the  neuralgia  had  given  way.  That  was  the 
longest  time  I had  ever  kept  a patient  under  the  influence  of  chloro- 
form. Since  the  grippe  had  made  its  advent  in  the  country  I found 
it  very  imprudent  to  give  chloroform  in  all  cases. 

Dr.  Johns,  of  Lexington,  Ky. : On  the  question  of  vomiting 
after  anaesthesia  there  was  suggested  here  the  third  of  Bismuth  as  a 
remedy  for  it.  I want  to  say  I would  rather  use  the  one  hundred 
thousandth  of  Ipecac.  I would  put  it  in  a little  pellet,  and  put 
that  into  about  three  gallons  of  water,  and  pour  it  down  the  patient 
rapidly  in  full  quantities,  and  start  him  to  vomiting,  and  he  will 
get  up  a heat.  I would  put  another  in  about  as  much  water,  and  I 
wyould  cleanse  the  bowels  from  below.  Now,  whether  the  medicine 


ETHER  OR  CHLOROFORM. 


249 


or  water  would  do  it  is  a question.  I am  not  a Hydropath,  but  a 
Homoeopath.  I have  never  had  any  trouble  along  these  lines.  I 
want  to  state  that  all  the  benefits  of  this  cure  we  have  found  out  by 
Homoeopathy. 

E.  H,  Pratt,  M.D. : There  are  several  reasons  why  I do  not 
wish  to  speak.  One  is  I do  not  want  to  break  the  rules  governing 
the  time  that  is  allowed.  In  the  next  place,  if  I was  to  speak  upon 
this  subject,  I would  want  fifty  minutes  instead  of  five.  As  it  is, 
I will  put  in  the  five  minutes  as  best  I can.  In  the  first  place,  let 
me  say  that  I had  nothing  to  do  with  the  construction  of  the  human 
body.  I never  made  any  suggestions  as  to  the  way  it  was  to  be 
built.  I never  had  anything  to  do  with  the  telephonic  wires  that 
ramify  through  it.  I had  nothing  to  do  with  its  mechanism.  I 
had  nothing  to  do  with  the  causes  that  make  the  milk  come  in  the 
woman’s  breast  at  just  the  right  time  for  the  baby.  I had  nothing 
to  do  with  these  things,  and  I am  not  to  be  held  responsible  for 
them.  I wish  to  escape  punishment,  you  see.  I will  make  this 
suggestion,  however,  that  when  a person  struggles  in  anaesthesia  he 
needs  rectal  dilatation.  Rectal  dilatation  would  shorten  the  time  of 
that  anaesthesia  by  fifty  per  cent. 

With  reference  to  the  forms  of  the  anaesthetics  employed,  I agree 
with  the  popular  idea  that  ether  is  dangerous,  and  I think  that 
chloroform  is  dangerous.  I use  a mixture  of  the  two,  and  have  no 
respect  for  the  heart,  lungs,  kidneys  or  anything  else,  simply  be- 
cause I know  this  fact,  and  know  it  beyond  any  question,  so  far  as 
my  judgment  goes,  that  what  is  needed  is  rectal  dilatation  and  flush- 
ing of  the  capillaries.  By  rectal  dilatation  and  flushing  of  the  cap- 
illaries we  will  remove  the  congestion  from  the  kidneys  and  relieve 
the  pressure  upon  the  heart  which  chloroform  will  cause.  I don’t 
know  why  the  medical  profession  ignores  the  fact  that  rectal  dilata- 
tion is  the  greatest  resuscitator  from  narcosis.  I do  not  understand 
why  they  don’t  wish  to  investigate.  A gentleman  from  the  oppo- 
site school  came  to  me  from  Mississippi.  He  had  made  some  obser- 
vations and  some  study  of  this  question.  He  came  here  to  learn  a 
little  more,  and  wished  to  compare  what  he  saw  and  knew  with  other 
physicians.  He  visited  one  of  the  clinics  of  this  city,  and  it  ought 
to  be  published  throughout  the  length  and  breadth  of  this  land  that 
any  human  being  would  allow  a patient  to  die  for  the  reputation  of 
“ legitimate”  measures,  rather  than  to  save  him  by  what  they  didn’t 
know  anything  about.  They  ought  to  be  placarded  as  unfit  for 
the  practice  of  medicine.  They  were  operating  for  laceration  of  the 
perinseum.  The  patient  didn’t  respire  for  five  minutes,  and  was 
apparently  a corpse.  He  stood  there  and  saw  the  operation,  and  he 
had  seen  cases  of  Bright’s  disease  and  dropsy ; and,  forgetful  of  the 
stigma  that  would  be  placed  upon  him  if  he  failed,  he  sprang  into 
the  arena,  into  that  tremendous  stillness,  and  said,  “ This  is  a case 


250 


world’s  homoeopath  ro  congress. 


for  rectal  dilatation.”  The  operator  stood  dumbfounded,  and  said, 
“We  have  no  speculum.”  He  says,  “ Have  you  any  objection  to 
my  dilating  the  rectum?”  They  said,  “We  have  not  any  specu- 
lum.” He  put  his  finger  into  the  anus.  This  happened  to  be  a 
good  case,  and  soon  he  had  the  satisfaction  of  hearing  the  welcome 
sound  ; the  groan  of  the  patient  greeted  his  ear,  and  she  was  revived, 
and  they  went  on  and  finished  the  operation,  and  the  reputation  of 
the  school  was  saved.  What  was  the  result?  The  next  day  they 
published  upon  the  blackboard  a notice  that  “ Hereafter  all  who 
wished  to  obtain  tickets  to  the  clinics  must  obtain  the  tickets  below.” 
In  fact,  they  weren’t  grateful  that  the  patient  was  saved.  They 
would  rather  she  would  have  died  under  the  legitimate  idea  than  be 
saved  by  rectal  dilatation. 

Dr.  Packard  : I will  take  a few  moments  to  close  the  discussion. 
I wish  to  correct  a few  erroneous  ideas,  and,  first,  that  there  is  great 
danger  after  the  anaesthesia  from  ether.  It  is  just  the  opposite  with 
chloroform.  Death  occurs  in  twelve,  eighteen  or  twenty  hours,  be- 
cause of  the  result  of  fatty  degeneration.  That  is  one  of  the  dan- 
gers of  chloroform.  It  is  a danger  that  follows  very  frequently. 
We  grant  that  there  is  sometimes  pneumonia  and  violent  bronchitis, 
but  it  is  extremely  rare.  I would  like  to  speak  of  the  deaths  from 
ether  in  comparison  with  chloroform.  I make  the  statement  that 
in  the  Massachusetts  general  hospital  since  its  organization,  twenty- 
three  years  ago,  nothing  but  sulphuric  ether  has  been  used,  and  there 
never  has  been  a death  attributed  in  any  shape  or  manner  to  ether. 
I cannot  wonder  that  the  West  likes  chloroform.  Chloroform  has 
always  had  the  reputation  of  being  so  fast. 

Abroad,  human  life  is  not  held  for  as  much.  If  the  patient  dies 
in  a case  of  anaesthesia,  it  don’t  amount  to  so  much.  Chloroform 
will  be  relegated  to  a few  cases  which  present  some  form  of  nephri- 
tis and  those  other  rare  cases  that  will  succumb  completely  to  mus- 
cular relaxation.  In  the  250  cases  that  I have  tried  with  that 
instrument  there  have  been  but  two  in  which  I have  not  secured 
complete  anaesthesia.  Cases  of  execution  and  capital  punishment 
are  the  cases  for  chloroform.  It  will  kill  a good  deal  more  quickly 
and  a good  deal  more  humanely  than  the  gallows  or  electricity. 


SURGICAL  SHOCK. 


251 


SURGICAL  SHOCK. 

By  T.  L.  Macdonald,  M.D.,  Washington,  D.  C. 


Thanks  to  anaesthesia  and  antisepsis,  pain  and  poison  have  been 
eliminated  from  operative  surgery,  and  the  most  formidable  compli- 
cation now  remaining  for  the  surgeon  to  cope  with,  is  shock.  Its 
paramount  importance,  and  the  meagreness  of  the  subject,  make  its 
further  study  eminently  advisable.  As  here  considered,  the  subject 
has  nothing  to  do  with  “ railroad  spine  ” or  “ litigation  symptoms,” 
but  is  to  deal  with  the  immediate  constitutional  phenomena  pro- 
duced by  local  traumatism,  and  will  be  used  synonymously  with  col- 
lapse. It  will  not  be  understood  by  this  that  shock  cannot  be  pro- 
duced by  psychic  as  well  as  traumatic  influences.  The  interdepend- 
ence of  the  mind  and  body  is  shown  by  the  influence  of  impressions 
that  fall  upon  the  retina  from  without.  Let  a patient  who  is  to  be 
operated  gaze  upon  an  elaborate  array  of  instruments,  and  in  some 
cases  the  effect  is  most  pronounced.  Through  the  mind  the  knees 
quake  with  terror,  the  hair  stands  on  end,  the  brain  reels,  the  heart 
beats  tumultuously,  the  respiratory  apparatus  stammers  and  gasps, 
the  perspiration  oozes  from  every  pore,  the  urine  is  voided  or  sup- 
pressed— in  fact  any  of  these  organs  may  be  transiently  disturbed  or 
even  paralyzed.  These  are  familiar  illustrations,  but  serve  to  show 
that  psychical  disturbances  mav  act  powerfully  upon  our  physical 
being;  and  who  can  tell  (and  I ask  it  in  all  charity  and  kindness) 
how  much  this  had  to  do  with  the  death  of  Col.  Shepard  ? 

The  above  examples  would  seem  to  indicate  that,  turn  and  twist 
it  how  we  will,  we  cannot  escape  from  the  fact  that  the  mind  is  a 
power  within  our  muscular  being  (Mueller),  or  that  the  psychical 
and  physical  are  practically  one,  and  that  the  normal  status  of  our 
grosser  structures  is  more  or  less  dependent  upon  the  mind  as  well 
as  the  heart  or  lungs.  Although  shock  of  this  variety  may  be  pro- 
found, it  is  not  necessarily  surgical,  but  the  varieties  which  are  the 
accompaniment  of  visible  trauma,  and  especially  if  coincident  or 


252 


world’s  homceopathic  congress. 


subsequent  to  surgical  operation,  are  of  special  interest  to  us.  Be- 
cause the  symptoms  of  shock  are  so  familiar,  they  may  wisely  be 
omitted  ; but,  on  the  other  hand,  its  pathology  is  so  obscure  that  it 
demands  further  study.  The  most  advanced  work  on  surgery  takes 
up  surgical  shock,  and  dismisses  the  subject  of  its  pathology  with 
the  statement  that  it  consists  of  paralysis  of  the  vaso-motor  sys- 
tem. Other  works,  devoting  several  pages  to  the  pathology,  add 
nothing  to  the  above  except  what  is  conjectural.  We  know  that 
peripherally  the  capillary  resistance  is  diminished  ; so,  too,  is  the 
motive  power  of  the  cardiac  centres.  If  the  vaso-motor  supply  be 
cut  off  from  one  part  of  the  body,  the  vessels  therein  dilate,  but 
in  a few  days  recover  their  tone,  although  future  contraction  and 
expansion  are  dependent  upon  local  stimuli.  The  abdominal  ves- 
sels may  or  may  not  be  dilated.  Further  than  this,  everything  at 
present  lies  beyond  the  range  of  human  perception.  We  may 
say  that  in  shock  there  is  a disturbance  of  the  molecular  equilib- 
rium, which  can  no  longer  liberate  force,  but  this  is  of  little  sat- 
isfaction to  the  analytical  mind.  Autopsies  teach  us  nothing  of 
the  pathology,  no  post-mortem  traces  ever  having  been  discovered. 
The  whispering  of  molecular  vibrations,  which  constitute  human 
agony,  is  lost  in  the  roar  of  hurrying  dissolution. 

The  clinical  phenomena,  however,  corroborate  the  vaso-motor 
theory,  and  the  consequent  relaxed  vascular  system.  It  is  borne 
out  especially  by  the  intense  thirst  and  the  incredible  quantities 
of  water  that  many  of  these  patients  drink  during  profound  col- 
lapse. 

Case  I. — Removal  of  four  and  one-half  inches  of  rectum  for 
epithelioma.  The  operation  was  tedious  but  not  very  bloody,  only 
two  vessels  being  ligated.  The  operation  was  completed,  and  the 
patient,  in  the  most  profound  collapse,  was  placed  in  bed.  The 
pulse  was  but  an  occasional  flicker,  the  respiration  faint;  features 
pinched  and  ghastly,  pupils  dilated.  The  ears  and  supra-sternal 
fossa  were  filled  with  cold  sweat,  and  the  body  and  limbs  wet  and 
cold.  Hypodermic  stimulation  brought  about  little  or  no  improve- 
ment, and  as  there  was  fortunately  no  vomiting,  I decided  to  try 
stimulating  fluids  by  the  stomach.  Brandy  and  hot  water  was  ad- 
ministered, at  first  a few  drops  at  a time,  but  it  was  soon  given 
freely,  when  it  was  perceived  that  deglutition  was  unimpaired. 
Suffice  it  to  say  that  during  that  night  he  drank  nearly  five  quarts 


SURGICAL  SHOCK. 


253 


of  the  liquid,  though  much  of  the  time  too  weak  to  do  more  than 
turn  his  eyes  appealingly  toward  the  glass.  He  rallied  the  next  day, 
the  temperature  not  running  above  normal.  In  such  cases  the  de- 
sideratum seems  to  be  to  give  the  relaxed  vascular  system  something 
to  contract  upon. 

The  proneness  of  intestinal  lesions  to  produce  shock  is  worthy  of 
attention,  and  so  is  the  deception  in  its  manifestations,  especially 
during  the  period  preceding  dissolution.  It  is  characterized  by  ces- 
sation of  pain  and  sometimes  vomiting,  both  of  which  may  have 
been  persistent,  and  the  patient  becomes  perfectly  easy  and  rational 
and  the  temperature  may  be  normal.  This  is  augural  of  collapse, 
which  is  precipitated  by  operation. 

Case  II. — I was  called  hurriedly  to  the  suburbs,  and  went  pre- 
pared to  operate  for  suspected  intestinal  obstruction.  Found  the 
patient  able  to  sit  up,  feeling  perfectly  comfortable  and  having  a 
normal  temperature.  The  history  as  well  as  condition  upon  exami- 
nation corroborated  the  tentative  diagnosis,  and  after  giving  the 
family  a most  guarded  prognosis  the  patient  was  hastily  prepared 
for  operation.  The  abdomen  was  quickly  opened  and  a quantity  of 
dark  brownish  fluid  came  to  view,  and  instantly  the  patient  was  col- 
lapsed. The  pulse  was  lost  and  the  respiration  consisted  of  an  occa- 
sional gurgling  in  the  throat.  Inversion  and  subcutaneous  stimula- 
tion were  quickly  resorted  to.  A hasty  examination  of  the  abdomen 
revealed  a twist  in  the  small  intestines  lying  in  the  left  hypochon- 
drium.  Below  this  the  gut  was  collapsed  ; above  it,  markedly  dis- 
tended and  five  or  six  feet  of  it  black  and  gangrenous.  Holding 
the  intestines  in  with  hot  sponges,  we  placed  her  in  a warm  bed 
and  surrounded  her  with  artificial  heat  and  continued  the  stimula- 
tion, the  abdominal  wall  being  sutured  in  the  meantime.  She  ral- 
lied slowly,  only  to  die  seven  hours  later,  and  another  death  was 
registered,  hastened  by  operation,  and  yet  preventable  by  earlier 
interference.  Here  life  is  unstable,  and  the  slightest  molestation 
is  sufficient  to  destroy  the  equilibrium,  but  humanity  prompts  us 
to  attempt  to  aid  while  yet  the  fingers  of  our  surgical  instincts 
are  palpating  the  lean  possibilities  that  lie  beneath  the  abdominal 
wall. 

Before  going  further,  I wish  to  wring  the  neck  of  a moss-grown 
delusion.  There  has  been  much  teaching  to  the  effect  that  surgical 
shock  is  in  proportion  to  the  extent  of  the  injury  received.  This  is 


254 


world’s  homoeopathic  congress. 


not  true ; the  extent  of  the  injury  is  no  standard  by  which  to  estimate 
the  intensity  of  the  shock.  It  has  been  said  that  “shock  is  the  measure 
of  the  ability  of  an  individual  to  resist  hurtful  influences  from  with- 
out.” In  a general  way  this  is  good,  but  it  is  far  more  likely  that 
it  is  a measure  of  the  power  of  resistance  possessed  by  certain  organs  or 
structures. 

Case  III.  will  illustrate  my  meaning.  A female  about  forty,  with 
a hydatid  cyst  of  the  liver  as  large  as  a cocoanut.  Being  incapaci- 
tated for  household  duties,  she  desired  an  operation.  The  abdomen 
was  opened  freely,  but  the  cyst  was  non-removable  (en  mass)  because 
firmly  adherent  in  all  directions  save  toward  the  line  of  incision. 
The  intestines  were  pushed  aside  and  a passage  to  the  tumor  main- 
tained by  a firm  packing  of  Iodoform  gauze.  In  spite  of  the  rather 
free  handling  of  the  abdominal  contents  (because  of  a desire  to  ex- 
tirpate if  possible),  there  was  little  or  no  shock  following  the  oper- 
ation. During  the  next  few  days  her  general  condition  improved, 
and  when  sufficient  time  had  elapsed  to  allow  the  bowels  to  be  walled 
off  firmly  the  cyst  was  opened,  and  this  simple  procedure  was  fol- 
lowed by  the  most  pronounced  disturbance  of  all  the  vital  functions. 
The  pulse  was  a mere  thread,  and  running  one  hundred  and  seventy- 
six  to  the  minute,  and  vomiting  was  quite  troublesome.  It  was  evi- 
dent that  her  life  was  greatly  imperilled,  and  I was  quite  doubtful 
as  to  the  issue.  A pint  of  hot  black  coffee  in  the  rectum  and  hypo- 
dermic injections  of  twenty  minims  of  Digitalis  tincture  brought  the 
pulse  down  in  two  hours  to  one  hundred  and  twenty  to  the  minute. 
She  was  then  complaining  of  the  strong  taste  of  the  coffee,  and  was 
tided  over  the  danger  of  the  hour. 

Case  IV.  is  even  more  suggestive.  Mrs.  G.,  set.  51,  suffering 
from  a large  ovarian  cyst.  The  abdomen  was  opened  and  the  tumor, 
weighing  fifty-five  pounds,  removed.  There  was  no  post-operative 
shock,  and  she  laughed  and  joked  with  the  return  of  consciousness. 
A few  days  later  an  enema  of  warm  water  was  given  by  a competent 
nurse,  and  was  promptly  followed  by  profound  shock.  It  was  a 
very  good  picture  of  Travers’s  “ prostration  with  excitement.”  She 
tossed  wildly,  the  respirations  were  quick  and  shallow,  pulse  lost  in 
one  wrist  and  flickering  in  the  other,  skin  clammy  and  cold.  She 
complained  of  nothing  definite,  but  the  face  was  expressive  of  inde- 
scribable anguish.  Arsenicum  3x  was  administered,  and,  aided  by 
sharp  stimulation,  she  made  a good  recovery. 


SURGICAL  SHOCK. 


255 


There  was  a suspicious  flabbiness  about  this  patient  that  I did  not 
like,  and  on  this  account  the  operative  work  was  conducted  with 
all  possible  dispatch  in  order  to  avert  shock.  The  significant  fact, 
however,  is  that  she  could  withstand  a laparotomy  but  not  a rectal 
injection. 

The  examples  showing  that  the  extent  of  the  injury  is  not  in  pro- 
portion to  the  shock  might  easily  be  multiplied.  Opening  a digital 
abscess  has  produced  death ; a slight  blow  upon  the  testicle  or  epi- 
gastrium will  result  in  alarming  depression  of  all  the  vital  forces. 
I have  seen  simple  skin  plantation  for  an  ulcer  of  the  leg  followed 
by  severe  shock,  from  which  the  patient  did  not  recover  for  forty- 
eight  hours. 

In  one  particular,  shock  has  not  been  sufficiently  dwelt  upon, 
either  by  writers,  teachers,  or  operators,  and  that  is,  that  sudden 
cessation  of  life  in  an  individual  does  not,  of  necessity,  mean  cessa- 
tion of  cellular  life  in  the  tissues.  This  is  a legitimate  conclusion, 
and  is  based  upon  investigations  in  physiological  chemistry,  corrob- 
orated by  observations  in  natural  history  and  by  the  experiences  of 
surgical  clinicians.  We  may  say  that,  grossly,  the  animal  life  is 
extinct,  but  histologically  there  is  yet  life  and  function  in  the  tissues. 
This  is  shown  by  the  fact  that  muscle  removed  from  an  animal 
killed  suddenly  will  for  some  time  give  off  carbon  dioxide,  absorb 
oxygen,  and  respond  to  electric  stimuli.  Even  after  rigor  mortis 
has  occurred,  tremblings,  elongations,  and  contractions  have  been 
observed.  After  cross  section  of  a tadpole  the  tail  will  not  only  live 
for  some  time,  but  will  actually  grow  if  allowed  to  remain  in  the 
water  (Vulpian).  For  more  than  twenty-four  hours  after  removal 
from  the  animal  the  pancreas  continues  its  fermentation,  and  the 
liver  also  produces  sugar  slowly  after  death.  Surgeons  know  that 
ends  of  fingers  severed  and  left  upon  the  block  have  been  sent  for 
and  made  to  live  and  grow  upon  their  stumps,  and  that  skin  from 
recent  corpses  has  been  successfully  grafted  upon  the  living. 

Now,  if  the  cellular  structures  of  the  grosser  muscles  and  glands 
thus  continue  their  function,  so  must  the  histological  elements  of  the 
heart  muscle,  or  the  respiratory  apparatus  or  nervous  system. 

How  often  have  we  seen,  upon  the  operating  table,  extinction  of 
life  which  would  be  eternal  were  the  surgeon  to  turn  his  back  to  the 
patient,  and  how  often  the  operation  resolves  itself  into  a question, 
not  of  obtaining  primary  union,  removing  the  tumor,  or  preventing 
a hernia,  but  of  saving  a human  life. 


256 


world’s  homoeopathic  congress. 


The  ghastly  but  tranquil  features  bedewed  with  tomby  mist,  the 
motionless  thorax,  the  pulseless  wrist — all  these  shape  themselves 
into  a picture  with  which  almost  every  surgeon  is  familiar.  In  this 
case  life. is  extinct,  and  from  death  to  dust  the  pathway  is  straight, 
and  all  that  lies  between  the  patient  and  the  grave  is  a death  certifi- 
cate. 

The  following  I take  from  our  hospital  records : 

Case  V. — Patient  60  years  of  age  and  quite  feeble.  Heart,  lungs 
and  kidneys  sound.  Small,  hard  tumor  in  Douglas’s  cul  de  sac, 
which  causes  much  suffering.  Prognosis  very  grave.  Treatment: 
rapid  abdominal  section.  The  growth,  an  ovarian  carcinoma,  lifted, 
and  a ligature  passed  through  the  broad  ligament,  when  it  was  an- 
nounced that  both  respiration  and  circulation  had  stopped.  The 
heart  was  still,  and  not  the  faintest  sign  of  respiratory  effort  could 
be  detected.  The  patient  was  inverted  and  artificial  respiration  re- 
sorted to,  and  was  accompanied  by  hypodermic  stimulation.  For 
some  time  all  effort  seemed  in  vain,  but  slowly  and  faintly  the  pulse 
reappeared,  and  in  about  ten  minutes  she  began  to  breathe  and  life 
was  resumed.  Actual  time  of  operation  a little  over  fifteen  minutes. 

There  is  no  more  tragic  scene  in  human  life  than  sudden  collapse 
on  the  operating  table.  To  know  that  one’s  hand  has  shortened  the 
life  of  a patient,  even  though  doomed  by  some  pre-existing  disease, 
is  a horribly  unwelcome  sensation,  but  to  know  that  resuscitation  is 
possible,  even  when  life  seems  extinct,  robs  operative  surgery  of 
much  of  its  horror. 

While  we  regret  exceedingly  that  with  our  present  knowledge  we 
are  unable  to  give  the  rationale  of  the  phenomena  of  surgical  shock, 
the  great  and  absorbing  question  should  be  its  prophylaxis,  and  I 
believe  there  is  no  other  means  by  which  so  much  can  be  accom- 
plished in  this  direction  as  by  rapid  operating.  Remember,  that 
upon  the  operating  table  it  is  often  impossible  to  differentiate  trau- 
matic shock  from  the  toxic  effects  of  our  anesthetics  ; that  this  period 
is  usually  characterized  by  subnormal  temperature ; that  beyond  a 
certain  point  every  inhalation  of  the  anesthetic  increases  the  depres- 
sion ; that,  at  best,  operative  insensibility  means  the  establishment 
of  a tendency  toward  death,  and  that  the  culmination  of  this  ten- 
dency may  occur  during  one  single  minute  which  is  unnecessarily 
added  to  the  time  of  operation.  This  thought  should  underlie  all 
our  surgical  procedures,  but  I am  afraid  we  may  justly  be  charged 
with  more  or  less  disregard  of  this  principle.  There  is  not  enough 


SURGICAL  SHOCK. 


257 


attention  devoted  to  the  pre-operative  arrangements,  and  conse- 
quently too  much  dilly-dallying  during  the  operation.  How  often 
have  I seen  an  hour  and  more  consumed  in  a simple  trachelorraphy 
which  could  easily  be  accomplished  in  twenty  minutes,  or  even  twelve 
or  fifteen  minutes,  with  competent  assistants.  This  must  not  be  re- 
garded as  a reproach  to  beginners,  but  to  those  who  have  been  ope^ 
rating  long  enough  to  possess  much  better  technique.  I would  not 
be  understood  as  desiring  to  sacrifice  methods  (good  methods)  for  ra- 
pidity, but  that  I plead  for  better  methods  in  order  that  the  opera- 
tive period  may  be  reduced  and  with  it  the  tendency  to  shock. 

The  preparation  of  the  patient  for  a state  of  invalidism,  too,  is  all 
important,  and  this  having  been  done  it  should  be  a part  of  our  pro- 
fessional ritual  to  operate  in  the  morning  whenever  possible.  I am 
well  aware  that  there  are  lesions  that  can  neither  wait  for  preparatory 
treatment  nor  the  morning  hours,  but  the  fact  that  this  is  just  the 
class  most  prone  to  shock  but  shows  the  importance  of  the  above 
observations — when  they  can  be  carried  out. 

Tranquilizing  the  patient’s  mind,  the  administration  of  medicine 
before  operation  and  the  maintenance  of  proper  temperature  during 
the  operation  are  too  familiar  to  bear  comment. 

Nineteen  years  ago  it  was  taught  that  inflammation  and  suppura- 
tion were  reduced  to  the  minimum,  and  that  they  were  the  inevit- 
able accompaniments  of  operative  surgery.  Let  us  hope  that  our 
present  ideas  may  be  as  abruptly  changed,  and  that  shock  may  yet 
be  dispelled  from  the  list  of  surgical  complications.  At  present, 
however,  it  must  be  admitted  that  shock  cannot  be  positively  averted 
and  that  the  best  the  surgeon  can  do  is  to  equip  himself  for  the  com- 
prehensive grasp  of  critical  emergencies. 

Collapse  on  the  table  has  been  sufficiently  dwelt  upon  already.  I 
might  add  that  in  two  cases  I fancied  I obtained  relief  by  Maass’ 
method  of  rapid  and  rhythmic  compression  of  cardiac  region,  but  I 
cannot  speak  with  any  degree  of  positiveness  of  this  method.  In 
one  case  I obtained  an  abrupt  renewal  of  respiration  by  anal  dilata- 
tion. It  has  failed  me  in  many  others.  In  post-operative  shock 
we  can  find  a place  for  our  Homoeopathic  remedies,  and  while  I 
never  omit  the  general  measures  deemed  necessary  or  at  least  essen- 
tial, I have  acquired  an  immense  amount  of  faith  in  Camphora  (low, 
of  course).  I would  give  more  for  this  drug  than  for  all  the  rest 
of  our  Materia  Medica.  Arsenic  is  good,  and  so  is  Veratrum  alb., 

17 


258 


world’s  homoeopathic  congress. 


but  often  the  vitality  is  so  low  that  the  stomach  is  inactive  and  we 
can  obtain  no  results  by  this  route. 

In  such  cases  a favorite  resort  with  me  is  enemata  of  warm  and 
strong  black  coffee;  from  a half  pint  to  a quart,  and  repeated  as  fast 
as  it  is  absorbed  or  till  reaction  is  secured.  Dr.  Van  Lennep  has 
obtained  good  results  from  enemata  of  whiskey  and  Valerianate  of 
ammonia — a teaspoonful  of  each. 

After  all,  our  main  reliance  is  upon  cardiac  and  respiratory  stimu- 
lants, artificial  respiration  and  artificial  heat.  Copious  intra-venous 
or  intra-cellular  saline  injections  will  always  be  remembered,  especi- 
ally if  there  has  been  much  haemorrhage. 

The  most  manifest  indications  point,  with  imperative  necessity,  to 
tiding  the  patient  over  the  perilous  but  brief  period  and  our  success 
in  obviating  the  tendency  to  death  will  be  in  proportion  to  our  ability 
to  distinguish  the  direction  from  which  death  is  threatening. 

Discussion. 

I.  T.  Talbot,  M.D. : The  subject  of  shock  is  one  of  great  interest 
to  every  surgeon.  First,  because  it  may  render  a simple  operation 
fatal,  or  in  grave  operations,  suddenly  turn  the  surgeon’s  victory  into 
defeat ; and  second,  because  he  can  never  know  beforehand  the 
liability  of  the  patient  to  shock,  or  the  extent  to  which  it  may  attain. 

This  paper  of  Dr.  Macdonald’s  suggests  certain  points  of  great 
importance  to  the  surgeon,  and  among  these  the  surgical  character 
of  the  affection.  We  all  appreciate  the  great  difference  in  which  dif- 
ferent persons  are  affected  by  syncope  or  fainting.  Some  may  with- 
stand the  most  violent  injuries  and  yet  retain  their  consciousness, 
while  others  faint  on  slight  exhibitions  of  pain,  or  the  sight  of  blood, 
or  even  the  thought  of  injuries;  and  the  effect  upon  the  circulation, 
even  to  the  almost  complete  cessation  of  the  pulse ; the  pallor ; the 
cold,  clammy  sweat ; and  the  entire  unconsciousness,  are  familiar  to 
us  all.  The  symptoms,  except  in  degree,  are  quite  similar  to  those 
of  shock,  and  it  is  difficult  to  determine  beforehand  the  patient  most 
liable  to  be  affected  by  it.  As  a rule  we  expect  it  more  in  those  of 
a highly  nervous,  active,  or  sanguine  temperament,  while  those  of  a 
plethoric  or  sluggish  condition  are  more  exempt.  Yet  even  this  does 
not  always  hold  true. 

Under  my  care  a strong,  highly  plethoric  man,  who  felt  most  fully 
able  to  go  through  the  operation  without  ether,  yet  finally  thought 
it  best  to  take  it  for  opening  a palmar  abscess,  took  the  ether  very 
favorably  with  little  or  no  struggling,  and  after  the  operation  had 
been  performed,  and  he  had  partially  rallied  from  the  ether,  sud- 


SURGICAL  SHOCK. 


259 


denly  went  into  collapse  from  which  it  was  quite  difficult  to  resusci- 
tate him. 

On  the  other  hand,  we  have  all  met  most  nervous  and  excitable 
men  and  women  who  have  gone  through  the  severest  and  most  long 
continued  operation  without  any  symptoms  of  shock  or  collapse. 
That  the  mind  may  affect  the  patient  unfavorably  I believe  to  be 
quite  certain,  and  in  looking  over  my  notes  I find  several  cases  in 
which  the  patient  had  previously  exhibited  great  dread  of  an  opera- 
tion feeling  quite  certain  that  she  would  not  recover,  in  which 
although  in  no  case  fatal  collapse  occurred,  yet  it  required  during 
the  operation  and  afterwards,  careful  watchfulness  to  relieve  the  first 
apparent  symptoms. 

In  cases,  then,  of  persons  subject  to  easy  syncope,  I think  it  of 
great  importance  from  the  first  to  see  that  as  far  as  possible  their 
systems  are  in  good  condition  physically,  that  they  should  have  previ- 
ously quiet  rest,  good  food,  and  cheerful  surroundings  ; that  how- 
ever much  their  friends,  or  the  family  may  be  informed  of  the  pos- 
sible dangers,  the  patient  should  only  look  to  the  most  hopeful  and 
encouraging  prospects. 

I fully  approve  of  the  use  of  Camphor  as  a stimulant,  as  suggested 
by  Dr.  McDonald,  yet  the  most  rapid  and  successful  measure  1 have 
ever  adopted  has  been  the  hypodermic  injection  of  the  finest  quality 
of  brandy.  The  motion  of  the  patient,  friction,  and  encouraging 
words  on  the  first  appearance  of  consciousness,  will  do  much  to 
speedily  restore  the  patient. 

L.  H.  Willard,  M.D.:  We  have  all  listened  to  Dr.  Macdonald’s 
paper  on  “ Surgical  Shock”  with  interest  and  attention  both  because 
the  subject  is  of  great  importance  and  because  of  its  able  presenta- 
tion. The  subject  is  of  especial  interest  as  the  opinions  of  surgeons 
differ  widely  not  only  as  to  treatment  but  as  to  the  proper  time  to 
operate  after  an  accident  involving  serious  shock.  I wish  to  discuss 
briefly  this  latter  phase  of  the  subject.  Before  doing  so,  however, 
let  me  present  in  a few  words  our  method  of  treating  shock  at  the 
Pittsburgh  Homoeopathic  Hospital,  a method  which  is  not  new  in 
any  essential  particular,  but  which  has  rendered  excellent  results. 

Our  hospital,  being  in  the  vicinity  of  many  mills  and  manufacto- 
ries, and  having  a railroad  patronage,  we  are  familiar  with  all  varie- 
ties of  shock  from  the  slightest  nervous  depression  or  exaltation  to 
the  most  profound  collapse.  A case  of  serious  injury  being  received 
is  at  once  taken  to  the  operating-room,  if  the  injury  requires  opera- 
tive treatment,  and  the  surgeons  of  the  staff  being  sent  for,  vigorous 
restorative  measures  are  begun  and  kept  up  continuously. 

These  consist  of,  briefly: 

1.  Control  of  haemorrhage,  by  tourniquet  or  ligature. 

2.  Heat — hot  water  bags,  etc. 

3.  Stimulation — by  means  of  brandy,  Digitalis,  or  the  alkaloid  by 


260 


world’s  homceopathic  congress. 


hypodermic  injection,  Sparteine,  Strychnine,  Atropine.  But  espe- 
cially have  we  found  efficacious  a mixture  of  brandy,  ether  and 
spirits  of  Camphor,  equal  parts,  which  administered  by  hypodermic 
injection,  seems  to  have  a salutary  effect  on  the  circulation  in  the 
state  of  collapse  incidental  to  profound  shock. 

If  there  has  been  loss  of  blood  we  use  hot  water  by  mouth  or 
rectum,  and  other  ordinary  means,  such  as  bandaging  the  limbs,  de- 
pressing the  head  and  shoulders,  etc. — Rectal  injections  of  warm 
water  seem  to  have  been  especially  beneficial  in  many  cases  even 
where  there  was  no  appreciable  loss  of  blood,  having  apparently  a 
stimulating  effect  on  the  circulation  and  promoting  the  freer  action 
of  the  kidneys  which  are  especially  prone  to  be  affected. 

The  addition  of  a little  salt  facilitates  absorption  by  raising  the 
specific  gravity  more  nearly  to  that  of  the  blood.  Our  custom  is  to 
inject  4-8  ounces  every  1-3  hours  depending  upon  the  necessities  of 
the  case.  If  the  sphincters  are  lax  a smaller  quantity  is  used. 
Many  cases  of  serious  and  seemingly  fatal  shock  have  been  saved,  I 
believe,  by  this  means  more  than  by  any  other.  As  instances  in 
point  I might  cite  two  or  three  recent  cases  of  crushed  limbs  requir- 
ing double  amputation,  one  case  of  leg  and  thigh  amputation  having 
been  brought  ten  miles  to  the  hospital  on  the  guard  of  an  engine 
after  a delay  of  two  or  three  hours  from  the  time  of  the  accident.  In 
this  instance  amputation  was  performed  at  once  and  restorative 
measures  were  kept  up  for  many  hours  after.  The  state  of  a patient’s 
vitality  is  indicated,  of  course,  by  the  condition  of  the  pulse  and 
respiration,  and  by  the  temperature.  Operative  measures,  if  not  of 
immediate  necessity,  are  delayed  only  long  enough  for  the  pulse,  res- 
piration and  temperature  to  indicate  a beginning  reaction — not  until 
full  reaction  has  taken  place.  And  it  is  in  this  particular  that  I 
wish  to  hazard  an  opinion  at  variance  with  the  generally  accepted 
belief. 

When  I have  a patient  suffering  from  shock  caused  by  an  acci- 
dent, the  first  thing  necessary,  it  seems  to  me,  is  to  relieve  the  de- 
pression, sustain  his  strength,  and  perform  any  operation  that  may 
be  necessary  as  soon  as  possible  and  as  quickly  as  can  be  done.  This 
we  know  is  the  generally  accepted  belief  of  a great  many  surgeons, 
who  give  as  reasons  for  such  procedure  that  an  operation,  when  the 
vitality  is  so  low,  would  surely  be  fatal.  No  one  who  has  waited 
patiently  for  his  patient  to  recover  fully  from  shock  can  help  but 
feel  that  this  waiting  should  be  avoided.  It  is  certain  that  the  older 
surgeons,  in  times  before  anaesthesia  was  known,  were  right  in  laying 
down  these  rules  in  regard  to  shock,  for  in  those  times  and  under 
such  conditions  it  would  have  been  fatal  to  operate  when  the  vitality 
of  their  patients  was  so  low,  thus  intensifying  the  shock.  But  now, 
when  we  have  anaesthetics  to  deaden  the  pain  and  even  to  improve 
the  heart  action  (as  it  seems  to  do  at  times),  and  Camphor  and  other 


SURGICAL  SHOCK. 


261 


remedies  to  assist  in  stimulating  the  circulation,  I cannot  think  it 
necessary  to  wait  until  full  reaction  has  taken  place  before  oper- 
ating. 

By  so  doing  we  nearly  always  produce  a second  shock,  which  may 
throw  the  patient  into  a condition  beyond  any  help  we  may  be  able 
to  render.  In  a given  accident — a patient  with  crushed  arms  or 
legs,  for  example — tourniquets  are  applied  to  the  part  to  prevent 
haemorrhage;  and  they  not  only  control  the  haemorrhage,  but  they 
also  cut  off  the  entire  circulation  of  the  part.  The  nerves  are  pressed 
upon,  and,  in  fact,  the  limb  below  the  tourniquet  is  for  the  time  being 
practically  dead,  and  remains  so  until  after  the  operation.  Now  it 
seems  to  me  that  the  mere  fact  of  an  amputation  when  the  patient 
is  in  a condition  of  shock,  can  do  little  harm  to  a part  virtually 
dead.  Mangled  tissues  are  generally  cut  off  and  splintered  bones 
removed.  It  is  but  little  more  to  take  away  the  entire  crushed 
mass,  sawing  off  the  bone,  and  completing  the  necessary  dressings, 
thus  ending  at  once  the  pain  and  irritation  caused  by  a mangled 
limb. 

We  are  now  speaking  of  crushed  limbs  and  of  operations  done  in 
the  quickest  possible  manner,  care  being  taken,  of  course,  to  insure 
complete  antisepsis,  and  the  pulse  and  respiration  being  sustained  by 
all  necessary  means.  There  are  at  times  cases  requiring  long  and 
tedious  operative  interference  where  it  would  be  advisable  to  wait 
until  the  patient’s  condition  shall  better  enable  him  to  withstand  such 
a trial  of  his  vitality. 

Many  cases,  such  as  abdominal  injuries,  with  protrusion  or  lacer- 
ation of  any  of  the  viscera,  require  immediate  surgical  attention. 
Such  cases  do  not  seem  to  be  markedly  affected  either  by  the  use  of 
an  anaesthetic  or  by  the  operation  itself,  so  that  even  in  cases  not  re- 
quiring immediate  attention  it  is  my  custom  to  operate  at  once  if  the 
pulse  shows  any  sign  of  returning  vitality,  rather  than  submit  the 
patient  to  the  risk  of  a second  shock. 

And  in  this  line  let  me  say  that  I believe  the  anaesthetic,  especially 
chloroform,  to  have  rather  a stimulating  than  a depressing  effect  on 
the  circulation  in  such  instances. 

The  Chairman  : The  subject  is  now  open  for  general  discussion. 

Dr.  Boothby  : Mr.  President , it  seems  to  me  that  it  has  not  been 
made  clear  to  us  just  what  is  considered  surgical  shock.  We  must 
distinguish  between  surgical  shock  and  the  shock  from  an  injury, 
as  has  been  spoken  about  in  the  last  one  of  these  discussions.  In 
regard  to  surgical  shocks  proper,  we  have  to  distinguish  between  a 
true  shock  and  the  case  that  Dr.  Talbot  referred  to.  My  opinion  is 
that  a surgical  shock  is  a very  rare  occurrence.  In  the  first  place,  I 
believe  that  a great  cause  of  surgical  shock  is  having  the  room  too 
full,  or  the  patient  entirely  denuded  over  a large  portion  of  the  body, 
and  that  the  chill  that  comes  from  that  is  the  cause  of  a great  deal 


262 


world’s  homceopathic  congress. 


of  the  shock.  I speak  from  my  own  experience  and  from  the  experi- 
ence of  my  brothers,  Packard  and  Emerson.  We  have  almost  never 
had  a case  of  true  surgical  shock.  We  have  done  our  operating  in 
a very  warm  room,  writh  a temperature  as  high  as  85°.  I have 
almost  had  it  90°,  and  while  it  is  uncomfortable  to  the  operator,  and 
very  uncomfortable  to  those  looking  on,  it  is  decidedly  beneficial  for 
the  patient.  In  the  case  of  No.  1 in  the  original  paper,  while  it  is 
distinctly  said  that  there  was  comparatively  little  haemorrhage,  I 
believe  that  the  collapse  was  due  to  the  haemorrhage.  I don’t  see 
how  an  operation  can  be  made  without  considerable  haemorrhage  if 
the  patient  is  susceptible  to  fainting.  In  Cases  2 and  3 I have  no 
doubt  the  septic  condition  of  the  system,  and  the  changes  the  opera- 
tor made  in  the  anaesthetic,  caused  the  trouble.  I want  to  say  one 
word  in  regard  to  the  suggestion  in  the  paper  that  the  operation 
should  be  made  as  rapidly  as  possible.  Perhaps  I wouldn’t  agree 
with  Dr.  Packard,  for  he  operates  very  rapidly.  I do  not  and  can- 
not. I take  a great  deal  of  time  for  my  operations.  I believe  if 
you  are  careful  with  your  anaesthetics,  and  don’t  give  too  much,  and 
keep  your  patient  just  over  the  line  and  no  further,  you  will  have 
no  trouble  to  keep  him  under  the  influence  of  ether.  In  regard  to 
the  administration  of  coffee,  I hope  you  won’t  use  it.  I have  no 
argument  in  its  favor,  and  I wouldn’t  use  it. 

W.  F.  Knoll,  M.D. : This  subject  of  shock  after  operation  or  in- 
jury is  a very  important  one  to  any  surgeon  who  has  done  work  a 
great  while  in  public  hospitals  or  railways.  When  such  a complica- 
tion arises  in  the  course  of  an  operation,  it  always  goes  far  in  the 
mind  of  our  surgeons,  and  they  have  tried  to  find  out  its  causes  and 
what  shock  is.  And  after  careful  investigation  of  the  subject,  and 
from  pathological  observation,  I have  concluded  that  a shock  is  a 
sudden  suspension  of  nerve  forces.  Now,  shock  is  produced  in 
one  patient  very  easily  and  in  another  not  so  easily.  I have  seen  it 
caused  from  dilatation  of  the  rectum.  I have  seen  shock  from  pull- 
ing a tooth.  I have  seen  shock  from  a man  simply  washing  out  his 
ear.  I have  seen  a patient  upon  whom  I have  amputated  three 
limbs  of  the  body,  not  affected  a particle  by  shock.  I have  seen  a 
patient  at  the  age  of  90  upon  whom  I have  made  an  operation 
where  there  was  scarcely  any  variation  in  the  pulse.  You  never 
can  say  when  a patient  is  going  to  have  shock ; it  depends  altogether 
upon  the  nervous  organization  of  the  patient,  and  taking  that  as  a 
basis,  what  is  the  term  “ shock?”  Take  your  patient  as  you  find 
him.  What  do  you  see?  You  find  a slow  or  a rapid  pulse.  You 
see  that  respiration  is  superficial.  You  have  general  relaxation  and 
sometimes  a discharge  of  urine.  There  is  complete  relaxation,  the 
nervous  system  has  been  so  profoundly  affected  that  you  have  mo- 
mentary paralysis.  What  you  want  to  get  at  is  to  preserve  the  tem- 
perature of  the  body.  Heat  is  an  important  thing;  it  is  one  of  the 


SURGICAL  SHOCK. 


263 


main  things.  And  in  the  second  place,  you  want  to  give  a medicine 
which  in  a certain  measure  will  restore  the  operation  of  the  brain 
and  the  nerve  centres,  and  the  best  thing  is  Strychnine.  We  have 
received  from  the  hospitals  some  profound  results  from  hypodermic 
injections  of  grain  of  Strychnine.  I believe  in  something  that 
will  have  a stimulating  effect  also  upon  the  circulation  and  upon  the 
brain,  and  for  that  I believe  Camphor  is  the  best  remedy.  I believe 
it  is  a very  good  thing  to  place  the  head  below  the  rest  of  the  body. 
I believe  hypodermic  injections  of  some  stimulant,  especially  brandy, 
and  the  flushing  of  the  bowels  with  warm  water  with  whiskey  in  it, 
is  a very  good  thing.  If  you  can  find  out  the  peculiarities  of  the 
patient,  you  can  very  often  prevent  shock.  If  you  have  a patient 
that  is  of  a very  highly  nervous  organization,  by  preparing  the  mind 
you  can  stop  a great  many  complications  that  may  follow  operation. 
Now,  the  treatment  that  wTe  have  used  with  so  much  success  can  be 
summed  up  in  this  way : First,  prepare  your  patients  for  the  opera- 
tion mentally  and  every  other  way ; assure  them  they  are  going 
through  their  operation  nicely ; don’t  have  a great  struggle  with 
them  under  anaesthetics.  In  the  second  place,  if  shock  takes  place, 
keep  up  the  temperature  of  the  body  at  once.  In  the  third  place, 
use  some  hypodermic  injection  like  Strychnine;  in  the  next  place, 
give  something  that  will  stimulate  the  heart’s  action. 

S.  B.  Parsons,  M.D. : Perhaps  I am  laboring  under  a wrong  im- 
pression but  it  strikes  me  that  Dr.  Macdonald’s  paper  referred  to 
shocks  from  accidents,  more  particularly  than  shocks  from  operative 
measures;  therefore  shocks  from  operative  measures  are  not  to  be 
discussed  at  this  time.  There  is  one  point  that  has  absolutely  been 
overlooked  in  the  paper  and  discussion — one  that  has  not  been 
touched  upon,  yet  one  that  has  a more  direct  effect  upon  the  patient 
than  all  the  other  matters  that  have  been  spoken  of,  and  that  is  re- 
flex action.  We  all  know  that  sudden  excitement  of  the  sensory 
nerves  will  disturb  the  heart’s  action  and  may  arrest  its  movement. 
If  the  patient  is  undergoing  the  operation  and  has  only  been  parti- 
ally anaesthetized  when  the  operation  began,  or  when  he  is  partially 
under  it  and  it  has  been  continued  for  some  little  time,  then  the 
sensory  nerves  will  reflex  painfully  and  affect  the  heart’s  action,  and 
its  inhibitory  movement.  That  is  why  we  see  sudden  collapse  dur- 
ing operations.  There  is  another  reason  and  that  is  the  vitality  of 
the  patient.  The  energy  is  so  far  below  par  that  they  are  not  able 
to  stand  both  the  shock  and  the  anaesthetic  without  great  stimulation. 
The  heart  is  the  thing  to  be  looked  after,  not  the  warmth  of  the 
body  ; it  is  the  heart.  You  have  your  collapse  coming  on  suddenly  ; 
it  is  the  action  of  the  reflex  movement  upon  the  heart.  That  is  all 
I have  to  say. 

The  Chairman  : If  there  is  none  other  Dr.  Macdonald  will  have 
an  opportunity  of  saying  anything  he  may  desire  in  closing  the  dis- 
cussion. 


264 


world’s  homceopathic  congress. 


Dr.  Macdonald.  Mr.  Chairman , Members  of  the  Congress:  I 
will  keep  you  just  a moment.  Something  was  said  about  Camphor. 
I don’t  want  to  be  misunderstood  as  to  the  use  of  Camphor  or  any 
other  internal  remedy,  or  as  excluding  stimulation.  I believe  hypo- 
dermic stimulation  of  importance.  Something  has  been  said  with 
reference  to  chloroform  as  a heart  stimulant  in  cases  of  shock.  My 
experience  has  been  very  different ; where  I have  used  chloroform 
and  the  heart  has  become  dangerously  depressed  I immediately  use 
ether  as  a heart  stimulant.  I think  that  ether  is  a better  heart  stimu- 
lant than  chloroform.  I say  I had  some  cases  that  collapsed.  I 
want  to  say  that  all  these  cases  were  anaesthetized.  You  have  been 
warned  against  the  use  of  coffee.  I admit  in  Boston  there  is  a well- 
known  way  of  using  coffee,  which  is  much  better  than  putting  it 
into  the  rectum.  My  experience  is,  as  far  as  aesthetic  matters  go,  it 
is  better  not  to  give  it  in  that  way.  This  is  a matter  of  human  life, 
and  I don’t  think  of  small  matters  like  that.  I am  looking  after 
the  patient  and  human  life.  One  of  the  cases  I reported  was  said 
to  have  been  influenced  by  septicaemia.  It  was  charged  by  Dr. 
Boothby  with  having  caused  the  collapse  ; that  it  was  probably  due 
to  septicaemia,  and  that  it  was  a dangerous  operation.  Let  me  say 
that  it  was  a case  of  either  performing  the  operation  or  losing  the 
patient.  So  I felt  that  the  operation  was  justifiable.  But  I don’t 
want  to  be  knocked  down  by  the  chairman,  because  he  has  an  old 
grudge  against  me,  and  I will  stop  now. 

Dr.  Biggar  : What  objection  is  there  to  preparing  the  patient 
and  anticipating  the  shock  by  giving  a small  quantity  of  whiskey  or 
a hypodermic  injection  in  proper  quantities  in  the  proper  time? 

Dr.  Macdonald  : I don’t  know  of  any  objection  to  it.  In  my 
paper  I spoke  of  the  use  of  medication  before  operation.  It  seemed 
to  me  so  common  and  so  ordinary  that  it  didn’t  require  any  comment 
at  all.  I use  coffee,  strychnine  and  brandy  ; in  many  cases  I deem 
it  advisable  to  use  stimulants  of  alcoholic  nature. 

Dr.  Nielson,  of  Michigan : What  shall  we  do  with  that  large 
and  growing  class  of  people  who  object  'to  alcoholic  stimulants  in 
any  shape  or  form. 

Dr.  Macdonald:  From  my  acquaintance  with  the  members  of 
this  Congress  I think  we  should  have  to  go  outside  of  it  to  find 
them. 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


265 


A CONTRIBUTION  TO  THORACIC  SURGERY. 

By  Henry  L.  Obetz,  M.D.,  Detroit,  Mich. 


In  the  wonderful  progress  of  modern  surgery,  every  anatomical 
field  has  been  worked  over  until  at  this  time  there  remains  but  one 
where  the  principles  are  undeveloped  and  where  experimental  re- 
search and  increased  clinical  experience  must  develop  new  paths 
before  we  can  relieve  humanity  of  many  ills,  cured  in  other  parts  of 
the  human  body  by  local  operations,  and  which,  reasoning  from  an- 
alogy, should  be  cured  by  like  means  in  this. 

The  field  is  that  of  “Thoracic  Surgery.” 

Every  accessible  point  of  the  cranium  has  been  invaded,  the  outer 
bony  covering  ignored,  and  found  not  to  be  in  the  way  of  reaching 
deeper  parts;  exploration  of  the  brain  finds  it  tolerant,  abscesses  can 
be  aspirated  or  incised  and  drained;  new  formations,  not  only  on  its 
surface  but  in  its  substance,  can  be  safely  removed  ; convolutions  of 
the  brain  found  diseased  or  abnormally  irritated  have  been  boldly 
excised,  and  the  patients  not  only  live  but  return  to  the  walks  of 
life  restored  to  health  and  usefulness. 

It  was  found  that  certain  diseases  of  the  kidney  were  amenable  to 
operative  influence,  but  this  did  not  cure  certain  other  supposedly 
incurable  conditions  which,  after  great  suffering  on  the  part  of  the 
patient,  always  ended  in  death.  The  new  fact  that  a kidney  could 
be  removed  and  the  other  could  and  would  do  its  work,  broadened 
the  regional  operative  field  until  now  tuberculosis  of  the  kidney  can 
be  cured  with  relative  certainty  by  its  excision. 

A single  ovarian  cyst  successfully  removed  by  abdominal  section 
demonstrated  the  feasibility  of  attacking  an  intra-peritoneal  disease. 
From  this  small  beginning  has  grown  up  the  great  field  of  abdominal 
surgery.  The  death-rate  was  high  at  first,  but  as  compared  with  the 
death-rate  of  the  diseases  sought  to  be  cured  meant  the  saving  of 
thousands  of  lives  which  would  have  been  lost  or  doomed  to  hopeless 
invalidism.  First  one,  then  both  ovaries,  then  the  uterus  and  ova- 


266 


world’s  homoeopathic  congress. 


ries  were  removed,  and  the  operations  perfected  and  classed  among 
remedies  for  the  relief  of  disease. 

Next,  the  liver,  stomach,  spleen  and  intestines  came  in  for  their 
share  of  attention,  until  now,  given  a condition  affecting  any  abdomi- 
nal viscus  and  we  have  the  remedy  at  hand,  in  a carefully  planned 
operation,  depending  on  experimental  research  and  clinical  experi- 
ence of  the  broadest  and  most  elaborate  kind.  I might  go  on  into 
other  fields,  all  of  which  have  been  as  carefully  worked  and  the  re- 
sults recorded  for  the  benefit  of  the  profession  present  and  future. 

Regional  surgery,  then,  is  in  its  infancy  when  applied  to  the  tho- 
rax, but  I feel  confident  that  the  day  is  not  far  distant  when  we  shall 
see  many  supposedly  incurable  affections  of  the  thoracic  viscera  cured 
by  practical  operations,  based  on  sound  principles,  to  be  established 
in  the  near  future. 

The  need  for  pushing  operative  work  to  a greater  degree  of  perfec- 
tion here  is  very  great,  and  thousands  of  lives,  now  lost,  may,  with 
a material  advance,  be  saved.  Experience  in  general  teaches  us  that 
tuberculosis  is  for  the  most  part  a local  disease  in  its  first  stages,  and 
can  be  eradicated  by  radical  local  treatment.  If  by  any  possible 
means  we  ever  arrive  at  a point  where  the  ravages  of  this  disehse  can 
be  stayed  by  surgical  means  when  it  attacks  the  lungs,  the  saving  of 
human  life  resulting  will  be  greater  than  from  any  other  single  ope- 
ration known  to  surgery. 

Many  other  conditions  here  demand  mechanical  interference,  and 
the  principles  governing  some  of  the  operations,  and  the  operative 
technique,  is  more  or  less  definitely  established  at  this  time ; but  no 
operation  here  has  the  same  wealth  of  experimental  observation  and 
clinical  experience  based  on  it  as  in  the  examples  cited  in  other  re- 
gions amenable  to  surgical  treatment. 

The  reasons  for  the  hesitancy  and  delay  in  attempting  surgical  in- 
terference in  this  region  are  partly  anatomical  and  partly  clinical. 

The  structural  difficulties  are  to  be  found  in  the  conformation  and 
make-up  of  the  chest.  In  the  inverted  cone  containing  the  vital 
organs,  we  have  the  flexible  yet  practically  immovable  spinal  column 
as  a centre,  flanked  on  either  side  by  the  ribs  and  their  attached 
muscles;  the  ribs  are  elastic  and  movable  in  some  respects,  firm  and 
resistant  in  others;  so  imbedded  in  the  thin  muscles  attached  to 
them  as  to  be  a part  of  a general  whole,  leaving  the  chest  cavity  but 
thinly  covered  when  removed.  If  the  ribs  are  not  removed  they 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


267 


prevent  collapse  of  the  chest- wall  and  the  physiological  rest  so  essen- 
tial to  the  healing  of  any  area  after  operation. 

Clinical  reasons  are  found  in  the  insidious  onset  of  many  chest 
affections,  the  extreme  difficulty  of  locating  and  determining  the 
first  stages  of  the  formation  of  abscess,  and  of  determining  the  exact 
location  and  extent  of  the  diseased  area. 

Patients  having  pulmonary  tuberculosis  are,  as  a class,  most  hope- 
ful, and  underestimate  the  dangers  confronting  them  ; they  have  no 
fear  of  death  as  a rule,  though  threatened  with  impending  dissolu- 
tion, and  insist  that  they  are  better,  and  have  great  hope  of  cure  as 
soon  as  this  or  that  refractory  organ,  usually  the  stomach  or  liver, 
shall  have  been  toned  up  and  made  to  do  its  duty. 

Operations  on  the  chest  are  the  most  formidable  ones  the  surgeon 
is  called  on  to  do.  The  stoutest-hearted  observer  of  such  an  opera- 
tion is  appalled  at  the  struggles  of  the  patient  for  breath,  at  the  con- 
vulsive cough  caused  by  the  reflex  irritation  resulting  from  the  injury 
inflicted  on  the  structures  of  the  chest-wall,  or  lung. 

Blood  is  blown  through  the  opening  into  the  pleural  cavity  by 
the  convulsive  efforts  of  the  patient,  and  the  operator  and  assistants 
are  covered  with  its  crimson  spray.  Syncope  may  threaten  and  the 
deathly  pallor  but  too  plainly  indicate  the  presence  of  the  grim  de- 
stroyer. Again,  fluids  are  drawn  or  forced  into  the  trachea  and  the 
livid,  bloated  countenance  and  cessation  of  pulse  and  respiration  show 
that  death  is  threatened  from  asphyxia.  In  no  other  class  of  cases 
have  surgeons  been  called  on  to  record  so  many  sudden  and  unac- 
countable deaths,  from  slight  operations. 

No  wonder  that  patients  shrink  from  such  measures  even  when 
life  is  in  danger  and  the  procedure  is  a necessity,  nor  is  it  a wonder 
that  the  medical  adviser  hesitates,  and  is  loth  to  urge  operative 
measures  in  chest  affections,  as  long  as  delay  seems  possible.  It  is 
this  very  delay,  the  putting  off  until  the  very  last  chance  of  the 
patient  is  gone,  which  gives  the  high  death-rate  to  the  operation  of 
dernier  ressort  in  this  region. 

Experience  and  experimental  observation  teach  that  aside  from 
the  effects  on  the  lung  caused  by  free  air  pressure,  the  size  of  a 
wound  in  the  chest  makes  no  difference.  Thus  after  a small  opening 
in  the  chest- wall  the  lung  may  not  collapse;  if  the  opening  in  the 
chest-wall  is  larger  than  the  opening  in  the  trachea  of  the  patient 
the  lung  does  collapse. 


268 


world’s  homoeopath ic  congress. 


It  is  also  a fact  borne  out  experimentally  and  by  the  history  of 
accidental  injuries  of  the  chest,  that  both  pleural  cavities  may  be 
opened  at  the  same  time  without  ending  in  the  death  of  the  person 
so  injured.  We  have  numerous  examples  of  this  in  the  history  of 
gunshot-wounds,  both  in  civil  and  military  practice. 

A case  of  this  kind  came  under  my  observation  in  which  a pistol- 
bullet  of  large  size  entered  the  chest  under  one  armpit  and  came  out 
at  the  same  point  on  the  opposite  side,  completely  traversing  both 
pleural  cavities  and  by  some  means  missing  the  great  vessels  of  the 
chest.  The  patient  had  abundant  evidence  of  injury  to  the  lungs 
followed  by  some  traumatic  pneumonia  but  after  a time  recovered 
and  since  has  been  perfectly  well. 

South,  in  his  notes  in  Chelius’s  Surgery  relates  the  case  of  a man 
pinioned  by  the  shaft  of  a chaise,  which  was  thrust  entirely  through 
both  pleural  cavities  and  after  a severe  illness  he  recovered  and 
lived  ten  years. 

He  further  quotes  a conclusive  case  of  a gun-shot  injury  from 
Home,  who  relates  the  case  of  a man  shot  through  both  lungs,  who 
recovered  and  lived  thirty-two  years.  After  death,  post-mortem 
examination  verified  the  fact  of  the  wound  of  both  lungs  by  the 
bullet. 

In  part  first  of  the  Surgical  History  of  the  Late  War,  we  have  a 
number  of  such  cases  reported  but  it  is  unnecessary  to  repeat  them 
here.  I only  wish  to  give  evidence  of  the  single  fact  that  both 
pleural  cavities  can  be  opened  at  the  same  time,  and  both  lungs 
wounded  as  well,  and  yet  the  patient  recover. 

Parts  of  the  lungs  have  been  removed  after  injury  of  the  chest- 
wall  leaving  a hernial  protrusion  of  the  lung. 

I refer  to  these  cases,  that  we  may  study  the  methods  by  which 
this  was  done  and  the  results  which  followed. 

In  his  chapter  on  wounds  of  the  lungs,  I find  the  following  cases 
cited  by  Cooper.  See  Dictionary , p.  485.  He  says,  the  protrusion 
of  a portion  of  the  lungs,  in  consequence  of  wounds  penetrating  the 
chest,  is  a very  unusual  case ; but  there  are  some  instances  recorded 
by  writers.  Schenekius  relates  an  example  taken  from  Rolandus.  He 
was  called  to  a man  who  had  been  wounded  in  the  thorax  six  days 
before.  A portion  of  the  lung  protruded  in  a state  of  mortification. 
Rolandus  extirpated  it,  and  the  patient  soon  recovered. 

Tulpius  has  recorded  a similar  fact.  A man  received  an  exten- 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


269 


sive  wound  just  below  his  left  nipple.  His  naturally  gay  disposi- 
tion led  him  to  neglect  the  injury  ; and  on  the  third  day  a piece  of  the 
lungs  three  inches  in  length  protruded.  The  patient  went  to  Ams- 
terdam which  was  two  days’  journey,  for  the  purpose  of  receiving  aid 
in  one  of  the  hospitals  of  that  city.  The  protruded  piece  of  lung 
which  was  already  mortifying,  was  tied  and  cut  off  with  scissors.  It 
weighed  three  ounces.  The  wound  healed  in  a fortnight,  and  the 
patient  experienced  no  complaint  afterwards,  except  a slight  cough, 
with  which  he  was  occasionally  troubled. 

He  survived  the  accident  six  years,  leading  a wandering  drunken 
life.  After  death  nothing  particular  was  observed  in  the  thorax, 
except  that  the  lungs  had  become  adherent  to  the  pleura,  in  the  situ- 
ation of  the  wound. 

Hildanus  related  another  case ; a man  was  wounded  with  a knife 
between  the  fifth  and  sixth  ribs  near  the  sternum.  As  a piece  of 
lung  protruded  at  the  opening  and  was  of  a livid  color,  it  was  extir- 
pated with  the  actual  cautery.  The  wound  was  then  dilated,  and 
the  ribs  kept  apart  with  a wooden  wedge,  under  which  plan  the 
portion  of  lung  girt  by  the  opening  shrunk  within  the  chest.  The 
patient  was  soon  completely  well. 

A fourth  example  of  a protrusion  of  a piece  of  lung  through  a 
wound  in  the  thorax  is  among  the  cases  recorded  by  Ruysch.  The 
servant  of  a seafaring  man  was  wounded  in  the  anterior  and  inferior 
part  of  the  chest,  and  was  immediately  attended  by  a surgeon  who 
mistook  the  protruded  piece  of  lung  for  a portion  of  omentum  and 
applied  a tight  ligature  around  it.  Ruysch,  who  was  consulted,  soon 
detected  the  mistake  which  had  been  made,  but  he  delivered  his 
opinion  that  the  wound  would  heal  very  well  as  soon  as  the  tied 
piece  of  lung  was  detached.  The  event  justified  his  prognosis  and 
the  patient  recovered.  He  continues  : 

“ After  the  battle  of  Waterloo  I had  a patient  with  a protrusion 
of  a piece  of  lung  four  or  five  inches  in  length.  The  part  was 
much  bruised  and  could  not  be  easily  reduced.  I therefore  ap- 
plied a ligature  round  its  base  and  cut  it  off.  Previously,  how- 
ever, I made  an  incision  in  it  in  order  to  ascertain  whether  it  would 
bleed  freely,  which,  being  the  case,  induced  me  to  use  a ligature. 
I was  afterwards  informed  by  my  friend,  Mr.  Collier,  that  the  man 
died.” 

A more  recent  case  is  reported  in  the  London  Lancet  for  the  year 


270 


world’s  homoeopathic  congress. 


1886,  p.  466,  where  a case  is  reported  by  Dr.  Demons,  of  Bordeaux, 
France,  of  resection  of  a portion  of  the  left  lung  with  the  ecraseur, 
followed  by  haemorrhage,  which  was  controlled  with  the  thermo- 
cautery. The  patient  had  been  injured,  during  a quarrel,  with  a 
knife.  After  the  operation  on  the  lung  it  was  also  found  necessary 
to  remove  the  left  kidney.  The  patient  recovered.  Thus,  of  six 
cases  here  cited,  five  recovered  and  one  died. 

The  lung  was  removed  by  ligature  three  times  with  two  recoveries 
and  one  death.  The  remaining  other  cases,  which  all  recovered, 
were  removed  by  excision,  by  cautery,  and  by  the  ecraseur.  These 
were  all  clearly  operations  of  necessity,  but  convey  information 
which  must  prove  useful  and  instructive  as  to  method  in  develop- 
ing operations  of  choice  undertaken  for  the  relief  of  disease.  I 
cannot  refrain  here  from  calling  attention  to  the  fact  that  numerous 
cases  are  reported  where  patients  having  phthisical  symptoms  are 
said  to  have  been  cured  by  gun-shot  and  other  accidental  wounds  of 
the  chest. 

Thus  well-marked  symptoms  of  phthisis,  asthma,  and  chronic 
cough  are  reported  to  have  been  radically  cured  or  greatly  relieved 
by  the  rough  medium  of  a gun-shot  wound.  (See  notes,  Medical  and 
Surgical  History  of  the  War  of  the  Rebellion.) 

Some  tabulated  lists  of  cases  are  reported  of  operations  on  the 
lungs  for  tubercular  and  other  diseases.  I shall  not  attempt  to  col- 
lect them,  but  rather  to  select  such  cases  as  serve  to  give  the  technique 
now  in  vogue,  and  by  comparison  with  some  of  my  own  cases  show 
wherein  I think  the  present  methods  are  faulty  and  subject  to  criti- 
cism. I shall  further  suggest  measures  which  I think,  if  adopted, 
will  give  us  a better  command  on  the  field  and  lead  to  a more  ex- 
tended practice. 

The  most  valuable  and  comprehensive  account  of  thoracic  opera- 
tions up  to  this  date  is  embraced  in  the  lectures  of  Rickman  J.  God- 
lee,  published  in  the  London  Lancet , vol.  i.,  for  the  year  1887. 

In  his  first  lecture  he  asserts  that  in  some  forms  of  pulmonary 
abscess  surgical  interference  is  obviously  inadmissible ; nothing,  for 
instance,  can  be  hoped  from  it  in  treating  the  lung,  which  is  riddled 
by  numerous  tubercular  cavities  or  the  multiplied  gangrenous  foci 
which  occur  in  the  course  of  embolic  pyaemia. 

Those  in  which  surgery  has  been,  or  may  be,  attempted,  may  be 
thus  classified: 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


271 


1.  Tubercular  cavities. 

2.  Cavities  resulting  from  gangrene  of  the  lung. 

3.  Cavities  resulting  from  the  bursting  into  the  lung  of  abscesses 
or  other  collections  of  irritating  matter  from  without. 

4.  Bronchiectasis,  from  whatever  cause  arising,  and  including 
those  which  depend  upon  the  presence  of  a foreign  body  in  the  air- 
passages. 

He  follows  with  an  interesting  detail  of  historical  references  on 
the  subject,  showing  the  various  attempts  made  by  surgeons  to  cure 
abscesses  and  pulmonary  cavities  left  by  them  by  operation.  Of 
the  cases  cited  by  him,  the  following  alone  can  be  quoted  here 
as  being  in  the  direct  line  of  thought  I wish  to  pursue.  He  says : 

1.  F , aged  forty  years.  Advanced  phthisis,  with  large  cavity 

at  left  apex. 

Resection  of  the  third  rib  to  allow  the  chest-wall  to  fall  in.  The 
patient  lived  a little  more  than  a fortnight.  Some  retraction  is  said 
to  have  occurred. 

2.  F , aged  fifteen.  Advanced  phthisis,  with  consolidation 

and  excavation  of  lower  lobe  of  the  left  lung. 

Parts  of  the  second  and  third  ribs  were  excised,  and  threads  were 
passed  through  the  pleura  into  the  lung  in  order  to  insure  adhesions 
if  these  were  not  present.  Four  days  later  an  attempt  to  reach  a 
large  cavity  resulted  only  in  the  discovery  of  a small  one.  The 
operation  appears  to  have  had  but  little  influence  on  the  progress 
of  the  disease.  The  patient  died  three  weeks  after  the  first  opera- 
tion. 

3.  F , aged  twenty-five.  Advanced  phthisis;  cavities  in  the 

left  upper  lobe. 

Parts  of  the  second  and  third  ribs  were  removed  and  a large 
cavity  was  opened.  The  cough  and  expectoration  were  very  much 
relieved,  and  the  cavity  decidedly  contracted,  the  patient  living  five 
weeks  after  the  operation. 

A far  more  heroic  method  of  dealing  with  tubercular  lung  has 
been  in  recent  years  suggested  by  certain  Italian  surgeons  who  have 
made  this  subject  a specialty,  though  it  has  been  followed  up  by  some 
observers  in  Germany. 

Dr.  Domenico  Biondi  showed  first  the  possibility  of  an  animal 
surviving  the  complete  extirpation  of  a healthy  lung,  and  then  pro- 
ceeded to  demonstrate  that  the  same  might  be  done  in  an  animal, 


272 


world’s  homoeopathic  congress. 


the  lung  of  which  had  been  previously  inoculated  with  some  of  the 
sputum  of  a tubercular  patient,  and  had  actually  become  the  seat  of 
tubercular  changes. 

A very  considerable  proportion  of  the  animals  (rabbits,  cats,  and 
dogs,  twenty-one  in  all)  died  as  the  result  of  the  first  or  the  second 
operation,  but  some  survived  and  lived  for  a very  considerable  time 
afterward. 

The  dogs  and  cats  were  not  very  favorable  subjects  for  the  devel- 
opment of  tuberculosis,  but  it  is  remarkable  and  interesting  that  in 
some  of  the  rabbits  tubercle  was  actually  developed  in  the  lung,  which 
was  removed,  and  after  the  removal  the  animal  remained  free  from 
further  development  of  the  disease. 

The  conclusion  that  the  author  wishes  to  draw  is  obvious,  but  he 
hardly  ventures  to  hint  at  the  application  of  the  treatment  to  the 
human  subject,  and  it  can  scarcely  be  suspected  that  it  will  ever  be 
placed  among  the  recognized  surgical  procedures.  It  could  only  be 
applied  in  the  early  stages  of  phthisis,  when  the  disease  may  be  con- 
sidered within  the  possibility  of  a practically  permanent  cure  by 
other  and  simpler  means.  And,  indeed,  the  same  may  be  said  of 
another  possible  deduction,  namely,  the  removal  of  tumors  of  the 
lung.  Diagnosis  must  clearly  reach  a much  greater  pitch  of  refine- 
ment before  the  physician  could  counsel  or  the  surgeon  attempt  the 
removal  of  a primary  tumor  of  the  lung,  rare  as  it  is,  and  difficult 
as  it  must  always  be  to  discover  in  its  earlier  stages,  when  alone  it 
could  conceivably  be  extirpated.  It  must,  however,  be  stated  that 
in  two  cases  of  phthisis,  parts  of  the  lung  have  been  actually  re- 
moved by  Ruggi,  one  of  the  patients  dying  in  a few  hours,  and  the 
other  on  the  ninth  day.  And  not  only  so,  but  tumors  of  the  lung 
also  have  been  removed,  though  it  must  be  owned  that  the  expe- 
rience of  the  surgeons  who  undertook  the  operation  is  not  very 
encouraging. 

Weinleicher,  in  1882,  removed  a round  tumor  as  large  as  a man’s 
head  from  the  thoracic  wall  of  a man  aged  37,  leaving  a huge  gaping 
opening  into  the  chest  and  taking  away  a part  of  the  lung  to  which 
it  was  adherent;  the  patient  died  twenty-four  hours  afterwards. 

Kroenlein  also  removed  a recurrent  sarcoma  in  the  same  situation 
from  a girl  aged  18,  taking  away  part  of  the  sixth  rib  and  some 
adherent  lung.  The  end  of  this  case  is  not  reported  in  the  interest- 
ing article  of  Albert’s  from  which  the  reference  is  taken. 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


273 


Gangrenous  Cavities  Resulting  from  Pneumonia. — These  cavities 
are  perhaps  the  most  promising  with  which  the  surgeon  is  called 
upon  to  deal,  especially  if  operation  be  not  too  long  delayed.  In 
the  course  of  time,  if  the  patient  survive,  the  surrounding  lung  be- 
comes condensed  and  inelastic;  but  in  the  earlier  stages  of  the  dis- 
ease it  retains  more  or  less  its  normal  characters,  and  the  walls  of 
the  cavity  are  able  to  fall  together  like  those  of  an  abscess  in  the 
soft  parts  elsewhere.  But  delay  is  almost  unavoidable,  on  account 
of  the  great  difficulty  of  localizing  the  position  of  the  cavity  with 
precision  and  the  still  greater  difficulty  of  ascertaining  the  absence 
or  the  presence  of  adhesions. 

I do  not  think  that  the  second  point  should  be  allowed  to  influ- 
ence the  surgeon  in  the  direction  of  delay,  and  certainly  should  not 
interfere  with  an  exploratory  puncture,  because,  in  the  first  place, 
experience  shows  that  even  adhesions  which  have  been  accurately 
diagnosed  by  the  most  competent  observers  may,  after  all,  be  found 
to  have  no  existence,  and  in  the  second  place,  it  seems  clear  that  ex- 
ploration with  an  aspirator  needle  may  be  safely  made  through  a 
patent  pleura,  even  if  the  instrument  pass  into  a collection  of  putrid 
pus. 

I do  not  say  that  mischief  will  never  follow  this  procedure,  and 
I am  sure  that  it  is  wise  to  ascertain  for  certain  the  condition  of  the 
pleura  before  making  a free  incision  into  a lung  containing  septic 
pus;  for  if  the  non-adherent  pleura  be  opened,  and  through  it  a 
drainage-tube  be  passed  into  a putrid  cavity,  very  serious  symptoms 
may  result.  This  was  well  illustrated  in  a case  of  bronchiectasis, 
where  we  had  ascertained  a week  or  two  previously,  that  there  was 
some  clear  fluid  in  what  was  thought  to  be  merely  a remnant  of  the 
pleural  cavity.  On  cutting  through  the  intercostal  space,  it  was 
found  that  the  two  layers  of  the  pleura  had  become  adherent  since 
the  preliminary  puncture,  but  only  by  very  weak  adhesions,  which 
easily  broke  down  under  the  pressure  of  the  finger  and  the  expira- 
tory efforts  of  the  patient  whilst  the  opening  was  being  made  into 
the  bronchiectatic  cavity. 

This  led  to  the  opening  up  of  a large  remnant  of  the  pleural  sac, 
the  walls  of  which  were  non-adherent,  and  the  consequence  was  that 
the  pus  from  the  bronchiectasis,  escaping  into  the  pleura,  set  up  a 
septic  pleurisy  from  which  the  patient  nearly  died. 

It  will  be  well,  therefore,  to  consider  at  the  outset  what  should  be 

18 


274 


world’s  homoeopathic  congress. 


done  when  these  adhesions,  so  commonly  but  yet  not  invariably 
found,  are  wanting.  One  plan  would  be  that  mentioned  above,  as 
recommended  by  De  Cerenville  as  a precautionary  measure — namely, 
to  pass  needles  armed  with  silk  through  the  pleura  into  the  lung; 
but  as  in  almost  all  cases  the  lung  is  solidified,  and  will,  therefore, 
not  fall  away  to  any  extent  from  the  thoracic  wall,  even  if  no  adhe- 
sions at  all  be  present,  I do  not  think  that  this,  though  quite  unob- 
jectionable, can  be  considered  to  be  a necessary  precaution. 

The  right  method  of  procedure,  though  I confess  it  is  not  a very  easy 
one,  is  carefully  to  stitch  the  lung  up  to  the  opening  which  has  been 
made  in  the  chest-walls.  It  is  a difficult  proceeding,  because  the  parts 
are  in  a constant  state  of  movement  from  the  act  of  respiration,  and 
because  the  lung  itself  is  but  ill  suited  to  retain  the  stitches  that  are 
placed  in  it,  and  also  because  the  hole  in  which  the  manoeuvres  have 
to  be  carried  on  is  a rather  deep  one,  and  mostly  obscured  by  the 
presence  of  blood.  I have  only  once  had  to  put  this  plan  into  prac- 
tice, and  though  here  it  was  only  partially  successful,  it  was  suffi- 
ciently so  to  show  that,  with  a little  more  care,  the  closure  of  the 
pleura  might  have  been  effected.  We  found  in  this  case,  at  the  end 
of  a few  days,  that  a part  of  the  stitching  had  given  way;  but  as 
no  cavity  was  reached,  no  evil  consequences  as  regards  the  pleura 
resulted,  the  wound  remaining  aseptic. 

Of  course,  after  the  stitches  have  been  placed,  the  attempt  to  open 
the  cavity  must  be  postponed  for  at  least  a week,  and  at  the  end  of 
that  time  the  instruments  used  must  be  sharp,  and  their  employment 
gentle,  lest  the  accident  which  it  is  intended  to  avoid  may,  after  all, 
happen. 

In  his  second  lecture  he  quoted  the  following  cases  from  Copeland 
and  closes  with  the  remarks  which  follow  the  report  of  the  cases. 

1.  A boy,  aged  seventeen,  swallowed  a bone  in  November,  1883. 
He  developed  bronchiectasis,  but  completely  recovered  after  cough- 
ing up  the  bone  in  February,  1884. 

This  I think,  is  most  instructive,  not  only  as  showing  that  the 
bronchiectasis  and  induration  of  the  lung,  which  had  taken  four 
months  to  develop,  could  be  completely  recovered  from,  but  as  in- 
dicating the  line  of  treatment  in  such  cases. 

2.  I)r.  Magrath’s  case,  where  a piece  of  grass  became  impacted 
in  the  right  lung  of  a boy  of  seven.  Death  occurred  after  ten  weeks. 
The  lower  lobe  of  the  lung  was  riddled  with  abscesses.  The  dia- 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


275 


phragm  (as  in  one  of  my  cases)  had  been  perforated  by  the  abscesses, 
and  there  was  secondary  caries  of  the  spine. 

Dr.  Cayley’s  case,  which  was  one  of  a low  form  of  pneumonia,  re- 
sulting in  a basic  cavity  containing  five  or  six  ounces  of  offensive 
pus  and  sloughs  of  lung  substance.  He  had  only  been  ill  for  five 
weeks,  but  had  the  appearance  of  a man  in  the  last  stages  of  phthisis. 
The  cavity  was  opened  in  the  ninth  interspace,  but  the  case  ended 
fatally,  being  already  too  far  advanced. 

There  were  signs  of  old  tubercular  mischief  in  the  lungs. 

4.  Dr.  Solomon  Smith,  of  Halifax,  records  a case  where  gangrene 
followed  acute  pneumonia,  and  where  death  followed  an  incision 
into  the  abscess  after  nine  days. 

5.  Dr.  Cayley’s  case  of  a gangrenous  abscess  following  ear  dis- 
ease, in  which  Dr.  Gould  punctured  the  abscess  with  a trocar,  but 
on  introducing  the  tube,  failed  to  drain  the  abscess  at  first ; it  after- 
wards, however,  burst  into  the  artificial  opening,  and  the  patient 
made  a good  recovery. 

6.  Some  cases  are  recorded  in  a paper  read  by  Dr.  Mosler  before 
the  German  Medical  Congress  at  Weisbaden  in  1883,  in  which  he 
recommends  the  incision  of  the  lung  with  the  actual  cautery  for  the 
extraction  of  foreign  bodies. 

I am  not  able  to  strongly  endorse  this  advice  (though  with  deep 
incisions  it  may  possibly  be  advisable)  for  the  use  of  the  knife  does 
not,  as  a rule,  lead  to  formidable  haemorrhage,  and  the  charring  of 
the  tissues  must  cause  considerable  difficulty  in  any  exploration  with 
the  finger. 

7.  Dr.  Ed.  Bull,  of  Christiana,  records  a case  of  circumscribed 
gangrene  of  the  lung  which  was  opened  successful ly. 

It  may  be  taken  for  granted  then,  that  the  majority  of  the  cases 
of  gangrenous  abscess  which  come  into  the  hands  of  the  surgeon  are 
the  result  of  acute  pneumonia,  and  are  situated  near  the  base  of  the 
lung;  and  it  may  be  added  that  his  aid  is  most  likely  to  be  needed 
in  those  cases  in  which  the  gangrene  is  not  very  extensive,  so  that 
the  patient  survives  the  immediate  effects  of  this  process.  Some  of 
these  cases,  it  is  well  known,  recover  spontaneously,  the  pus  being 
expectorated  ; but  in  others  a condition  of  things  results  such  as  is 
often  met  with  in  abscesses  bursting  spontaneously  in  other  parts  of 
the  body — namely,  that  the  opening  being  insufficient,  and  perhaps 
unsuitably  placed,  the  sac  is  always  more  or  less  filled  with  the  dis- 


276 


world’s  homoeopathic  congress. 


charges,  which  in  the  cases  we  are  considering  are  always  highly 
septic,  and  therefore  irritating.  The  abscess,  consequently,  shows 
no  tendency  to  close,  but  on  the  contrary,  increases  in  size.  It  is 
not  a good  plan  in  such  cases  to  wait  long  before  making  the  external 
opening — that  is,  if  the  position  of  the  abscess  can  be  accurately 
determined — because  as  was  pointed  out  when  the  subject  of  em- 
pyema bursting  into  the  lung  was  discussed,  the  presence  of  foetid 
pus  in  the  bronchi  and  trachea  is  very  likely  to  lead  not  only  to  seri- 
ous consequences  in  the  diseased  lung,  but  also  in  the  sound  one ; 
but,  at  the  same  time,  it  is  not  often  wise  to  make  an  incision  through 
the  chest- wall  until  the  situation  of  the  abscess  has  been  ascertained 
by  means  of  an  exploring  trocar,  and  even  then  the  troublesome 
question  of  the  presence  or  absence  of  pleural  adhesions  has  to  be 
settled  before  the  lung  itself  is  incised. 

Another  case  in  point  is  the  following: 

Resection  of  the  lung  in  incipient  tuberculosis  and  operation  for 
hernia  of  the  lung. 

On  May  5,  1891,  M.  Tuffier  resected  the  lung  of  a man,  aged  25, 
with  incipient  phthisis,  apparently  limited  to  the  right  apex.  He 
made  an  incision  in  the  second  intercostal  space  and  exposed  the 
pleura.  In  order  to  draw  the  apex  more  easily  through  the  small 
incision  he  produced  an  extra  pleural  pneumothorax  by  separating 
the  parietal  pleura  from  the  chest-wall  around  the  apex  ; the  mem- 
brane was  lightly  torn,  but  the  hole  was  stopped  with  the  finger  and 
then  with  gauze,  so  that  but  little  air  entered  the  pleura.  The  apex 
of  the  lung  was  then  seized  with  special  forceps  and  drawn  out.  The 
area  of  consolidation,  which  was  about  the  size  of  a large  hazelnut, 
firm  in  the  centre  and  slightly  granular  at  the  circumference,  could 
be  distinctly  felt  and  defined.  A silk  ligature  was  then  tied  tightly 
around  the  protruding  lung,  five  centimeters  from  the  apex  and  two 
beyond  the  area  of  consolidation  ; the  lung  was  cut  otf  and  the  pedi- 
cle accurately  sewn  to  the  periosteum  of  the  internal  surface  of  the 
second  rib,  so  as  to  avoid  the  production  of  pneumothorax.  The 
divided  muscles,  layer  by  layer,  were  then  carefully  sutured  with 
catgut;  Florence  hair  sutures  were  used  for  the  skin  wound,  and  an 
iodoform  wool  dressing  was  applied.  The  patient  was  under  chlo- 
roform for  thirty-five  minutes,  and  there  was  no  disturbance  what- 
ever of  the  breathing  or  the  circulation.  An  excellent  recovery  fol- 
lowed without  fever,  cough,  or  any  sign  of  reaction,  local  or  general. 


A CONTRIBUTION  TO  THORACIC  SURGE  BY. 


277 


The  dressing  was  first  changed  on  the  sixth  day,  and  beyond  slight 
weakness  of  the  breath-sounds  over  the  whole  lung,  no  abnormality 
could  be  detected.  The  dressing  was  left  off*  on  the  ninth  day,  when 
the  patient  was  well  enough  to  be  exhibited.  On  November  30, 
1890,  he  also  performed  an  operation  for  radical  cure  of  a sponta- 
neous hernia  of  the  lung,  returning  the  lung  and  sewing  up  the 
wound.  The  patient  was  well  by  the  seventh  day.” 

I shall  include  resection  of  the  lung,  or  pneumonectomy,  and  in- 
cision of  the  lung,  or  pneumotomy,  under  the  same  heading,  as  I be- 
lieve the  same  method  of  attack  should  be  made  in  each. 

“ A patient  presented  himself  at  London  Chest  Hospital,  with 
pain,  cough  and  shortness  of  breath.  Examination  showed  absence 
of  movements  of  left  side  of  chest,  with  anterior  and  posterior  dul- 
ness;  tubular  breath' sounds,  with  vocal  resonance  and  fremitus  in- 
creased ; right  side  healthy.  In  the  course  of  a few  days  the  tem- 
perature ran  up  from  normal  to  lOOy8^,  but  soon  fell  again;  night 
sweats,  with  a free,  foetid  expectoration,  set  in.  At  the  suggestion 
of  Dr.  Samuels  an  aspirator  needle  was  inserted  between  the  fifth 
and  sixth  ribs,  and  two  ounces  of  foetid  pus  drawn  off.  Considerable 
tumefaction  at  the  point  of  aspiration  followed,  and  a free  incision 
was  decided  upon.  About  three  ounces  of  pus  escaped,  and  a drain- 
age-tube was  inserted.  Until  this  time  it  was  thought  the  pus  came 
from  the  pleural  cavity,  but  when,  a few  days  later,  a portion  of  the 
seventh  rib  was  resected  and  the  thickened  pleura  incised,  it  was 
shown  that  an  abscess  of  the  lung  about  the  size  of  an  orange  was 
the  source  of  the  pus.  The  cavity  was  washed  out  with  a solution 
of  perchloride  of  mercury  1-500,  and  a drainage-tube  inserted.  The 
patient  began  to  improve  in  every  respect,  but  on  the  evening  of  the 
fourteenth  day  he  was  suddenly  seized  with  an  epileptiform  attack, 
followed  by  paralysis  of  the  right  arm.  In  an  attack  similar  to  this, 
a few  days  later,  he  became  unconscious,  was  completely  paralyzed, 
and  died  five  days  later.  Post-mortem  showed  healthy  granulations 
in  the  cavity  of  the  lung.  Smaller  abscesses  were  found  in  the  up- 
per portion  of  the  lung. 

“The  disease  undoubtedly  originated  in  pneumonia,  and  the  close 
proximity  of  the  pleura  caused  an  extension  of  the  inflammation  and 
adhesions.  Abscesses  of  the  brain,  the  cause  of  death,  were  undoubt- 
edly embolic  in  origin,  which  is  claimed  to  be  the  rule  in  abscesses 
of  the  lung  or  pleura.” 


278  world’s  homoeopathic  congress. 

I have  now  done  some  twenty  operations  on  the  thorax,  major 
and  minor.  Of  these  but  two  could  properly  be  reported  here  as 
illustrating  some  points  which  I urge  in  the  text  further  on.  They 
are  as  follows : 

April  9,  1888,  was  called  by  Dr.  F.  X.  Spranger  to  see  Mrs. 
F , aged  40. 

History. — Seven  weeks  previously,  while  visiting  in  a southern 
city,  was  taken  with  fever  of  a continued  type.  The  doctor  in  at- 
tendance pronounced  the  disease  “ malaria,”  and  treated  the  case  on 
general  terms  as  a common  case  of  malarial  fever.  As  the  patient 
did  not  improve,  she  was  advised  to  come  to  her  home  in  the  North, 
trusting  that  the  change  might  be  of  benefit.  On  Dr.  Spranger’s 
first  visit  he  found  the  patient  emaciated,  weak,  pulse  and  respira- 
tion quickened,  respiratory  murmur  faint  in  lower  lobe  of  left  lung, 
although  not  entirely  absent.  Marked  tenderness  on  pressure,  and 
the  patient  stated  that  there  had  been  a deep-seated  soreness  and  a 
little  pain  in  this  side  from  the  first.  This  had  been  ascribed  to  the 
stomach  by  her  attendant.  Morning  temperature,  101  ; evening, 
102  to  102 J.  Percussion  elicited  some  dulness  over  lower  lobe  of 
left  lung;  no  increase  in  size  of  side  or  bulging  of  the  intercostal 
spaces.  There  was  some  cough,  with  expectoration  of  muco-puru- 
lent  type.  During  the  whole  sickness  the  patient  had  experienced 
light  chills  at  irregular  intervals.  After  consultation  we  decided 
that  the  condition  was  one  of  localized  empyema,  or  pulmonary  ab- 
scess affecting  lower  lobe  of  the  left  lung,  and  decided  to  attempt  to 
locate  it  with  the  aspirating  trocar.  April  12th,  under  the  influence 
of  chloroform,  the  exploration  was  undertaken. 

I selected  the  space  between  the  seventh  and  eighth  ribs  in  the 
centre  of  axillary  line  as  being  at  about  the  upper  level  of  the  area 
of  tenderness.  Introduction  of  aspirating  needle  two  and  one-half 
inches  straight  in  gave  a negative  result,  then  the  needle  was  with- 
drawn from  the  lung  and  reintroduced  downward  and  backward 
again  with  no  result.  Again  I withdrew  it,  and  this  time  thrust  it 
downward,  inward  and  forward  and  this  time  , was  rewarded  with  a 
few  drops  of  thick  foetid  pus.  It  was  determined  at  this  consultation 
to  operate  on  the  case,  and  the  operation  was  fixed  for  the  next  day 
at  two  o’clock. 

Operation. — The  anaesthetic  used  was  chloroform,  and  beyond  the 
effects  of  shock  and  irregularity  of  respiration  during  the  last  part 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


279 


of  the  operation  there  is  nothing  in  regard  to  the  anaesthetic  worth 
recording.  I commenced  to  make  a four  inch  incision  over  the 
seventh  rib  from  the  axillary  line  forward.  I next  removed  the 
periosteum  and  attached  muscles ; for  cutting  the  rib  I used  the 
common  rib  shears.  I now  attempted  to  open  the  pleural  cavity  in 
the  rib  space  but  found  at  the  point  of  attack  the  union  between  the 
pleural  surfaces  so  intimate  that  this  was  impossible.  Explorations 
further  up  gave  me  an  opening  through  which  I thrust  my  index 
finger.  I found  the  lung  intimately  adhered  to  the  chest-wall  at 
all  points.  I now  dissected  the  lung  from  its  attachments,  opening 
the  cavity  to  the  full  length  of  the  space  from  which  I had  removed 
the  rib.  I now  directed  my  finger  towards  the  diaphragmatic  attach- 
ment of  the  chest- wall,  dissecting  my  way  carefully  and  {thrusting 
back  the  lung.  The  struggles  of  the  patient  at  this  time  were  very 
great  and  the  bleeding  as  the  adhesions  gave  way  quite  free,  as  the 
edge  of  the  lung  folded  up.  I found  the  adhesions  continued  over 
the  surface  of  the  diaphragm.  Suddenly  I broke  into  a large  cavity 
having  its  base  on  the  diaphragm  and  its  apex  in  the  base  of  the 
posterior  lobe  of  the  left  lung.  There  now  came  a great  gush  of 
badly  smelling  and  very  thick  matter.  During  this  part  of  the  ope- 
ration Dr.  E.  P.  Gaylord  who  had  charge  of  the  anaesthetic  pro- 
nounced the  patient  very  weak,  and  stopped  it  temporarily  lifting 
out  the  tongue  to  aid  respiration.  Dr.  Spanger  held  the  ribs  well 
apart  with  stout  curved  retractors.  I now  with  the  finger  separated 
all  adhesions  to  the  diaphragm,  and  costal  pleura  as  far  up  on  the 
upper  side  of  the  wound  in  the  chest-wall  as  I could.  I did  this  to 
allow  the  lung  to  collapse  and  thus  get  it  up  out  of  the  way  in  order  to 
better  drain  the  cavity.  The  lung  was  partly  infiltrated  with  in- 
flammatory matter  and  contracted  some,  but  to  no  great  degree. 
With  the  finger  as  a curette,  I removed  all  flakes  of  fibrin  and 
granulations  in  sight. 

With  the  finger  I drew  the  lung  into  the  opening  and  trimmed  the 
abscess  edges  just  as  I would  have  done  in  any  other  region.  We  were 
satisfied  that  the  cavity  had  an  opening  into  a bronchus  and  the 
great  problem  now  was  whether  it  would  do  to  wash  out  the  cavity. 
This  I did  with  a mild  boracic  acid  solution  at  a temperature  of  100, 
keeping  the  wound  fully  dilated  all  the  time,  and  allowing  a free 
outflow  of  the  water.  This  done  I inserted  a flanged  drainage-tube 
at  the  lower  angle*of  the  wound,  left  the  wound  open  and  enveloped 


280 


world’s  homoeopathic  congress. 


the  whole  side  of  the  body  in  an  ample  antiseptic  dressing  consisting 
of  gauze,  mackintosh  over  this  to  distribute  the  discharge,  and 
lamb’s  wool  over  all.  The  patient  reacted  well,  the  pulse  improved, 
the  temperature  fell  to  normal.  On  the  seventh  day  the  dressing 
began  to  smell  and  the  first  change  was  made.  Found  the  cavity 
smelling  quite  badly,  but  little  discharge.  With  the  patient  in  a 
sitting  posture  we  used  a claret-colored  solution  of  permanganate 
of  potash.  We  allowed  the  cavity  to  fill  from  below  until  the 
patient  coughed  when  we  stopped  the  flow  and  allowed  all  the  liquid 
to  escape;  the  cough  brought  sufficient  of  the  solution  through  the 
bronchus  into  the  mouth  to  color  the  saliva.  After  this  as  often 
as  the  cavity  became  foul  we  repeated  the  irrigation  and  to  the  very 
last  time,  the  patient  was  able  to  raise  some  of  the  solution.  The 
general  progress  of  the  case  was  good,  and  by  the  middle  of  May 
the  opening  had  granulated,  and  the  patient  was  well.  Her  health 
has  remained  good. 

A.  M.,  aet.  19,  patient  of  Hr.  Isaac  Bentley  was  one  of  the  victims 
of  the  Tilden  school  fire,  and  was  severely  burned  about  the  hands 
and  face.  Inhaled  flame  and  smoke  and  complained  constantly  of 
left  lung  for  months  afterwards.  In  July,  1890,  was  taken  with 
several  other  members  of  his  family  with  typhoid  fever. 

The  fever  in  his  case  was  rather  more  severe  than  in  the  others, 
and  about  the  middle  of  August  he  was  taken  with  a sudden  op- 
pression of  breathing  and  constitutional  symptoms  of  haemorrhage. 
On  examination  Dr.  Bentley  found  a large  accumulation  of  blood 
pushing  down  the  diaphragm  and  filling  the  left  pleural  cavity.  It 
was  at  this  time  that  I was  first  consulted.  I confirmed  the  diag- 
nosis, and  as  the  bleeding  had  stopped  I advised  delay  for  the 
present.  August  19th,  the  oppression  of  the  breathing  having  in- 
creased to  such  an  extent  as  to  cause  great  embarrassment  of  respi- 
ration and  circulation  we  decided  to  tap  him.  This  was  done  under 
strict  antiseptic  precautions,  and  three  pints  of  liquid  blood  drawn 
off.  The  patient  was  much  relieved  and  seemed  better  for  some 
days.  Ten  days  later  was  again  called  and  found  the  patient  again 
suffering  from  oppression  of  breathing.  Tapped  again  and  drew 
off  about  the  same  amount  of  blood.  I left  with  Dr.  Bentley,  the 
patient  being  very  comfortable.  Two  hours  later  I was  hastly  sum- 
moned and  found  the  patient  had  suffered  from  another  severe 
haemorrhage,  the  side  being  tightly  distended,  and  diaphragm  pushed 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


281 


down  making  a rounded  fluctuating  tumor  in  left  hypochondrium. 
The  patient  was  suffering  from  combined  blood  loss  and  pressure, 
and  his  friends  were  told  to  prepare  for  the  worst.  His  death  seemed 
sure.  After  hard  work  on  the  part  of  his  attending  physician  he 
rallied,  and  except  for  the  pressure  symptoms  his  condition  was 
much  improved.  At  the  request  of  the  family  Dr.  E.  L.  Shurley 
was  called  in  for  consultation  September  4th,  and  after  examination 
agreed  that  the  bleeding  proceeded  from  an  abscess  of  the  lung,  and 
advised  a third  tapping.  This  the  patient  and  friends  refused  to 
allow,  the  friends  being  particularly  against  doing  anything  further. 
Four  days  later  I was  again  called,  and  found  the  pressure  symp- 
toms much  worse,  the  patient  being  in  such  agony  that  he  not  only 
consented,  but  demanded  that  something  should  be  done  to  relieve 
him.  The  patient  was  given  chloroform,  and  on  introducing  the 
trocar  the  contents  of  the  thorax  was  found  to  be  pus.  Free  inci- 
sion was  decided  on  and  the  space  between  the  seventh  and  eighth 
ribs  in  the  axillary  line  chosen  to  make  the  opening.  Incision  made, 
measured  three  inches,  and  a full  gallon  of  pus  flowed  slowly 
through  the  wound.  The  patient  rallied  well  and  was  much  relieved. 
Dressing  changed  four  days  later,  some  discharge;  new  tube  inserted 
and  wound  redressed.  Patient  seemed  to  do  fairly  well  until  October 
11th,  when  I was  again  called.  The  tube  was  still  continued  by 
Dr.  Bently,  but  on  examination  it  was  found  that  it  no  longer  drained 
the  whole  cavity.  Adhesions  had  formed  a second  cavity,  which 
occupied  the  upper  half  of  the  pleural  space. 

The  patient  was  again  placed  under  chloroform  and  the  space 
between  the  fourth  and  fifth  ribs  selected  as  the  base  of  accumula- 
tion. Opening  two  and  one-half  inches  long  entered  a cavity  holding 
a quart  of  very  offensive  pus.  Both  the  old  and  new  cavities  were 
now  thoroughly  washed  out  with  claret-colored  permanganate  of 
potash  solution.  Daily  irrigation  with  calendulated  water  was  kept 
up.  The  patient  did  not  seem  to  improve,  the  pulse  being  weak 
and  as  high  as  140  beats  per  minute,  respiration  ranging  from  24 
to  36.  Temperature  from  102  in  the  morning  to  104  in  the  evening. 
The  patient  seemed  in  desperate  straits  and  I decided  on  radical 
measures;  accordingly  on  December  2d,  one  month  and  twenty-one 
days  after  my  last  operation,  under  chloroform,  I resected  four  inches 
of  the  fifth  rib.  I now  opened  the  upper  cavity  through  the  rib 
space  and  with  my  index  finger  broke  down  the  adhesions  dividing 


282 


world’s  homoeopathic  congress. 


the  pleural  space  as  far  back  as  the  finger  could  reach.  I next  turned 
my  attention  to  the  stump  of  the  lung  in  the  posterior  part  of  the 
upper  cavity.  It  seemed  firmly  adherent  in  all  parts,  and  com- 
pletely solidified.  With  the  finger  I broke  up  all  adhesions  and 
pockets  around  it  and  finished  by  washing  out  the  cavity  with  a 
warm  boracic  acid  solution. 

The  patient’s  surroundings  were  not  the  most  favorable,  his 
parents  living  in  a small  cottage  heated  by  soft  coal  stoves.  After 
much  urging  he  was  removed  to  St.  Mary’s  Hospital  and  placed  in 
charge  of  the  sisters.  The  upper  opening  now  ceased  to  discharge 
and  tube  was  withdrawn.  His  general  condition  began  to  improve, 
and  by  the  middle  of  January  he  returned  home  cured.  Examina- 
tion at  this  time  shows  the  lung  to  have  fully  expanded  and  no  trace 
of  the  trouble  left  but  the  scars  which  mark  the  lines  of  incision. 

Operation. — May  be  undertaken,  when  there  is  a lung-cavity,  due 
to  bronchiectasis,  gangrene  or  hydatid,  and  it  is  evident  that  drainage 
is  imperfect. 

The  case  is  urgent  when  the  expectoration  is  profuse,  foul  and 
irritating,  when  the  cough  is  constant  and  exhausting,  when  sleep  is 
interfered  with,  appetite  is  poor,  or  lost ; when  there  is  diarrhoea, 
night-sweats,  chills,  or  the  commencement  of  hectic  fever. 

The  operation  should  be  undertaken  before  the  whole  lung  is  in- 
fected, and  when  only  one  lung  is  diseased. 

Anaesthetic. — I have  now  imperfect  notes  of  more  than  twenty 
cases  of  thoracic  surgery  and  have  used  chloroform  in  most  of  the 
cases.  In  those  with  weak  heart  action  I have  used  narcosis  from 
whiskey,  using  from  6 to  12  ounces  according  to  the  age  and  condi- 
tion of  the  patient  and  the  degree  of  effect  desired.  In  every  case 
the  whiskey  is  supplemented  with  small  doses  of  chloroform  as 
needed  to  keep  the  patient  in  the  operative  stage  of  narcosis.  Care 
should  be  taken  not  to  allow  the  patient  to  rise  up  suddenly  during 
the  excitement  from  the  anaesthetic,  and  in  lifting  the  patient  from 
the  bed  to  the  operating  table,  care  should  be  exercised  lest  the 
patient  be  doubled  up,  or  the  chest  constricted,  thus  forcing  fluids 
into  the  trachea.  I have  seen  at  least  two  patients  almost  drowned 
in  this  way. 

Incision. — It  will  be  seen  from  the  cases  taken  from  current  litera- 
ture that  small  incisions  have  so  far  been  the  rule.  Much  stress  is 
laid  on  the  fact  of  determining  the  existence  of  adhesions,  and 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


283 


where  these  are  absent  it  is  advised  to  first  stitch  the  lung  to  the 
costal  pleura,  and  wait  until  adhesions  form  before  proceeding  to 
open  the  cavity.  It  has  always  seemed  to  me  to  be  timid,  unsurgi- 
cal,  if  w7e  have  sufficient  grounds  upon  which  to  base  the  operation, 
in  the  first  place. 

In  the  cases  reported  by  me  I violated  all  these  rules,  and  now 
looking  back  I do  not  think  I did  as  good  work  in  either  case,  as  I 
might  have  done  with  a larger  opening.  In  both  my  cases  I freed 
the  lung  from  the  chest-wall,  by  tearing  up  all  adhesions;  in  the 
first  case  it  would  have  been  necessary  to  incise  the  lung,  ip  order  to 
reach  the  cavity  ; it  would  then  have  been  imperfectly  drained,  from 
its  shape  and  situation,  and  could  not  have  contracted  as  rapidly  as 
it  did  after  loosening  it  from  its  attachments  to  the  diaphragm.  In 
the  second  case  the  patient  did  not  improve  but  remained  very  ill 
until  I tore  up  the  adhesions  and  from  that  time  on  he  constantly 
improved. 

T think  all  adhesions  should  be  broken  up,  and  the  whole  cavity 
thoroughly  drained.  I do  not  think  we  have  greater  cause  to  fear 
septic  pleurisy  after  thoracic  operations  than  we  have  cause  to  fear 
septic  peritonitis  after  abdominal  operations,  where  pus  or  other 
irritating  fluids  escape  into  the  peritoneal  cavity,  and  we  avert  all 
trouble  by  thorough  irrigation  and  complete  drainage.  Now  as  to 
the  opening  in  the  chest-wall.  Is  it  not  possible  that  in  the  future 
if  we  can  find  a feasible  way  to  open  the  lung  cavity,  that  the  ex- 
ploratory operation  for  purposes  of  diagnosis,  will  be  both  more 
common  and  more  useful  than  it  is  now  in  abdominal  surgery? 

How  then  shall  we  make  even  a guess  at  the  way  this  can  be  done, 
so  as  to  avoid  the  most  important  structures  and  yet  give  room  to 
work  with  ease? 

The  opening  should  be  so  planned  and  so  large,  as  to  give  us 
complete  control  of  the  field,  thus  allowing  us  with  the  eye  and 
finger  to  examine  every  part  of  the  pleura  and  every  portion  of  the 
pulmonary  tissue.  I have  long  been  convinced  that  the  ribs  are 
the  only  bar  to  the  complete  mastery  of  the  situation  here  ; if  there 
were  no  ribs,  or  if  these  could  be  dispensed  with,  dealing  with  the 
lung  and  its  diseases  would  present  no  special  difficulties  other 
than  those  arising  from  its  structure  and  physiological  functions. 

We  need  an  opening  here  like  that  in  the  linea  alba  in  abdominal 
surgery,  one  giving  the  minimum  of  danger  and  the  maximum  of 


284 


world’s  homoeopathic  congress. 

usefulness.  What  this  will  eventually  be,  we  can  no  more  than 
conjecture  now,  and  it  will  take  many  trials  and  much  work  to 
finally  perfect  it  and  make  it  stand  the  test  of  practical  experience. 

In  a case  of  gangrene  of  the  right  lung  resulting  from  whiskey- 
drinker’s  pneumonia,  which  presented  itself  in  the  charity  ward  of 
Grace  Hospital,  Detroit,  I determined  to  open  the  chest  after  the 
following  plan  if  necessity  demanded  operative  interference. 

The  case  began  to  improve  and  I decided  to  wait,  after  a consul- 
tation with  a number  of  my  colleagues.  Three  days  after  we  came 
to  this  decision,  the  patient  while  sitting  up  in  bed,  became  faint, 
fell  back  on  her  bed  and  expired.  Post-mortem  examination  re- 
vealed the  pleural  cavity  foul,  full  of  blood  and  covered  with 
decomposed  fibrin;  the  lower  lobe  of  the  lung  necrotic.  Death 
was  caused  by  haemorrhage,  from  the  bursting  of  a bloodvessel  in 
the  lung. 

Plan  of  Operation. — To  avoid  the  mammary  gland  I decided  to 
commence  an  incision  in  front  of  the  line  of  the  coracoid  process,  and 
carry  it  straight  across  the  ribs  to  the  scapular  line  between  the  sixth 
and  seventh  ribs. 

In  order  to  miss  the  superior  intercostal  I decided  to  commence 
the  incision  over  the  second  rib,  but  to  make  the  third  rib  the  upper 
margin  of  my  flap.  From  the  commencement  to  the  end  of  my 
proposed  line  of  incision  I intended  to  divide  all  structures  down  to 
the  ribs,  and  after  controlling  all  haemorrhage,  to  resect  portions  of 
each  rib  from  the  third  to  the  sixth.  I now  proposed  to  carry  an 
incision  between  the  sixth  and  seventh  ribs  with  a scissors  far 
enough  forward  to  give  plenty  of  room,  even  if  this  point  was  at  the 
junction  of  the  costal  cartilages  with  the  ribs.  By  now  carrying  the 
incision  along  the  junction  of  the  cartilages  and  ribs  to  the  upper 
border  of  the  third  rib,  and  from  this  point  to  the  place  of  com- 
mencement, at  the  point  where  this  rib  had  been  resected,  I would 
have  my  opening  complete.  I planned  to  allow  the  integument  to 
be  one  inch  broader  than  this  flap  around  the  whole  margin  so  that 
when  the  flap  was  laid  back  and  stitched  in  place,  the  integu mental 
suture  line  should  not  correspond  with  the  line  of  incision  into  the 
chest-wall.  The  great  question,  of  course,  was  how  to  deal  with  the 
bloodvessels;  I hoped  to  manage  these  with  plenty  of  catch  forceps, 
and  to  avoid  the  internal  mammary  by  keeping  well  away  from  the 
sternum.  I argued  that  my  carrying  my  lower  incision  to  the  point 


A CONTRIBUTION  TO  THORACIC  SURGERY. 


285 


of  election  would  give  me  a perfect  drainage-point;  that  by  resecting 
the  ribs  in  the  proposed  line  I should  make  a trap-door  flap  with  all 
the  ribs  in  it,  which  could  be  lowered  and  thus  completely  open  the 
cavity;  that  the  free  opening  would  allow  collapse  of  the  lung,  thus 
rendering  it  easier  to  manage  than  when  it  does  not  collapse  and 
moves  with  each  movement  of  the  chest  as  it  does  in  the  small 
opening. 

Observation  at  the  post-mortem  examination  convinced  me  that 
no  smaller  opening  could  possibly  have  enabled  me  to  manage  the 
gangrenous  lung  tissue.  I intended  to  clamp  and  ligature  it  in  mass, 
and  then  sear  the  stump  with  the  cautery,  or,  by  imitating  the  cases 
of  hernia  cited  above,  drag  the  diseased  lung  through  the  chest  wall, 
confine  it  there,  and  allow  nature  to  slough  it  off  at  the  line  of  con- 
striction. If  this  plan  can  be  carried  out  at  all,  it  may  be  possible 
to  include  the  second  rib  when  necessary,  or  a central  section  of  this 
rib  may  be  removed  to  allow  it  to  contract  and  help  to  contract  the 
chest- wall  after  operation. 

With  this  kind  of  an  opening  caseous  masses  could  be  felt  and 
removed,  dilated  bronchi,  when  obstructed  and  filled  with  secretion, 
incised,  drained,  irrigated,  the  foreign  body  removed  and  the  opening 
in  the  bronchus  continuously  drained  by  sewing  in  a bone  drain,  or 
closed  with  catgut.  Abscesses  could  be  incised,  curetted  and  closed 
or  cauterized  to  control  bleeding  and  left  wide  open  to  drain  into  the 
pleural  cavity  and  heal  by  granulation. 

If,  according  to  Godlee,  we  may  never  hope  to  see  a whole  lung 
successfully  removed,  we  may  yet  hope  that  large  portions  of  necro- 
tic tissue  may  be  removed  and  the  patient  recover. 

A word  more  about  the  sudden  deaths  from  slight  operations,  and 
even  from  simple  irrigation  of  the  pleural  cavity. 

In  many  of  the  reported  cases  death  occurred  after  irrigation  had 
been  practiced  many  times.  I think  some  of  these  patients  are 
killed  from  shock  caused  by  fluids  too  warm  or  too  cold  ; others  are 
drowned  by  fluids  going  into  the  trachea  through  an  open  bronchus; 
or  that,  the  lung  floated  on  top  of  the  fluid  like  a cork,  empties  partly 
pent-up  secretions  into  the  trachea  suddenly,  and  thus  causes  death 
from  asphyxia.  Thus,  one  of  my  cases  became  faint  and  livid,  but, 
on  coughing,  brought  up  much  pus  and  mucus,  and  at  once  felt 
better.  Every  portion  of  a thoracic  operation  and  after-treatment 
should  be  guarded  by  strict  observation  of  Listerian  principles. 


286 


WORLD  S HOMOEOPATHIC  CONGRESS. 


THORACOPLASTY. 


By  H.  F.  Biggar,  M.D.,  Cleveland,  O. 


At  Ventnor,  in  the  Isle  of  Wight,  is  a consumptive  hospital.  The 
location  is  very  suitable,  as  the  island  is  formed  of  limestone  rock 
covered  with  a few  inches  of  light  soil.  The  drainage  is  so  perfect 
that  no  mould  collects  in  dark  closets  or  deep  cellars.  At  this  beau- 
tiful island  hamlet  I found  patients  suffering  from  pulmonary  dis- 
eases greatly  relieved,  and  some  who  were  apparently  incurable  re- 
stored to  health  by  surgical  procedures  upon  the  walls  of  the  chest 
or  upon  the  deeper  structures  within.  The  operations  were  for 
removal  of  portions  of  the  shafts  of  ribs,  for  hydrothorax,  pyotho- 
rax,  pneumonic  abscess  and  growths  of  a sarcomatous  and  hydatid 
character. 

Estlander  has  improved  the  surgery  of  the  chest,  and  it  is  now 
abreast  with  the  advancement  of  surgery  of  the  abdomen  and  of  the 
brain.  To-day  the  ribs  are  separated  from  the  cartilages  or  sternum 
or  resected  along  the  axillary  line  for  adhesions  of  the  deep  struc- 
tures, for  the  purpose  of  freeing  the  lung  from  its  abnormal  encase- 
ment. The  ribs  thus  severed  will  fall  forward  and  meet  the  lung 
tissue,  and  permit  the  development  of  the  lung.  Where  these  adhe- 
sions exist  the  ribs  act  like  parallel  hoops  and  must  be  separated. 

Thoracoplasty  will  restore  many  who  are  now  hopelessly  con- 
demned. It  has  already  given  new  life  to  patients  afflicted  with 
osteo-chondroma  of  the  chest- walls,  to  exostosis  of  ribs,  to  neoplasm 
of  the  mediastina,  and  to  gangrene  of  the  lungs.  May  we  not  hope 
that  in  foreign  bodies  in  the  bronchi,  where  tracheotomy  has  proven 
useless,  th  it  ere  long  bronchotomy  through  the  chest-walls  may  not 
be  an  anatomical  impossibility?  If  bronchotomy  can  be  performed 
with  success,  many  lives  will  be  saved.  It  will  then  do  what  tra- 
cheotomy has  not  been  able  to  do,  as  in  that  recent  notable  case  of 
the  Rev.  Dr.  Bothwell,  of  Brooklyn,  N.  Y.,  who  inhaled  a small 
cork.  Although  his  surgeons  could  reach  the  cork  below  the  bifur- 


THORACOPLASTY. 


287 


cation  of  the  trachea  through  the  bronchus,  and  even  fixed  the  screw 
into  the  cork,  yet  they  were  unable  to  extract  it,  and  thus  a valuable 
life  was  lost.  Experiments  are  going  on  with  reference  to  this  ope- 
ration, and  it  is  found  that  the  position  of  the  arm  upward  and  for- 
ward will  separate  the  scapula  from  the  vertebrae  sufficiently  to 
permit  the  resection  of  ribs,  and  by  skillful  dissection  avoid  the 
aorta  and  nerves,  and  thus  reach  the  primary  bronchi.  As  yet,  these 
experiments  on  dogs  have  proved  fatal.  Were  bronchotomy  re- 
sorted to  before  any  other  operation,  the  chances  of  success  might 
be  better.  The  question  arises,  would  the  surgeon  be  justified  in 
first  operating  for  bronchotomy  without  resorting  to  tracheotomy? 

The  following  is  a report  of  five  clinical  cases  demanding  surgical 
interference.  One  case  recovered  without  an  operation,  and  one 
recovered  where  two  operations  were  performed  without  accomplish- 
ing the  end  intended,  except  that  he  was  benefited  in  the  operation 
per  se. 

Case  I. — Resection  of  a portion  of  the  shaft  of  the  sixth  rib. 

Mrs. , set.  37,  mother  of  five  children,  had  a history  as  follows: 

A retro-mammary  abscess  of  the  left  side,  with  necrosis  of  the  sixth 
rib.  The  abscess  had  appeared  fifteen  months  previous  to  my  first 
visit.  General  health  impaired  and  patient  ansemic.  Douglas’s 
pouch  contained  fluid.  I removed  the  necrosed  part  of  the  rib,  aspi- 
rated Douglas’s  pouch  per  vaginam,  and  removed  two  ounces  of  pus. 
Gave  Silicea  30x.  Recovery.  Query:  Did  the  pus  burrow  from 
the  left  mamma  to  the  diaphragm,  thence  through  the  ligamentum 
arcuatum  externum,  by  way  of  the  quadratus  lumborum,  or  may  it 
have  followed  the  sheath  of  the  abdominal  aorta  to  the  pelvis,  filling 
Douglas’s  pouch  ? 

Case  II. — Thoracoplasty.  Resections  of  portions  of  the  shafts 
of  the  sixth  and  seventh  ribs. 

October,  1892,  J.  B.,  set.  43,  laborer.  In  February,  1892,  had 
pleuro-pneumonia,  which  terminated  in  pneumonic  abscess  with  per- 
foration of  the  chest-wall,  at  the  sixth  space,  two  inches  below  the 
nipple  and  to  the  left.  Previous  to  coming  to  me,  while  in  another 
hospital,  drainage  was  attempted.  The  health  was  much  impaired, 
the  urine  albuminous.  The  probe  could  touch  the  chest-wall  at  a 
point  corresponding  to  the  inferior  angle  of  the  scapula.  Removed 
three  inches  of  the  sixth  and  seventh  ribs.  The  fistula  was  a guide 
to  the  abscess,  which  was  very  large,  as  determined  by  the  probe. 


288 


world’s  homoeopathic  congress. 


The  abscess  was  irrigated  with  a 1 per  cent,  solution  of  carbolic 
acid  and  drained.  The  patient  did  not  do  well,  so  changed  the  irri- 
gation to  an  injection  of  bichloride  of  mercury  in  the  proportion  of 
1 to  10,000  and  15,000;  still  no  improvement;  then  gave  perman- 
ganate of  potash  for  awhile,  which  was  followed  with  boracic  acid. 
The  general  health  did  not  improve,  and,  being  suspicious  of  the 
medicated  irrigations,  they  were  omitted.  Washed  with  sterilized 
water,  and  the  patient  gradually  improved ; the  cavity  filled  up  and 
the  left  chest  increased  coequal  with  the  right.  The  case  was  tedious, 
for  he  was  very  indiscreet  in  regard  to  intemperance  and  exposure. 
Remedies,  Hepar  and  Bryonia.  The  abscess  was  connected  with  a 
bronchus. 

Method  of  Operation. — The  operation  was  performed  as  follows : 
The  patient  was  given  a general  soap  bath  the  day  before  the  opera- 
tion. A thorough  action  of  the  bowels  the  night  before,  and  the 
morning  of  the  operation  the  axillary  cavity  shaved.  Examination 
of  the  water  showed  albumen.  At  the  time  of  the  operation  the 
chest  was  washed  with  bichloride  of  mercury  1 to  2000,  and  the  sur- 
rounding parts  protected  with  towels  saturated  with  the  mercurial 
solution.  A vertical  incision  of  four  inches  was  made  over  the 
opening  of  the  fistulous  tract  and  down  to  the  intercostal  muscles; 
the  parts  were  forcibly  retracted  and  the  periosteum  of  the  sixth  and 
the  seventh  ribs  split  in  the  middle  line  of  the  long  axis  of  the 
shafts.  With  the  staphylorraphy  periosteum  peeler  of  Mr.  Thomas 
Smith,  the  periosteum  is  easily  separated  from  the  inner  surfaces  of 
the  ribs  to  the  extent  desired.  Removing  the  periosteum  in  this 
way,  the  intercostal  arteries  are  better  secured,  and  we  avoid  any 
haemorrhage.  The  ribs  were  severed  with  a Hayes  saw;  a broad 
metal  retractor  was  placed  under  the  rib,  protecting  the  pleura;  the 
edges  of  the  cut  ribs  were  smoothed  with  bone  forceps,  and  the  peri- 
osteum of  both  ribs  cut  through  the  middle  with  blunt-pointed  scis- 
sors, and  used  as  coverings  to  the  ends  of  the  ribs,  after  the  manner 
of  periosteal  flaps  in  amputations.  The  pleura  is  in  full  view.  A 
soft  metal  probe  is  put  into  the  fistulous  tract,  which  serves  as  a 
guide,  and  the  opening  gradually  enlarged  by  dilators  sufficient  to 
insert  a large  drainage-tube.  The  abscess  is  thoroughly  cleaned  with 
carbolic  acid  solution  of  1 per  cent.,  drainage-tube  inserted  and  held 
in  position  by  the  eyelet  of  the  flange ; the  edge  of  the  external  in- 
cision is  sutured  with  a silkworm-gut;  the  mouth  of  the  tube  pro- 


THORACOPLASTY. 


289 


tected  with  sterilized  gauze,  covered  with  a rubber  dam,  and  the 
dressing  is  complete.  The  patient  was  given  Hypericum  3x  every 
two  hours.  The  next  day  the  outside  soiled  dressings  were  removed, 
the  cavity  washed  out  with  a carbolic  acid  solution  of  1 per  cent., 
and  the  sterilized  gauze  applied  and  covered  with  the  rubber  dam. 
The  same  manner  of  dressing  was  continued  for  ten  days,  with  the 
exception  of  the  medicated  washings.  The  carbolic  acid  , solution 
was  changed  to  the  bichloride,  1 to  5000,  then  1 to  15,000.  This 
was  continued  for  four  days,  when  permanganate  of  potash  was  sub- 
stituted for  three  days ; then  boracic  acid  for  three  days.  These 
medicated  washings  seemed  to  retard  the  process  of  healing.  Finally,, 
sterilized  water  was  used,  but  the  chest-pains  were  not  relieved.  All 
were  abandoned  and  the  patient  began  .to  improve.  The  drainage- 
tube  was  changed  every  three  days,  and  at  the  end  of  six  weeks  re- 
moved, the  patient  being  virtually  well.  On  examination,  the  urine 
was  normal.  The  diet  was  sustaining  and  nutritious. 

Case  III. — Thoracoplasty.  Resection  of  four  inches  of  the  shaft 
of  the  seventh  rib. 

Mrs. , set.  29,  married,  one  child.  Fell  down  a flight  of  stairs 

and  struck  the  newel  post,  injuring  the  seventh  rib  of  the  right  side 
immediately  below  the  nipple.  The  accident  was  followed  with  peri- 
ostitis and  necrosis.  The  rib  was  curetted  to  the  healthy  tissue,  the 
disease  of  the  bone  returned,  and  I resected  four  inches  of  the  seventh 
rib  with  recovery. 

Case  IV. — Thoracocentesis,  followed  by  thoracoplasty.  Resec- 
tion of  the  shafts  of  the  sixth  and  seventh  ribs. 

Miss  L.,  set.  23.  In  August,  1886, 1 removed  a 47-pound  ovarian 
tumor.  In  May,  1887,  her  physician,  of  the  opposite  school,  called 
me  in  consultation  for  pleuritic  elfusion.  Thoracocentesis  was  de- 
cided upon,  and  we  removed  fifty-two  ounces  of  serum.  Did  not 
completely  empty  the  cavity.  Drainage  was  established  by  another 
opening  above  at  the  fifth  space.  Septic  symptoms  followed,  and  we 
resected  three  inches  of  the  sixth  and  seventh  ribs.  The  patient  im- 
proved for  a few  weeks,  but  died,  twelve  weeks  after  the  resection, 
from  tuberculosis. 

Case  V. — Thoracostenosis,  thoracoplasty.  Resection  of  the  shafts 
of  the  sixth  and  seventh  ribs. 

Lilly  S.,  set.  10.  Four  years  before  operation  fell  against  a door- 
knob, injuring  the  left  side.  Pneumonic  abscess  formed,  involving 

19 


290 


world’s  homoeopathic  congress. 


lobes  of  the  left  lung,  with  spontaneous  perforation  at  the  sixth  space. 
There  was  deformity  of  the  left  chest  from  collapse  of  the  entire 
lung.  The  thoracometer  showed  four  inches  difference  in  the  semi- 
circumference, lateral  curvature  of  the  spine;  the  patient  was  ema- 
ciated and  hectic;  temperature,  102.4;  pulse,  135;  the  fingernails 
were  clubbed  ; the  pyrexia  was  continuous;  oedema  of  the  skin  pro- 
nounced ; and  the  urine  albuminous.  I resected  three  inches  of  the 
sixth  and  seventh  ribs,  and  explored  the  lung  cavity,  which  was  so 
large  that  the  finger  could  easily  surround  the  apex  of  the  heart. 
Curetted  the  cavity,  washed  out  with  sterilized  water,  and  gave  Ar- 
senicum. Good  recovery,  with  partial  reduction  of  the  contour  of 
the  chest  and  a lessening  of  the  curvature  of  the  spine.  The  abscess 
was  connected  with  bronchus. 

Case  VI. — Thoracoscopy. 

Mr.  , set.  19,  unmarried,  attempted  suicide  by  shooting  with 

a revolver  in  the  left  chest.  The  ball  entered  the  fourth  intercostal, 
midway  between  the  nipple  and  the  middle  of  the  sternum,  and  was 
imbedded  in  the  walls  of  the  heart , perhaps  in  the  septum,  between 
the  left  ventricle  and  auricle.  The  physicians  who  arrived  before 
me  probed  and  found  the  location  of  the  ball.  By  keeping  the 
probe  on  the  ball,  the  probe  was  moved  corresponding  to  the  heart’s 
contraction.  Did  not  interfere  surgically.  The  patient  was  care- 
fully nursed  and  all  inflammatory  symptoms  kept  in  subjection  with 
Hypericum,  Aconite  and  Bryonia.  In  two  weeks  he  left  the  hospital 
and  is  now  living,  though  eleven  years  have  passed  since  the  shoot- 
ing. 

Case  VII. — Tracheotomy  for  foreign  body. 

Master  C.,  set.  13,  had  a bone  collar-button  lodged  in  his  air- 
passage.  He  came  to  the  hospital  eleven  months  after  the  accident. 
The  boy  was  emaciated  and  hectic,  and  the  right  lung  was  seriously 
implicated.  I performed  tracheotomy  low  down,  but  failed  to  find 
the  button.  Within  four  days  after  the  operation  the  patient  began 
to  improve  in  his  general  health,  yet  we  felt  certain  that  the  button 
was  not  dislodged  by  the  operation.  The  parents  were  solicitous  for 
another  trial.  After  the  lapse  of  six  days  the  tube  was  removed 
from  the  trachea,  and  exploration  carefully  and  thoroughly  made. 
The  second  attempt  was  also  a failure  as  to  the  finding  of  the  button, 
yet  the  patient  continued  to  improve,  and  returned  to  his  home  in 
Virginia,  having  been  in  the  hospital  a month.  About  two  months 


THORACOPLASTY. 


291 


after  his  return,  during  a violent  fit  of  coughing,  he  expectorated 
the  button.  His  health  is  completely  restored. 

Suggestions. — Before  the  operation,  let  the  patient  and  operator 
closely  observe  antiseptics  and  have  the  technique  of  the  operation 
perfect. 

If  an  aspirator  is  to  be  used,  boil  the  needle  in  soda  or  liquor  po- 
tassse  before  sterilizing. 

Before  inserting  the  needle,  pull  the  skin  a little  to  one  side  be- 
fore cutting,  and  make  a valve-like  flap,  which  may  be  of  service 
later. 

Before  inserting  the  aspirator,  use  a hypodermic  syringe ; it  will 
determine  the  character  of  the  fluid,  if  any. 

If  there  are  pus  clots,  or  if  the  discharge  is  foetid,  wash  out  the 
cavity  after  excision  with  boracic  acid,  permanganate  of  potash, 
Labbarraque  sol.,  or  carbolic  acid  1 per  cent.  When  clots  or  foetid 
discharges  are  removed,  cease  the  irrigation. 

The  thoracic  fistula  will  assist  in  determining  the  parts  of  the  ribs 
to  be  resected. 

If  there  is  no  fistula,  try  and  establish  drainage  along  the  axillary 
line,  in  front  of  the  latissimus  dorsi  muscle,  where  the  pleura  is  more 
prominent,  and  between  the  eighth  and  fifth  ribs,  in  front  of  the 
angle  of  the  scapula. 

The  pleura  may  be  very  thick,  so  guard  the  trocar  or  knife,  that 
it  may  not  puncture  the  lung. 

The  semi-  or  recumbent  position  is  the  best. 

If  merely  thoracocentesis,  watch  the  pulse,  for  fear  of  syncope.  If 
blood  appears  in  the  fluid  drawn,  or  the  patient  coughs,  stop. 

Never  empty  the  cavity  at  the  first  drawing.  Examine  the  urine 
for  Bright’s  disease  or  amyloid  changes. 

The  safest  and  best  irrigant  is  sterilized  water.  For  foetid  dis- 
charges use  carbolic  acid,  permanganate  of  potash,  Labbarraque  sol., 
or  boracic  acid. 

Recollect  that  a small  diseased  area  may  secrete  large  quantities  of 
pus. 

If  the  space  between  the  ribs  is  so  narrow  as  to  interfere  with 
proper  drainage,  remove  an  inch  of  a rib. 

Let  the  dressings  be  enveloped  with  rubber  dam. 

If  the  abscess  is  large,  two  openings  are  better  by  resection  of  the 
ribs  above  and  below. 


292 


world’s  homoeopathic  congress. 


Avoid  the  intercostal  artery ; it  lies  along  the  inferior  border  of 
the  rib. 

In  punctured  wounds  of  the  lung,  if  hemorrhage  exists,  carefully 
examine  the  intercostal  artery. 

Higgins’s  empyema-tube,  with  flange,  is  the  best  thoracic  drain- 
age-tube. A corrugated  white  rubber  tube  is  next  best.. 

Use  the  thermo-cautery  in  deep-seated  disease. 

In  gangrene  of  the  lung  the  only  hope  is  in  thoracoplasty. 

After  resection  of  the  ribs  use  the  thermo-cautery  in  its  removal. 
The  mortality  is  large,  but  without  it  the  case  is  hopeless. 

Beware  of  the  drainage-tube.  A physician  failed  to  guard  a tube 
with  a safety-pin.  It  slipped  into  the  pleural  cavity,  and  I had  to 
resect  a portion  of  a rib  to  remove  the  lost  tube. 

Exclude  air  from  the  operations  upon  the  chest-wall  as  far  as  pos- 
sible. Blunt  knives  are  preferable  to  sharp  ones. 

In  foreign  bodies  in  bronchi,  statistics  are  in  favor  of  non-surgical 
interference. 

Do  not  remove  the  drainage-tube  too  soon. 

It  is  not  always  necessary,  though  it  is  safer,  to  excite  adhesions 
of  the  pleura  before  operating. 

Chloroform  is  the  best  anaesthetic.. 

If  cavities  are  to  be  opened,  if  possible  do  not  enter  from  behind 
for  fear  of  haemorrhage,  from  severing  vessels  which  mainly  lie  along 
the  posterior  part  of  the  bronchi. 

In  injuries  to  the  chest  from  bullets  be  cautious  in  probing,  and 
carefully  deliberate  before  attempting  the  extraction  of  the  ball. 

I have  found  that  washings  of  lung  cavities,  as  a rule,  are  inju- 
rious, and  not  demanded  after  pus-clots  and  foetid  discharges  cease. 

For  thoracocentesis  I use  Tiemann  & Co.’s  aspirator. 

Do  not  “ incise  a putrid  cavity  of  the  lung  unless  the  pleural  sur- 
faces are  adherent.” 

In  “ localized  gangrene,  if  it  has  already  lasted  some  time,  the 
danger  is  not  so  great ; adhesions  are  usually  present  under  these 
conditions,  and  the  lung  is  so  consolidated  by  inflammation  that  it 
is  in  but  slight  danger  of  collapsing.” 

“ In  acute  cases  and  in  bronchiectasis  it  is  impossible  to  be  cer- 
tain. An  attempt  may  be  made  to  find  out  by  ascertaining  the  mo- 
bility of  the  lung.  If  a needle  be  driven  through  an  intercostal 
space  into  the  pulmonary  tissue,  it  will  show  to  a certain  extent  by 


THORACOPLASTY. 


293 


its  movement  whether  the  lung  is  fixed  or  not.  In  some  instances 
it  may  be  possible  to  suture  the  two  surfaces  together  and  wait  for  a 
week,  or  to  procure  adhesions  by  means  of  the  cautery  applied  to  the 
intercostal  muscles.” 

Are  tracheotomies  necessary  for  the  removal  of  foreign  bodies  from 
the  air-passages  ? 


294 


world’s  homoeopathic  congress. 


VIVISECTION  AND  PULMONARY  SURGERY. 

By  Walter  F.  Knoll,  M.D.,  Chicago,  III. 


Modern  surgery  has  made  it  possible  to  safely  enter  every  cavity 
of  the  body  except  the  thorax.  Except  for  a few  simple  lesions  and 
under  very  special  conditions,  it  keeps  a closed  door,  and  the  faith- 
ful and  aggressive  surgeon  must  pass  by  and  leave  his  patient  to  the 
few  meagre  chances  which  nature  parcels  out  to  him.  The  many 
methods  which  have  been  adopted  and  tested  for  surgical  interference 
with  the  organs  of  the  thorax  have  been  in  a large  measure  unsatis- 
factory. It  is  only  in  diseases  of  the  thoracic  wall  and  the  pleurae 
that  our  ideal  has  been  imperfectly  attained.  The  names  of  Est- 
lander,  Koch,  and  Bull  are  inseparably  connected  with  the  progress 
which  has  been  made  in  this  direction.  When  the  surgeon  has  at- 
tempted to  go  beyond  these  structures  there  were  two  serious  com- 
plications which  have  confronted  him,  and  which  have  in  a measure 
barred  his  further  progress.  The  first  of  these  is  haemorrhage  and 
the  second  is  collapse  of  the  lung.  The  former  is  now  fairly  well 
managed  with  the  actual  cautery  and  aseptic  ligature,  but  the  latter 
remains  an  unsettled  problem. 

About  ten  years  ago,  when  pulmonary  surgery  was  a subject  of 
special  study,  I became  intensely  interested,  and  from  that  time  to 
the  present  I have  carefully  noted  the  experiments  and  the  reports 
of  clinical  work  of  other  men,  and  in  all  my  thorectomies  for  pleural 
and  costal  diseases,  and  in  my  vivisections  for  class  demonstrations, 
I have  tried  to  discover  some  means  by  which  the  lung  and  pericar- 
dium could  be  operated  upon  without  danger  from  haemorrhage  or 
collapse  of  the  lung. 

The  enthusiasm  which  was  then  manifested  in  this  work  is  well- 
known  to  the  members  of  this  Congress,  and  it  perhaps  has  lost 
none  of  its  interest  even  at  the  present  time.  The  large  number  of 
localized  lung  diseases  which  are  untouched  by  remedies  or  climate, 
and  which  in  spite  of  all  the  known  means  at  our  command  gradu- 


VIVISECTION  AND  PULMONARY  SURGERY. 


295 


ally  progress  until  they  destroy  the  life  of  the  patient,  has  made  pul- 
monary lesions  in  all  time  the  most  interesting  and  important  subject 
in  the  category  of  diseases.  Every  surgeon  at  that  time  was  testing 
his  skill,  and  the  surgical  journals  were  reporting  with  each  issue 
new  cases  of  pneumotomy  and  pneumectomy.  A young  Italian  sur- 
geon was  so  confident  of  the  efficacy  of  his  art  that  when  his  fiancee 
was  blushing  with  the  fire  of  an  incipient  phthisis,  tested  his  skill, 
and  when  he  was  rewarded  with  a bitter  failure  ended  his  existence 
with  his  own  hand.  The  interest  did  not  abate  until  the  cool  and 
logical  statistician  published  the  reports  of  cases  and  showed  the 
futility  of  the  efforts  which  had  been  made.  But  from  these  statistics 
a few  important  deductions  may  be  drawn,  and  they  clearly  point  to 
a road  which  ultimately  must  lead  to  success.  Of  the  successful 
cases  reported  there  were  present  antedating  the  operation  certain 
pathological  changes  in  the  pleurae,  and  they  were  produced  either 
as  a part  of  the  disease  for  which  the  operation  was  made  or  else  as 
independent  processes.  In  80  per  cent,  of  the  successful  pneumecto- 
mies  reported  there  were  firm  adhesions  betwten  the  costal  and  pul- 
monary pleurae,  and  to-day  it  is  a law  well  established  in  pulmonary 
surgery  never  to  attempt  to  operate  upon  the  lung  unless  there  are 
extensive  pleuritic  adhesions,  and  Dr.  Koch  has  given  us  a reliable 
test  by  which  this  can  always  be  known  before  the  operation  is 
undertaken.  He  says,  thrust  a long  needle  into  the  lung,  and  re- 
quest the  patient  to  breathe.  If  the  outer  end  of  the  needle  rises 
with  inspiration  and  falls  with  expiration,  there  are  no  adhesions. 
If  the  outer  end  of  the  needle  does  not  change  its  relation  to  the 
body  with  respiration  there  are  adhesions.  Firm  pleuritic  adhesions 
are  an  absolute  prerequisite  before  lung  tissue  can  be  safely  interfered 
with  surgically.  When  this  is  accomplished  the  lung  falls  within 
the  dominion  of  surgery,  and  he  deals  with  it  as  he  does  with  the 
rest  of  the  organs  of  the  body. 

During  the  past  few  years  I have  slowly  worked  out  a method  by 
which  these  adhesions  can  be  produced  by  artificial  means,  and  the 
lung  tissue  entered  and  operated  upon  without  fear  of  collapse  of  the 
organ  or  great  danger  from  haemorrhage.  While  some  authors  teach 
that  the  collapse  of  a lung  during  an  operation  is  no  serious  compli- 
cation, yet  those  who  have  had  the  unfortunate  occurrence  have 
fears  which  are  not  founded  upon  theory.  The  immediate  shock 
aud  the  subsequent  sepsis  and  countless  other  coincidences  make  it 


296 


world’s  homceopathic  congress. 


imperative  upon  the  surgeon  never  to  court  such  a danger.  The  means 
by  which  I have  produced  pleuritic  adhesions  and  the  results  which 
I have  obtained  upon  the  lower  animals,  I shall  briefly  recount. 
The  animal  wThich  is  selected  for  the  experiments  is  a dog.  The  side 
upon  which  the  operation  is  made  is  shaved  and  rendered  clean  and 
aseptic.  The  operator,  assistants,  instruments  and  materials  used 
during  the  operation  and  for  the  dressing  are  prepared  with  all  pos- 
sible care.  The  animal  is  placed  under  an  anaesthetic,  and  when  the 
region  over  the  particular  part  of  the  lung  which  is  to  be  operated 
upon  has  been  selected,  an  incision  is  made  along  the  course  of  the 
rib  through  the  skin  and  adipose  tissue  about  four  to  six  inches  in 
length.  This  tissue  is  dissected  from  the  muscles  on  either  side  of 
the  line  of  the  incision  for  about  one  and  a half  inches.  The  folds 
are  held  back  with  two  retractors  in  the  hand  of  an  assistant,  a needle 
made  especially  for  this  work,  threaded  with  number  8-10  catgut,  is 
held  in  a strong  needle  holder. 

The  operator  places  the  thumb  and  index  finger  of  his  left  hand 
on  a rib  at  a point  which  marks  the  outer  border  of  the  area  which 
the  adhesions  are  to  take  place.  The  needle  is  then  passed  close  by 
the  thumb  through  the  intercostal  tissue  down  into  the  lung,  carried 
through  a section  of  the  lung  tissue  and  out  through  the  intercostal 
space  on  the  other  side  of  the  rib.  The  stitch  includes  a rib,  inter- 
costal muscles  and  lung  tissue.  It  is  tied  with  only  a mild  amount 
of  tension  for  fear  of  tearing  the  lung  tissue.  A second  one  is  passed 
in  the  same  manner  as  the  former,  and  only  a quarter  of  an  inch 
from  it,  a third  and  so  on  until  the  lung  has  been  stitched  to  the  rib 
for  two  or  more  inches.  Now,  on  either  side  of  the  rib  and  corres- 
responaing  with  it  the  intercostal  tissue  is  stitched  to  the  lung  by  a 
back  and  under-stitch  so  placed  as  to  include  all  of  the  pulmonary 
pleura  and  fasten  it  to  the  chest  wall.  If  it  is  desired  to  remove 
more  than  one  rib  or  extend  the  operation,  a second  rib  and  inter- 
costal space  can  be  treated,  as  the  former  and  the  field  are  made 
almost  indefinite  in  size.  The  intercostal  stitches  are  placed  at  right 
angles  with  the  costal  ones.  The  kind  of  stitch  used  is  the  con- 
tinuous, as  it  answers  every  purpose  and  expedites  the  operation. 
In  the  centre  of  the  field  of  operation  a silk  thread  is  carried  around 
the  rib  to  serve  as  a landmark  in  making  the  second  operation. 
Catgut  absorbs  rapidly,  and  in  several  secondary  operations  I could 
not  find  a vestige  of  the  catgut.  The  wound  was  made  clean  and 


VIVISECTION  AND  PULMONARY  SURGERY. 


297 


thoroughly  asceptic.  Iodoform  is  sprinkled  over  it,  a piece  of  iodo- 
form gauze  laid  over  the  stitches,  the  end  of  which  hangs  out  of  the 
lower  end  of  the  wound.  The  skin  is  loosely  fastened  over  the  gauze 
with  a loose  continuous  suture,  and  the'  wound  closed  with  a vo- 
luminous antiseptic  dressing.  This  latter  need  not  be  removed  for 
from  five  to  seven  days  unless  there  are  evidences  of  sepsis,  and  in 
such  an  event  it  is  treated  the  same  as  an  infected  wound.  There  is 
no  danger  of  septic  material  entering  the  thoracic  cavity.  At  the  end 
of  from  six  to  eight  days  the  secondary  operation  can  be  made,  which 
consists  usually  of  the  resection  of  a rib  and  the  entrance  through 
the  pleura  into  the  lung  with  the  actual  cautery.  It  is  not  neces- 
sary in  all  cases  to  remove  the  rib,  but  since  generally  one  requires 
more  space  than  can  be  obtained  between  the  ribs  the  method  which 
I have  mentioned  is  the  best.  The  depth  which  one  can  go  in  the 
lung  with  the  cautery  depends  upon  the  size  of  the  subject.  It  seems 
safe  to  go  fully  one-half  the  thickness  of  the  lung,  and  the  incision 
should  be  in  line  with  the  ribs  to  avoid  cutting  into  the  adjoining 
lobes  which  may  be  in  close  proximity  to  the  spine.  To  accomplish 
this  work  easily  it  is  necessary  to  state  some  of  the  rules  which  have 
been  learned  by  experience.  In  my  early  attempts  I resected  the 
rib  first  and  then  tried  to  stitch  the  costal  to  the  pulmonary  pleura, 
but  the  tissue  was  so  thin  and  yielding  that  air  invariably  followed 
the  track  of  the  needle,  and  either  collapse  of  the  lung  or  sepsis  re- 
sulted, and  sometimes  both.  Then  I removed  all  of  the  muscles 
except  the  internal  intercostal  and  stitched  without  resecting  the  rib; 
this  also  was  a failure  for  the  same  reasons  as  the  former.  Then 
finally  no  muscular  tissue  was  removed,  the  stitches  introduced  as 
recommended,  and  every  trial  was  successful.  I am  of  the  opinion 
that  in  the  human  subject  where  there  is  much  emaciation,  one  can 
stitch  through  skin  and  all  without  making  the  primary  incision  and 
dissection.  There  must  always  be  enough  extra  pleural  tissue  to 
close  the  tract  of  the  needle.  The  number  of  stitches  which  one 
uses  has  nothing  to  do  with  the  results  so  long  as  enough  are  applied. 
The  ordinary  needle  is  of  little  value  in  this  work.  The  curve  is 
not  correct,  and  the  cutting  surface  reaches  too  far  along  the  shaft. 
For  ray  last  experiments  I used  a needle  which  I had  constructed 
especially  for  this  work.  It  is  made  of  round  steel  wire  with  a spear 
point,  the  edges  of  which  extend  only  about  one-eighth  of  an  inch 
along  the  side.  All  the  tissues  are  easily  punctured  and  the  long 


298 


world’s  homoeopathic  congress. 


tapering  cutting  point  of  the  ordinary  surgical  needle  did  an  amount 
of  wounding  which  was  wholly  unnecessary.  These  needles  are 
bent  on  a perfect  circle,  and  they  extend  T9g  of  a complete  circle. 
The  diameter  of  the  circle  is  one  and  a half  to  two  inches.  They 
can  be  obtained  from  Truax,  Greene  & Co.,  of  Chicago. 

Before  the  operation  is  begun  the  pulmonary  lobes  must  be  outlined 
and  their  limits  avoided  unless  one  wishes  to  stitch  two  of  them 
together  and  produce  adhesions  between  the  lobes  as  well  as  between 
the  pleurae.  But  fortunately  for  surgery  in  a large  percentage  of 
the  diseases  for  which  this  treatment  is  indicated  the  difficulty  is 
primarily  intra-lobar.  There  is  no  part  of  the  chest  which  cannot 
be  entered  so  long  as  the  rules  which  I have  given  are  carefully 
observed. 

In  pericarditis  with  effusion,  where  the  fluid  cannot  be  removed 
with  an  aspirator,  preliminary  stitching  followed  by  resection  and 
drainage  may  some  day  be  considered  advisable  and  proper. 

The  results  which  I have  thus  far  obtained  upon  dogs  are  emi- 
nently satisfactory.  The  specimens  which  I will  show  you  prove 
how  absolutely  harmless  it  is  to  both  lung  and  pleurae.  There  are 
no  traces  of  pneumonitis  and  the  pleuritis  is  confined  wholly  to  the 
tissues  enclosed  in  the  suture.  The  adhesions  are  firm,  and  if  the 
suturing  had  been  done  as  thoroughly  as  in  the  later  cases  the  ad- 
hesions would  cover  the  whole  area.  The  animal  was  killed  eight 
days  after  the  preliminary  suturing.  What  inferences  may  we  draw 
from  these  experiments,  and  what  value  are  they  to  humanity  ? In 
my  judgment  it  furnishes  a new  hope  to  a large  number  of  our  race 
who  by  the  aid  of  our  present  knowledge  of  therapeutics  are  under 
sentence  of  death.  The  child  with  a foreign  body  in  a bronchus, 
the  athlete  with  a ruptured  lobule  and  subsequent  infection  and 
abscess,  the  victim  of  a localized  tuberculosis,  the  pysemic  with  a 
metastatic  pulmonary  abscess,  the  victim  of  a pulmonary  cyst  or 
tumor,  and  indeed  many  others  which  could  be  mentioned  are  subjects 
which  under  this  treatment  can  find  relief  and  cure. 

If  opening  a tubercular  joint  and  removing  the  colonies,  followed 
by  perfect  drainage,  cures  the  limb  when  all  other  methods  have 
failed,  is  it  not  reasonable  to  believe  that  the  same  treatment  applied 
to  lungs  will  give  equally  good  results  ? The  great  reason  why  lung 
tissue,  when  it  begins  to  degenerate,  shows  so  little  disposition  to 
repair  is  because  the  drainage  at  best  is  imperfect  and  difficult. 


VIVISECTION  AND  PULMONARY  SURGERY. 


299 


I have  known  several  cases  in  my  practice,  and  there  are  perhaps 
members  in  this  Congress  who,  by  lowering  the  head  and  chest,  have 
evacuated  a pulmonary  abscess,  and  which  marked  a change  in  the 
tide  of  their  diseases.  Drainage  properly  established  is  the  greatest 
remedy  for  restoring  degenerating  tissue,  and  by  the  methods  here 
outlined  it  can  always  be  accomplished.  However,  I have  no  boast- 
ful claim  to  make.  I shall  carefully  submit  it  to  time  and  test,  the 
two  elements  which  ultimately  settle  the  intrinsic  value  of  every 
innovation. 

Discussion. 

C.  E.  Walton,  M.D.,  of  Cincinnati,  who  had  been  assigned  to  a 
discussion  of  Dr.  Biggar’s  paper,  then  presented  his  views  as 
follows : 

The  papers  just  presented  are  valuable  for  two  reasons:  first,  on 
account  of  what  they  specifically  state  and  illustrate,  and,  secondly, 
on  account  of  what  they  leave  unsaid,  but  suggest.  The  subject  of 
thoracic  surgery  is  both  new  and  old — so  old,  in  fact,  that  having 
been  well-nigh  forgotten,  it  comes  to  us  in  its  recent  resurrection  with 
all  the  impetus  of  a novelty.  We  have  been  kindly  spared  the  recital 
of  the  history  of  thoracic  surgery,  and  have  been  introduced  at  once 
to  one  of  its  most  modern  phases.  I cannot  forbear,  however,  al- 
luding to  the  first  authentic  operation  of  rib  resection,  done  ages  ago, 
under  the  influence  of  a profound  anaesthesia,  and,  judging  from  the 
results,  according  to  the  principles  of  an  enlightened  antisepsis : 
“ And  the  Lord  God  caused  a deep  sleep  to  fall  upon  Adam,  and  he 
slept;  and  he  took  one  of  his  ribs,  and  closed  up  the  flesh  instead 
thereof.’7  This  operation,  however,  has  not  been  reported  as  forming 
a basis  for  surgical  imitation,  but  those  who  always  want  authority 
for  their  procedures  can  find  some  warrant  in  this  bit  of  history  for 
the  so-called  mutilation  of  the  human  form  divine.  What  was  done 
with  that  rib  is  “ another  story,77  and  foreign  to  the  subject  in 
hand. 

Passing  from  sacred  to  profane  history,  we  find  that  Hippocrates 
defined  the  technique  of  thoracic  puncture  for  the  treatment  of  lung 
abscess  two  thousand  years  ago,  and  to-day  his  principles  remain 
unchanged. 

It  is  not  to  be  expected  that  the  discussant  of  a paper  from  so 
eminent  a gentleman  as  Professor  Biggar  shall  accept  unchallenged 
all  his  statements,  even  though  they  come  from  such  a distinguished 
source.  I gladly  take  issue  with  the  announcement  of  an  anatomi- 
cal impossibility  when  of  a possible  bronchotomy  he  says  that  the 
position  of  the  arm  upward  and  forward  will  separate  the  vertebras 
sufficiently  to  permit  the  resection  of  ribs,  etc. 

He  taught  me  better  anatomy  than  that  more  than  twenty  years 


300 


world’s  homceopathic  congress. 


ago,  and  I know  that  back-bones  do  not  grow  limber  with  age  to 
such  an  extent  as  to  warrant  this  declaration  unless  based  upon  his 
own  personal  experience. 

That  position  of  the  arm  will  widen  the  space  between  the  inner 
border  of  the  scapula  and  the  vertebral  column,  and  thus  render  the 
ribs  more  accessible,  but  the  vertebrae  will  interlock  as  closely  as 
ever. 

Again,  I question  the  location  of  pus  in  the  case  recited  where  it 
is  said  to  have  been  found  in  Douglas’s  pouch.  The  pus  was  aspi- 
rated per  vaginam,  it  is  true,  but  that  pus  was  extra-peritoneal  or 
else  his  patient  had  established  a most  unheard  of  tolerance  of  pus 
in  the  peritoneal  cavity.  Pus  has  been  known  to  separate  the  dia- 
phragm and  strip  up  the  peritonaeum  and  thus  appear  in  the  pelvis, 
but  it  would  scarcely  find  its  way  through  the  peritonaeum  without 
setting  up  a most  violent  inflammation. 

These  papers  emphasize  what  is  to  be  done  for  empyema,  what  is 
to  be  done  for  gangrene  of  the  lung,  and  what  is  not  to  be  done  for 
foreign  bodies  and  gunshot  wounds.  The  conclusions  reached  seem 
to  me  to  call  for  hearty  approval. 

The  empyemic  cavity  is  an  abscess  from  which  sound  surgical 
principles  demand  that  we  remove  the  pus;  in  which  we  are  to  limit 
and  prevent  the  formation  of  pus ; and  to  which  we  are  to  restore  as 
far  as  possible  the  intra-thoracic  pressure. 

The  principle  which  demands  the  amputation  of  a gangrenous 
area  is  novel  only  from  the  location  of  the  field  of  operation. 

In  regard  to  the  removal  of  foreign  bodies,  whilst  statistics  of  more 
than  a thousand  cases  show  that  non-interference  has  met  with  the 
best  result,  the  truth  seems  to  me  to  lie  very  close  to  the  statement 
that  every  case  both  of  foreign  body  and  of  gunshot  wound  is  a 
unique  case  and  its  management  will  depend  upon  its  own  peculi- 
arities. 

Not  every  sinus  indicates  a thoracic  cavity  opening.  Not  every 
foreign  body  can  be  shaken  out  by  the  heels.  Not  every  bullet  is 
an  instrument  of  death  even  though  it  takes  up  its  residence  in  the 
very  structure  of  the  heart. 

The  behavior  of  Prof.  Biggar’s  Case  No.  3 contains  a most  valu- 
able lesson  on  the  subject  of  irrigation  and  we  learn  again,  and  how 
many  times  we  have  to  relearn  that  nature  is  a most  important  factor 
in  our  work.  She  can  be  coaxed  but  not  coerced — led  but  not  driven. 
Irrigation  and  irritation  are  many  times  synonymous,  and  irritation 
in  surgical  work  has  many  times  meant  death. 

Thoracoplasty  has  been  on  trail  for  nearly  fifteen  years  and  as  a 
surgical  procedure  has  an  established  foundation.  It  does  away  with 
blind  work  with  its  uncertain  results,  and  we  should  not  be  slow  to 
learn  that  a stab  in  the  dark  even  though  done  by  a surgeon  is  some- 
times as  fatal  as  the  thrust  of  the  assassin. 


VIVISECTION  AND  PULMONARY  SURGERY. 


301 


The  value  of  these  papers  to  the  profession  lies  in  the  emphasis 
they  give  to  the  worth  of  operative  procedure  in  the  treatment  of 
disease.  The  practitioner  accustomed  to  the  management  of  cases 
purely  from  a therapeutic  standpoint  is  quite  apt  to  stop  at  the 
therapeutic  limit  and  consider  that  all  has  been  done  when  medicine 
has  exhibited  all  its  possibilities.  Many  a patient  has  been  sacrificed 
to  this  point  of  view.  Many  a patient  too  has  been  sacrificed  to 
surgical  rashness,  but  when  we  consider  the  number  of  cases  turned 
over  to  the  knife  as  a last  resort  when  they  should  have  been  pre- 
sented for  initial  treatment,  the  therapeutic  pot  will  hesitate  long 
before  it  upbraids  the  blackness  of  the  surgical  kettle. 

Has  no  one  seen  a pleuritic  effusion  pass  over  into  the  dangerous 
empyema,  or  seen  a fatal  peritonitis  follow  fast  upon  the  heels  of  a 
temporized  appendicitis?  Has  a strangulated  hernia  never  called 
upon  death  to  witness  the  defeat  of  a tardy  operation  demanded  at 
the  hands  of  a rash  conservatism  ? Has  the  ruptured  sac  of  an 
ectopic  gestation  never  confronted  the  obstetrician  while  calmly  con- 
sulting his  patent  calendar  to  see  upon  what  day  the  bursting  waters 
shall  announce  the  time  for  him  to  remove  his  coat?  If  not  then 
are  these  papers  written  in  vain  and  our  discussion  of  them  is  an 
untimely  event. 

Not  all  physicians  can  trap-door  the  thorax  or  the  cranium,  but  it 
is  of  value  to  know  that  such  work  can  be  done  and  that  sometimes 
even  the  patient  shares  in  the  triumph  of  the  operator. 

Sidney  F.  Wilcox,  M.D.,  New  York  City  : In  attempting  to  dis- 
cuss a paper  like  the  one  before  us,  giving  as  it  does  such  a range  of 
pathological  conditions  and  showing  such  excellent  results,  one  can 
but  feel  that  the  writer  himself  is  the  best  fitted  to  judge  as  to  the 
correctness  of  the  methods  and  technique  employed. 

In  reviewing  one’s  own  experience  one  is  frequently  struck  with 
the  fact  that  in  a long  series  there  has  been  a remarkable  similarity 
in  his  cases;  so  that  although  a surgeon  may  have  opened  the  thorax 
a good  number  of  times,  the  opportunity  for  a variety  of  methods  of 
operating  has  been  limited.  Unfortunately  (or  perhaps  fortunately) 
this  has  been  my  experience ; for  nearly  all  of  my  cases  of  thoracic 
surgery  have  been  those  in  which  an  accumulation  of  fluid,  either 
serous  or  purulent  has  followed  disease  of  the  pleura.  All  of  them 
have  recovered,  and  with  two  exceptions  all  have  been  treated  by 
making  a slit  between  the  ribs,  introduction  of  a drainage-tube  and 
irrigation,  or  simple  aspiration  has  been  employed  to  remove  the 
fluid. 

The  good  results  have  not  been  due  to  the  fact  that  the  cases  have 
been  simple  and  easy,  but  several  of  them  have  been  desperate  in 
character,  as  for  instance  the  case  of  a little  girl  eight  years  of  age. 
The  amount  of  purulent  effusion  into  the  left  pleura  was  enormous, 
so  much  so  that  there  was  a complete  transposition  of  the  thoracic 


302 


world’s  homoeopathic  congress. 


viscera  to  the  right  side  of  the  chest.  The  child  was  so  weak  that 
an  aspirator  was  first  used  to  remove  a portion  of  the  pus  as  a tem- 
porary measure  and  22  ounces  were  drawn  off.  A few  days  later  it 
was  found  necessary  to  make  permanent  drainage  and  as  the  heart’s 
action  was  so  weak,  and  the  breathing  capacity  so  limited,  it  was 
deemed  unsafe  to  use  either  chloroform  or  ether  as  an  anaesthetic. 
Cocaine  was  then  just  becoming  prominent  as  a local  anaesthetic,  and 
so  a few  drops  of  a five  per  cent,  solution  were  injected  over  the  site 
of  the  intended  incision.  The  result  was  appalling,  the  child  imme- 
diately went  into  a state  of  collapse  and  it  was  an  hour  before  we 
could  feel  that  she  was  in  a safe  condition. 

When  she  had  sufficiently  recovered  from  the  effects  of  the  Co- 
caine, the  ether  spray  was  used  as  a local  anaesthetic,  a rapid  slit  was 
made  along  the  seventh  intercostal  space  and  three  quarts  of  pus 
evacuated  at  once  without  any  distressing  symptoms.  A drainage- 
tube  was  introduced  and  the  cavity  washed  out  with  a bichloride  of 
Mercury  solution,  and  the  wound  dressed  antiseptically.  The  dress- 
ings were  changed  as  frequently  as  they  became  saturated  and  the 
cavity  only  irrigated  when  a rise  of  temperature  indicated  a condition 
of  sepsis.  Then  the  bichloride  solution  was  used. 

The  child  made  a perfect  recovery,  and  examination  over  a year 
after  revealed  only  the  slightest  difference  in  the  two  sides  of  the 
chest. 

My  other  cases,  which  required  incision,  have  been  very  similar, 
except  that  in  this  case  the  amount  of  pus  removed  was  greater  than 
in  any  other. 

In  one  case,  in  a child,  I was  obliged  to  remove  portions  of  two 
ribs  on  account  of  the  impossibility  of  otherwise  obtaining  sufficient 
drainage;  in  one  other  case  a portion  of  one  rib  was  removed  for  ab- 
scess following  an  accident,  and  in  a third  case,  what  appeared  to  be 
a cystic  tumor  of  the  breast  proved  to  be  a cold  abscess  connected 
with  a carious  rib  resulting  from  an  undiscovered  fracture. 

Aspiration  is  of  no  use  as  a curative  measure  except  where  the 
fluid  in  the  pleural  sac  is  serous.  Where  pus  is  present  it  may  be 
employed  to  gain  time,  as  has  been  remarked  in  Dr.  Biggar’s  paper, 
for  diagnostic  purposes. 

Formerly  my  method  was,  after  induction  of  anaesthesia,  either 
general  or  local,  to  feel  for  the  upper  border  of  the  rib,  introduce  the 
knife  through  the  chest  wall,  and  make  a rapid  slit  along  the  inter- 
costal space.  This  only  requires  a second,  and  has  always  been  sat- 
isfactory ; but  in  the  last  few  cases,  for  fear  that  I might  be  surprised 
by  a troublesome  haemorrhage,  I have  modified  the  technique,  al- 
though it  requires  more  time.  First,  an  incision  is  made  through 
the  skin  and  subcutaneous  tissue ; next,  the  muscular  tissue  is  cut 
through,  keeping  near  to  the  upper  border  of  the  rib.  This  is  done 
without  hurrying,  and  all  bleeding  vessels  are  compressed  and  tied. 


VIVISECTION  AND  PULMONARY  SURGERY. 


303 


Then  the  point  of  a director  is  pushed  through  the  remaining  struc- 
tures into  the  sac  ; the  director  is  quickly  withdrawn,  and  the  blades 
of  a uterine  dilator  introduced  in  its  place,  and  the  opening  can  be 
stretched  to  any  extent  desired  without  danger  or  fear  of  haemorrhage. 
This  operation  is  better  adapted  to  cases  where  it  is  possible  to  induce 
general  anaesthesia ; where  that  is  unsafe,  and  the  ether  spray  has  to 
be  employed,  the  more  rapid  operation  of  slitting  with  the  knife’ is 
preferable. 

In  recent  cases  of  empyema  I do  not  think,  as  a rule,  it  is  neces- 
sary to  resect  the  ribs.  ISo  far  as  my  experience  goes,  the  contour  of 
the  chest  is  better  preserved  without  resection,  and  the  lung  seems  to 
slowly  expand  and  again  fill  the  thoracic  space  as  the  cavity  closes 
up.  Various  forms  of  drainage-tubes  and  methods  of  fastening  them 
have  been  devised. 

A very  simple  arrangement  which  I have  employed  has  given 
perfect  satisfaction.  Take  a short  piece  of  stiff,  soft  rubber-tubing 
and  pass  two  safety-pins  through  the  walls  on  the  opposite  sides  of 
the  tube.  These  pins  simply  pass  through  the  walls  and  do  not  en- 
croach on  the  lumen  of  the  tube.  Then  take  two  strips  of  rubber 
adhesive  plaster  and  fasten  one  to  the  back  wire  of  each  safety-pin. 
Each  strip  of  adhesive  plaster  should  be  long  enough  to  go  nearly 
half  round  the  body.  The  tube  is  introduced  into  the  wound,  the 
two  strips  of  adhesive  plaster  pulled  in  opposite  directions  and  stuck 
to  the  skin. 

This  arrangement  is  made  in  a moment,  costs  almost  nothing,  and 
holds  the  tube  firmly  in  place. 

With  regard  to  antiseptics,  I have  always  used  bichloride  of  mer- 
cury and  have  never  had  any  trouble,  but  have  only  irrigated  the 
cavity  as  often  as  the  temperature  indicated  its  necessity. 

Dr.  Biggar  : I will  not  detain  you  but  a moment.  The  paper 
was  not  concluded,  as  it  was  longer  than  I expected.  I have  en- 
joyed very  much  the  paper  by  my  new  friend,  Dr.  Knoll.  I want 
to  say  this  in  regard  to  Dr.  Walton’s  criticism  about  the  position  of 
the  scapula.  He  evidently  misunderstands  the  paper,  or  else  I have 
made  some  clerical  errors,  and  I say  this,  that  the  paper,  I think, 
reads,  that  the  position  of  the  arm  will  bring  the  scapula  forward 
along  a certain  space,  between  the  border  and  the  vertebrae,  so  as  to 
permit  of  the  chance  of  the  resection  of  the  rib  in  bronchotomy.  That 
was  the  intention  of  the  paper,  and  no  person  supposed  that  the  po- 
sition of  the  arm — and  I think  that  my  good  friend  Walton  does  not 
absolutely  mean  it  to  himself,  except  as  a little  joke  upon  me — 
would  displace  the  vertebral  column.  He  knows  better,  but  I 
always  admire  him  whether  he  is  pro  or  con. 

Another  point  is  this — and  if  the  paper  had  been  continued  we 
would  have  come  to  that  point — let  your  cavities  alone.  We  have 
tried  the  medicated  irrigation  there,  and  irritants,  and  where  we  have 


304 


world’s  homoeopathic  congress. 


abandoned  the  irrigation  and  left  it  alone  the  formations  have  recu- 
perated much  better  and  much  faster. 

I must  say  this,  that  I was  greatly  pleased  by  the  masterly  effort 
of  the  paper  which  was  read  yesterday  by  my  good  friend,  Professor 
Obetz.  It  was  a masterly  effort  on  a subject  which  is  of  great  import 
to-day,  more  important,  I think,  than  almost  any  other  branch  of 
surgery.  My  first  introduction  to  this  branch  of  surgery  was  about 
eight  years  ago,  as  I told  you,  in  the  Isle  of  Wight,  at  this  consump- 
tive hospital,  which  gave  me  the  inspiration  that  there  was  a great 
deal  in  resection  of  the  ribs  for  pulmonic  diseases  and  for  diseased 
conditions. 

I never  was  so  pleased  in  results  as  I was  in  one  of  the  cases  that 
I narrated  of  that  little  girl  ten  years  of  age  who  came  with  all  the 
conditions  of  a lung  completely  destroyed — a lung  which  had  been 
degenerated  and  which  you  could  put  your  finger  inside  of.  When, 
with  the  condition  that  existed  in  that  little  girl,  with  her  spinal 
curvature  and  the  contour  of  the  chest  showing  tour  inches  difference 
between  the  right  and  left  sides — the  left  side  being  four  inches 
smaller — when  you  can  restore  such  a case  to  almost  a normal  res- 
piration, with  a greatly  improved  contour  and  complete  apparent 
physical  condition,  you  can  understand  that  the  joy  which  that  poor 
little  girl  gave  me  was  worth  more  than  gold,  and  well  repaid  me  for 
the  time  which  I devoted  to  the  study  of  thoracoplasty. 


THE  TREATMENT  OF  EPILEPSY,  ETC. 


305 


THE  TREATMENT  OF  EPILEPSY , IDIOCY  AND 
ALLIED  DISORDERS  BY  CRANIAL 
EXCISION  AND  INCISION. 

By  G.  F.  Shears,  M.D.,  Chicago,  III. 


At  the  annual  meeting  of  the  American  Institute  of  Homoeopathy,, 
held  in  1889,  the  Surgical  Bureau  took  for  its  topic  Brain  Surgery, 
and  presented  exhaustive  treatises  covering  almost  every  phase  of 
this  subject. 

I do  not  intend,  in  this  brief  article,  to  compete  with  the  report 
there  submitted,  but  rather  to  supplement  several  divisions  of  the 
subject,  by  considering  the  present  position  of  certain  surgical  pro- 
cedures and  by  presenting  some  personal  experience.  In  no  other 
department  of  surgery,  not  excepting  the  surgery  of  the  abdomen, 
have  more  new  methods  been  introduced  or  more  startling  innova- 
tions than  in  brain  surgery,  and  a large  part  of  this  history  has  been 
made  within  the  last  few  years. 

The  time  is  so  brief  that  much  of  the  work  done  has  not  been- 
recorded,  and  sufficient  data  is  not  at  hand  to  determine  its  value  or 
its  attendant  dangers.  It  is  only  by  the  trial  and  comparison  of  the 
results  obtained  that  the  true  value  can  be  determined.  It  is  the 
duty,  then,  of  every  one  to  record  his  results,  and  thus  contribute 
the  more  rapidly  to  a safe  surgical  practice ; for  surgical  practice  is 
the  result  of  the  consensus  of  surgical  opinion  rather  than  the  prac- 
tice of  one  man,  as  Nancrede  aptly  puts  it.  It  is  in  this  spirit  that 
I review  the  disorders  which  have  been  selected  as  the  subject  of  this 
paper,  and  append  thereto  some  surgical  cases.  The  disorders  se- 
lected are  epilepsy,  cephalalgia,  paralysis,  insanity  and  microcephaly. 

Epilepsy. — Removal  of  a portion  of  the  cranium  for  traumatic 
epilepsy  is  not  a new  operation.  In  1705  La  Motte  made,  I believe, 
the  first  recorded  operation.  From  that  time,  for  almost  one  hun- 
dred years,  the  operation  languished.  Although  made  from  time  to 
time  during  the  earlier  part  of  the  present  century,  it  was  not  until 

20 


306 


world’s  homoeopathic  congress. 


the  advent  of  antiseptic  surgery  and  the  closer  study  of  cerebral 
localization  that  it  began  to  be  generally  employed;  Even  during 
this  period  the  operation  was  confined  to  such  cases  of  traumatic 
epilepsy  as  were  accompanied  by  marked  depression  of  the  cranium 
and  in  which  the  history  of  a compound  fracture  was  undoubted. 
Within  the  last  four  or  five  years  the  sphere  of  the  operation  has 
been  extended,  and  operations  have  been  made  upon  non-traumatic 
cases  classed  under  the  head  of  Jacksonian  and  focal  epilepsy. 

Some  of  the  more  venturesome  have  even  advocated  the  use  of 
the  trephine  in  general  epilepsy — if  such  a term  may  be  employed. 
It  is  in  traumatic  cases  in  which  a decided  depression  is  present  that 
the  greatest  number  of  operations  have  been  made  and  in  which  the 
best  opportunity  for  determining  the  value  of  an  operation  exists, 
yet  medical  opinion  differs  widely  as  to  the  ultimate  result  of  the 
procedure.  Dr.  O.  Laurient  reports  102  cases  of  trephining  for  trau- 
matic epilepsy:  54  per  cent,  cured,  17  per  cent,  unimproved,  20 
per  cent,  improved,  2 per  cent,  worse,  7 per  cent.  died. 

Agnew,  in  his  review  of  work  of  Philadelphia  surgeons — in  which 
I see  no  notice  is  taken  of  the  work  of  surgeons  of  the  Homoeopathic 
School — reports  54  cases,  of  which  32  experienced  temporary  benefit. 
9 no  relief,  4 passed  out  of  observation,  4 were  cured  and  4 died. 
Briggs  reports  from  Stephen  Smith’s  table  92  American  operations, 
with  63  cures;  from  Bartholomew  Hospital  reports  130  cases,  75 
cures,  and  of  his  own,  30  cases,  with  25  cures.  Personally,  I report 
the  following  cases : 

Case  I. — Young  man,  set.  29  years;  nine  years  before  had  been 
kicked  by  a horse  in  the  forehead,  sustaining  a compound  fracture; 
three  years  later  he  was  badly  scared;  this  was  followed  by  convul- 
sions, which  gradually  ceased  ; four  years  later  convulsions  returned, 
and  at  the  time  of  the  examination  had  continued  two  years,  occur- 
ring regularly  two  or  three  times  a week.  The  depression  was  found 
in  the  left  frontal  region  beginning  two  inches  above  the  supraorbi- 
tal ridge  and  extending  two  and  a half  inches  upward  toward  the 
median  line.  The  entire  depressed  bone  was  removed.  It  was 
closely  adherent  to  the  superior  longitudinal  sinus,  and  was  dissected 
off  with  the  knife.  During  the  operation  the  sinus  was  punctured, 
and  for  a time  the  haemorrhage  was  profuse.  It  was  controlled  by 
sponge  pressure,  and  eventually  by  suturing  with  catgut.  Convul- 
sions ceased  after  the  operation,  and  did  not  return  for  six  months. 


THE  TREATMENT  OF  EPILEPSY,  ETC. 


307 


At  the  end  of  that  time  he  began  drinking  heavily,  and  the  convul- 
sions returned.  Upon  stopping  the  use  of  alcohol  they  ceased. 

Case  II. — Man,  set.  42  years.  Five  years  previous  was  struck 
by  a locomotive,  sustaining  a fracture  of  the  right  parietal  bone ; 
also  severe  injuries  and  possibly  fracture  at  some  other  point  of  the 
cranium.  The  patient  remained  in  a comatose  condition  for  three 
weeks,  and  did  not  fully  recover  consciousness  for  six  weeks.  All 
previous  knowledge  was  obliterated.  Three  years  after  the  injury  he 
began  having  convulsions,  two  or  three  times  a week.  The  spasms 
were  ushered  in  by  the  patient  turning  to  the  right;  then  the  head 
turned  toward  the  right,  followed  by  contractions  of  the  right  fore- 
finger and  thumb;  then  the  arm,  face,  and  leg.  An  irregular  de- 
pression was  found  on  the  right  side  about  two  inches  above  the  ear. 
Some  question  arose  as  to  the  best  locality  to  trephine.  Although 
the  depression  was  found  on  the  right  side,  the  symptoms  seemed  to 
indicate  an  irritation  of  the  left  motor  tract.  The  history  was  of 
little  assistance.  For  some  time  after  the  injury  the  patient  was  in 
such  a critical  state  that  he  was  expected  to  die  every  moment,  and 
a careful  examination  was  not  made.  Severe  contusions  were  found 
all  over  the  head,  any  one  of  which  might  have  been  accompanied 
by  a fracture.  It  was  therefore  decided  to  make  the  operation  over 
the  depressed  bone.  The  entire  area  was  removed..  The  dura  was 
much  thickened  and  inflamed.  The  patient  did  well  for  a few 
weeks,  having  no  convulsions.  Subsequently  they  returned  in  full 
force. 

Case  III. — Young  man,  set.  30  years.  Three  years  before  was 
struck  on  the  head  with  a hammer;  wound  never  healed  completely, 
a fistulous  opening  remaining.  Two  years  after  the  injury  convul- 
sions began,  and  continued  until  the  present  time.  They  occur  two 
or  three  times  a month,  the  patient  remaining  unconscious  for  half 
an  hour  after  each  one.  The  frontal  bone  was  uncovered  and  a small 
fistulous  tract  was  found  under  it.  The  trephine  was  applied  at  its 
upper  portion,  and  a small  sequestrum  and  pus  sac  found  on  its 
under  surface,  both  outside  the  dura.  They  were  removed.  No 
convulsions  occurred  for  one  year,  when  the  patient  was  lost 
sight  of. 

Case  IV. — Man,  aet.  39  years.  Kicked  by  a horse  in  the  left 
frontal  region,  producing  a compound  linear  fracture;  the  patient 
never  lost  consciousness ; the  wound  healed  promptly.  Three  weeks 


308 


world’s  homceopathic  congress. 


later  had  a convulsion,  followed  in  two  weeks  by  another.  Trephin- 
ing was  performed  over  the  seat  of  injury.  The  bone  was  not  de- 
pressed, but  a thin  blood  clot  was  found  between  the  skull  and  the 
dura.  This  was  removed.  The  patient  made  a prompt  recovery. 
No  convulsions  have  since  occurred. 

Case  V. — Man,  set.  46  years.  Fifteen  years  ago  a trap-door  fell 
on  him,  striking  his  head  a little  to  the  left  of  the  median  line,  pro- 
ducing a contusion  of  the  left  parietal  bone.  The  skin  was  not 
broken.  The  spot  has  remained  sensitive  and  the  skull  seems  more 
prominent  at  this  point.  Five  years  ago  he  began  to  have  a twitch- 
ing of  the  right  arm.  He  loses  consciousness  but  does  not  fall. 
The  sensitive  part  was  exposed  and  the  one-inch  trephine  em- 
ployed. The  bone  was  found  to  be  very  hard  and  much  thickened. 
No  diploe  existed.  No  depression  was  discernible,  and  the  mem- 
branes seemed  normal.  The  patient  recovered,  and  was  free  from 
the  convulsions  when  last  heard  from,  three  months  after  the  opera- 
tion. 

Jacksonian  Epilepsy. — In  this  form  of  epilepsy  the  convulsions 
are  confined  to  a single  group  of  muscles,  and  are  not  accompanied 
by  loss  of  consciousness.  Whether  the  cause  is  largely  traumatic  or 
idiopathic  is  not  known ; that  some  cases  are  due  to  cerebral  trauma- 
tism seems  certain,  but  that  others  have  no  such  history  seems  equally 
positive.  The  limited  muscular  involvement  indicates  that  the  brain 
lesion  is  of  limited  extent.  Our  study  of  brain  localization  enables 
us  to  locate  the  centres  involved.  Very  naturally  the  thought  arises, 
that  if  the  irritant  in  the  shape  of  a scar  or  in  non-traumatic  cases 
the  irritable  centre  were  removed,  the  spasm  might  be  prevented. 
The  plan  has  been  carried  into  execution,  but  while  the  theory  is  sim- 
ple, and,  upon  first  thought,  it  would  seem  the  plan  should  be  fol- 
lowed by  good  results,  there  are  certain  reasons  why  the  prospect  of  a 
cure  by  operation  in  this  form  of  epilepsy  is  not  encouraging.  In 
those  cases  in  which  no  lesion  is  apparent,  our  present  knowledge  is 
not  sufficient  to  locate  the  real  cause  of  the  trouble.  Even  if  wre 
locate  approximately  the  discharging  centre  according  to  the  rules  of 
cerebral  localization  and  by  means  of  the  electrode  applied  to  the  cor- 
tex of  the  brain  determine  the  exact  centre  of  discharge,  we  have  no 
assurance  that  the  irritation  which  causes  the  discharge  is  in  the 
centre  itself,  and  that  its  removal  will  remove  the  irritation.  In 
those  cases  in  which  a real  lesion  exists,  as  shown  by  cicatricial  tissue, 


THE  TREATMENT  OF  EPIEEPSY,  ETC. 


309 


the  removal  of  the  same  might  be  followed  by  relief.  Even  in  these 
cases  the  healing  is  necessarily  followed  by  a scar,  which  in  all  prob- 
ability will  give  rise  to  the  same  irritation  as  before.  That  many 
more  cases  are  due  to  traumatism  than  is  generally  admitted,  I have 
no  doubt.  In  this  connection,  an  interesting  article  by  Dr.  Ira  Van 
Gieson,  showing  the  changes  that  had  taken  place  in  the  brain,  ns 
proven  by  the  microscope  in  the  case  of  a patient  wdio  had  had  epi- 
lepsy as  the  result  of  a skull  injury,  but  in  which  there  was  no  frac- 
ture of  the  inner  table,  could  not  but  make  me  consider  how  many 
opportunities  there  are  for  brain  traumatism  in  the  injuries  of  child- 
hood, even  where  fracture  does  not  occur,  and  that  possibly  many 
cases  usually  considered  as  idiopathic  may  be  in  truth  traumatic.  In 
seventeen  cases  of  Jacksonian  epilepsy  which  I have  collected  in  my 
reading,  only  three  are  reported  as  cured.  Two  of  them  were  from 
traumatic  causes,  and  were  only  a short  time  under  observation. 
The  mortality  was  large,  about  47  per  cent.  My  own  experience  is 
limited  to  the  following  case,  in  which  a complete  operation  was  not 
made : 

Girl,  set.  17  years;  convulsions  occur  two  or  three  times  a week, 
commencing  in  the  hand  and  then  extending  to  the  neck,  ending 
with  a wagging  motion  of  the  jaw.  No  history  of  fracture  of  the 
cranium  could  be  elicited  and  no  scar  could  be  found  upon  the  scalp. 
The  mother  remembered,  however,  that  the  girl  had  fallen  down 
stairs  six  or  seven  years  before  and  had  complained  for  a long  time 
of  a pain  in  her  head.  Believing  that  a more  severe  injury  had  taken 
place  than  was  at  first  supposed,  and  with  the  determination  that  if 
any  visible  lesion  existed  that  the  discharging  centre  should  be 
removed,  an  operation  was  advised.  The  symptoms  indicated  the 
irritable  centre  to  be  the  middle  third  of  the  ascending  frontal  con- 
volution, and  accordingly  the  trephine  was  placed  a little  in  front  of 
the  middle  third  of  the  fissure  of  Rolando,  the  method  employed  to 
determine  this  line  being  that  recommended  by  Professor  Chiene. 
Although  the  dura  was  incised  and  the  brain  carefully  examined,  no 
scar  nor  inflammatory  patch  could  be  found.  The  removal  of  brain 
substance  was  therefore  abandoned,  and  the  wound  closed  in  the 
usual  manner.  To  my  delight  the  patient  had  no  more  convulsions 
while  under  my  charge,  some  three  weeks.  Whether  this  result  was 
due  to  shock,  relief  of  intracranial  pressure,  or  the  removal  of  some 
irritable  point  in  the  skull,  I do  not  know. 


310 


world’s  homoeopathic  congress. 


Cephalalgia. — The  results  of  operations  undertaken  for  this  dis- 
order, when  due  to  traumatic  causes,  are  very  encouraging,  both  as 
regards  benefits  derived  and  the  slight  mortality  of  the  operation,  if 
we  may  depend  upon  the  reports  made  in  our  medical  literature. 
Of  some  twenty  cases  which  I have  noticed  in  my  reading,  relief  was 
obtained  in  all,  even  in  those  in  which  no  appreciable  lesion  could 
be  found.  How  permanent  the  result  could  not  be  determined.  The 
following  case  published  some  time  ago  in  the  Clinique  is  the  only 
patient  upon  whom  I have  made  the  operation. 

A young  man,  set.  23  years,  was  struck  on  the  head  with  a stick, 
sustaining  a scalp  would.  For  twelve  weeks  was  never  in  full  pos- 
session of  his  faculties ; was  violent,  and  for  six  weeks  in  an  insane 
asylum.  A discharge  of  pus  relieved  the  insanity  ( Clinique , vol.  xiii., 
p.  518),  but  headache  remains  ; cannot  focus  the  eyes;  is  unable  to 
follow  his  business.  The  cicatrical  tissue  was  excised  from  the  scalp 
with  the  hope  that  this  would  relieve  the  irritation,  but  no  relief  was 
obtained.  The  scalp  is  sensitive  for  some  distance  around  the  scar. 
The  scar  was  excised  and  the  periosteum  underneath  it,  which  was 
adherent,  also  excised  and  a button  of  bone  removed  from  the  sensi- 
tive area.  No  thickening  of  the  bone  or  lesion  of  the  dura  was  dis- 
covered, and  yet  a perfect  cure  followed.  In  a somewhat  similar 
case  reported  by  me  in  the  Clinique,  but  not  reported  under  this  head 
because  there  was  no  operation  made  upon  the  bone,  the  headache 
was  relieved  by  the  removal  of  the  scar,  but  in  the  above  case  the 
removal  of  the  scar  alone  failed  to  affect  a cure. 

Insanity. — Excision  of  bone  or  trephining  for  insanity  is  an  opera- 
tion which  has  rarely  been  done.  That  such  an  operation  is  war- 
ranted when  the  insanity  follows  a depressed  fracture  rests  upon  the 
same  basis  as  that  of  the  operation  for  epilepsy,  yet  although  the 
number  of  cases  of  insanity  following  fracture  is  considerable,  I was 
surprised  to  find  that  few  cases  of  operation  for  the  relief  of  insanity 
Are  on  record.  Prof.  Briggs  reports  two  cases,  one  of  which  died, 
*nd  the  other  improved.  Dr.  Boyd  reports  one  case  with  no  im- 
provement, and  two  other  cases  reported  in  journals  were  quoted  as 
not  improved.  The  most  favorable  cases  are  those  in  which  depres- 
sion is  present  and  some  symptoms  indicating  local  pressure  are 
prominent.  My  only  operation  for  this  trouble  is  recorded  in  the 
following  case : 

Young  man,  set.  22  years  ; four  years  previous  was  kicked  by  an 


THE  TREATMENT  OF  EPIEEPSY,  ETC. 


311 


unshod  horse,  cutting  a gash  about  two  inches  long  nearly  trans- 
versely across  the  posterior  portion  of  the  right  parietal  bone.  It 
was  not  determined  at  the  time  whether  the  bone  was  fractured. 
The*  patient  was  unconscious  for  four  hours  after  the  accident.  Three 
months  later  the  first  symptoms  of  insanity  were  noticed.  He  would 
mutter  and  gesticulate  while  at  work,  and  when  unemployed  was 
restless  and  irritable.  For  some  time  previous  to  his  being  brought 
under  my  care  he  had  been  violently  insane.  No  appreciable  inden- 
tation of  the  skull  could  be  found.  The  seat  of  injury  was  uncovered 
by  a horseshoe-shaped  incision,  the  old  cicatrice  excised  and  a button 
of  bone  removed  from  the  cranium  just  under  the  scalp  wound.  No 
indentation  of  the  internal  plate  was  noticed.  The  dura  seemed 
normal  and  upon  opening  it  and  examining  the  cortex  no  injury 
could  be  detected.  The  patient  made  a good  recovery,  but  the  only 
benefit  was  an  increased  tractability  and  a lessened  violence.  This 
condition  remained  three  months  after  the  operation. 

Paralysis. — Local  paralysis  following  injury  to  the  skull  has  been 
treated  by  excision  of  the  depressed  bone,  although  the  number  of 
such  cases  recorded  are  very  few.  In  general  paralysis  operative 
treatment  has  been  believed  to  be  of  no  service.  Hey  argues  that 
in  the  early  period  of  general  paralysis  the  intense  congestion  in- 
creases the  volume  of  the  brain  as  well  as  diminishes  the  endocra- 
nial  cavity  by  thickening  bone.  The  removal  of  the  resulting  com- 
pression by  an  opening  at  some  point  may  set  aside  some  of  the  gen- 
eral phenomena,  but  in  confirmed  cases  surgical  interference  would 
be  powerless  to  hinder  the  change  due  to  chronic  meningic  enceph- 
alitis. The  following  case  was  operated  upon  by  me  December  19, 
1892: 

Man,  set.  41 ; fifteen  months  previous  was  struck  on  the  right 
parietal  bone  with  an  axe.  The  exact  extent  of  the  injury  was  un- 
known. Eight  months  later  he  began  to  feel  a numbness  in  the 
left  arm  and  leg  accompanied  by  some  impairment  of  motion.  This 
increased  rapidly  until  in  a short  time  he  was  confined  to  his  bed. 
He  lost  the  power  of  speech,  control  of  the  urine  and  faeces.  About 
three  months  before  I saw  him  the  right  leg  and  arm  commenced  to 
jerk.  Professor  Fellows  saw  him  in  consultation  with  his  physician 
and  saw  no  hope  of  benefit,  unless  it  might  result  from  operative 
interference.  When  seen  by  me  the  left  side  was  paralyzed,  the  arm 
completely,  the  leg  partially;  the  right  arm  and  leg  were  in  a state 


312 


WORLD  S HOMOEOPATHIC  CONGRESS. 


of  contraction.  The  head  and  body  inclined  to  the  right  side,  swal- 
lowing difficult,  eyes  unaffected,  conscious  but  could  not  speak.  The 
progress  of  symptoms  indicated  to  m}r  mind  a lesion  in  the  right 
motor  area  extending  over  into  the  left,  presumably  meningis-enceph- 
alitis.  The  lesion  seemed  so  extensive  that  an  operation  was  not  ad- 
vised, but  the  friends  were  so  anxious  that  some  effort  should  be  made, 
that  with  the  hope  that  pathological  changes  might  be  limited  to  the 
right  side  and  the  symptoms  of  left  sule  involvement  might  be  due  to 
sympathy,  an  operation  was  attempted,  a large  button  was  removed 
from  the  upper  portion  of  the  right  motor  tract  and  the  dura  found 
to  be  very  much  thickened  and  so  full  of  bloodvessels  that  for  a 
time  it  was  supposed  a new  growth  was  present.  The  opening  was 
rapidly  enlarged  with  the  cutting  forceps  and  a large  area  exposed 
extending  over  the  median  line.  The  inflamed  dura  extended  over 
into  the  left  motor  tract.  The  dura  was. incised  and  the  cortex  ex- 
amined. The  pia  mater,  while  not  adherent,  was  inflamed  and  the 
cortex  of  the  brain  had  a yellowish  hue.  While  separating  the  in- 
flamed dura  from  the  cranium  a large  vein  close  to  its  entrance  into 
the  superior  longitudinal  sinus  was  opened  and  haemorrhage  was 
profuse.  It  was  controlled  by  pressure  and  subsequently  by  liga- 
tion. The  patient  never  fully  recovered  from  the  shock  of  the  ope- 
ration and  died  twenty-four  hours  later. 

Microcephaly. — One  of  the  most  unpromising  conditions  which 
has  recently  been  attacked  by  the  surgeon  is  that  known  as  micro- 
cephalic  idiocy.  It  is  believed  that  a certain  number  of  cases  of 
idiocy  may  be  due  to  the  pressure  of  a prematurely  ossified  cranium. 
In  these  cases  Lannelongue  proposed  and  has  practiced  the  excision 
of  a groove  in  the  skull  in  order  to  permit  of  brain  expansion.  He 
reports  twenty-five  cases,  one  case  died;  most  of  the  remaining 
showed  marked  improvement.  My  own  experience  is  confined  to 
the  following  case  : 

Girl,  set.  6 years,  idiotic,  cannot  walk  ; moves  a few  steps  and 
falls;  cannot  stand  still  without  support.  Has  no  control  over  the 
urine  or  faeces ; cannot  talk  or  make  known  her  wants  except  by 
screaming  ; eyes  convergent.  Has  no  decided  convulsions  but  at 
times  very  restless  and  excited.  Head  is  irregular  in  shape  and  no- 
ticeable for  its  lack  of  frontal  development.  No  cause  could  be  as- 
signed by  the  parents.  At  birth  labor  was  normal  except  that  it  was 
a footling  instead  of  a cephalic  presentation.  Do  not  know  whether 


THE  TREATMENT  OF  EPILEPSY,  ETC. 


313 


the  fontanelles  closed  early  or  not.  Following  the  plan  suggested 
by  Lannelongue  a section  of  bone  three-eighths  of  an  inch  wide  and 
extending  in  a curvilinear  line  from  a little  to  the  left  of  the  occi- 
pital eminence  to  a point  a little  below  the  frontal  eminence,  was 
excised.  By  this  means  a long  flap,  U-shaped,  with  the  base  below 
was  formed  over  the  whole  motor  tract.  The  wound  healed 
promptly  and  the  child  showed  signs  of  improvement.  Three 
months  after  she  had  control  of  urine  and  faeces,  was  able  to  walk  and 
use  three  words.  More  than  this  could  hardly  be  expected  in  so 
short  a time. 

A review  of  my  own  work  shows  five  cases  of  traumatic  epilepsy, 
with  four  successes  and  one  failure;  one  case  of  Jacksonian  epilepsy, 
with  one  success;  one  case  of  cephalalgia,  with  complete  relief  of 
the  symptoms;  one  case  of  insanity,  not  improved;  one  case  of 
paralysis,  with  one  death,  and  one  case  of  microcephalus,  with  de- 
cided improvement.  In  the  fatal  case  the  result  was  due  to  the  shock 
of  operation  during  the  active  progress  of  encephalitis,  and  in  esti- 
mating the  dangers  of  operative  interference  in  non-inflatnmatory 
cases,  such  as  epilepsy,  cephalalgia  and  microcephaly,  ought  not  to  be 
taken  into  consideration.  In  the  other  cases  no  evidence  of  a se- 
rious operation  having  been  made  was  evinced.  In  every  instance 
the  wound  healed  with  suppuration,  the  patients  were  up  at  the  end 
of  one  week,  and  often  discharged  at  the  end  of  two ; indeed,  I 
know  of  no  operation  in  which  so  rapid  recovery  takes  place,  and  I 
am  inclined  to  believe  with  Dr.  Roberts,  who  expressed  himself 
some  time  ago  before  the  American  Surgical  Association  to  the  effect 
that  the  operation  of  trephining  added  no  more  risk  than  the  ampu- 
tation of  a finger. 

A consideration  of  my  own  cases  and  a careful  reading  of  the 
results  obtained  by  others  lead  me  to  several  conclusions. 

1.  That  after  a careful  removal  of  all  other  exciting  causes  that 
may  produce  epilepsy,  cephalalgia,  paralysis  or  insanity — especially 
when  a history  of  cranial  injury  is  obtained — the  surgeon  is  in  duty 
bound  to  attempt  the  removal  of  this  possible  exciting  cause. 

2.  That  there  is  a good  probability  of  success  attending  his  efforts 
in  traumatic  epilepsy,  cephalalgia  and  localized  paralysis,  and,  in 
lesser  degrees,  in  insanity.  In  this  connection  it  must  be  remem- 
bered that  in  the  production  of  these  brain  disorders  there  are  two 
conditions  present — an  acquired  or  hereditary  abnormal  excitability 


314 


world’s  homoeopathic  congress. 


of  the  reflex  centres  and  a peripheral  irritation  from  depressed  bone, 
inflamed  dura,  clot  or  scar.  The  removal  of  the  exciting  cause  leaves 
still  the  acquired  abnormal  excitability  of  the  reflex  centres,  and  some 
other  irritation  may  occasionally  reproduce  the  convulsion.  Again, 
the  habit  once  acquired  becomes  in  a degree  independent  of  the  origi- 
nal lesion.  For  this  reason  one  must  not  be  discouraged  or  deter- 
mine the  operation  a failure  if  convulsions  do  not  immediately  cease. 
The  anatomical  cause  may  be  removed,  but  therapeutic  measures  are 
still  necessary  to  remove  the  tendency.  Many  cases  given  up  as 
failures  might  have  been  classed  as  successes  if  careful  treatment 
had  followed  the  operative  procedure.  The  earlier,  then,  the  opera- 
tion, the  less  the  probability  of  an  acquired  habit  and  the  greater  the 
prospect  of  success. 

3.  That  the  operation  for  microcephalic  idiocy  is  still  an  experi- 
ment, but  one  that,  considering  the  deplorable  condition  of  the  pa- 
tient and  the  little  risk  undertaken,  warrants  further  trial.  Although 
possibly  not  a logical  conclusion  from  the  consideration  of  the  treat- 
ment of  epilepsy,  idiocy  and  allied  disorders  as  outlined  in  the  cases 
reported,  I have  been  deeply  impressed  with  the  fact  that  so  many 
cases  report  an  imperfect  examination  of  the  original  cranial  injury, 
or  so  timid  a treatment  of  a serious  injury,  and  I feel  warranted  in 
advising,  in  the  interest  of  primitive  measures,  a bolder  treatment 
of  cranial  injuries.  It  may  have  been  wisest  before  the  time  of  anti- 
septic surgery  to  treat  all  cases,  except  those  showing  evidence  of 
compression,  by  conservative  measures:  but  with  our  present  methods, 
and  basing  my  conclusions  on  the  excellent  results  that  have  followed 
this  plan  of  treatment  in  my  own  practice,  I feel  it  my  duty  to  urge 
thorough  examination  and  trephining  in  all  cases  of  fracture  of  the 
cranium  attended  with  depression,  and  in  all  compound  fractures, 
whether  accompanied  by  depression  or  not.  It  may  not  be  inappro- 
priate to  add  a few  words  regarding  the  technique  of  the  operation. 
It  is  my  custom  to  shave  the  entire  scalp,  scrub  it  with  soap  and 
water,  wash  the  skin  with  ether,  then  bathe  with  a 1-2000  solution 
of  bichloride  of  mercury,  and  apply  a skull-cap  of  gauze  wet  in  the 
solution  and  covered  with  gutta-percha  tissue.  This  is  done  twenty- 
four  hours  before  the  operation,  and  the  dressing  left  until  the  mo- 
ment of  operating.  I invariably  use  chloroform,  unless  contraindi- 
cated by  some  trouble,  as  an  anaesthetic,  as  there  is,  I believe,  less 
venous  congestion  and  less  haemorrhage.  The  opening  is  made  with 


THE  TREATMENT  OF  EPILEPSY,  ETC. 


315 


the  trephine,  and  subsequently  enlarged  with  the  cutting  forceps  or 
chisel.  If  upon  the  removal  of  the  bone,  the  brain  pulsates  natu- 
rally and  the  dura  appears  normal,  the  latter  is  not  incised.  If,  how- 
ever, the  dura  is  inflamed,  if  pulsations  are  absent,  or  if  there  is  no 
cranial  lesion  to  account  for  the  trouble,  the  dura  is  incised  about  a 
quarter  of  an  inch  from  the  bony  boundary  and  the  brain  examined. 
Until  the  excising  of  the  dura  the  bichloride  solution  is  used.  Upon 
exposing  the  brain,  boiled  water  only  is  used.  I have,  however,  used 
the  1-2000  solution  in  accident  cases  in  which  the  brain  substance 
was  exposed,  with  no  bad  effects.  Before  closing  the  scalp  the  dura 
is  united  by  catgut  sutures  and  rubber  drainage-tubes  placed  between 
the  dura  and  the  scalp.  If  there  is  any  tension  from  the  excision  of 
the  scalp  scar,  the  scalp  is  united  by  silver  wire  sutures  rather  than 
with  catgut.  A simple  dressing  of  iodoform  and  sterilized  gauze  is 
employed  ; no  ice  cups  or  lotions  are  applied.  The  wound  is  dressed 
in  twenty-four  hours,  and  not  again  until  the  seventh  day.  I do 
not  replace  the  bone  discs  or  chips,  believing  that  we  desire  to  re- 
move all  possible  sources  of  irritation. 

Discussion. 

DeWitt  G.  Wilcox  M.D.,  was  called  upon  by  the  chairman  to 
discuss  Dr.  Shear’s  paper,  and  responded  as  follows  : Mr.  President , 
Ladies  and  Gentlemen:  I have  listened  to  this  paper  with  much 
pleasure  and  pride — the  pleasure  because  it  has  been  so  interesting 
and  instructive,  and  pride  because  such  excellent  results  have  been 
attained  by  a member  of  the  school  which  is  accused  of  knowing 
little  of  surgery. 

One  statement  that  was  made  early  in  the  reading  of  the  paper  I 
most  heartily  endorse;  that  it  is  the  duty  of  every  surgeon  to  record 
carefully  his  operations,  with  their  results.  I believe  it  the  duty  of 
every  surgeon,  and  indeed  of  all  surgical  practitioners,  to  keep  a 
record  of  all  cases.  What  we  need  in  our  surgical  literature  of  to- 
day  is  an  accumulation  of  records,  with  their  results;  and  it  seems 
to  me  that  one  of  the  most  childish  mistakes  that  the  physicians  of 
the  Old  School  make  in  their  records,  such  as  the  annual,  and  the 
year  book  is  the  omission  of  these  operations  performed  by  Homoeo- 
pathic surgeons.  Or,  perhaps  if  they  do  mention  them,  it  is  in 
some  such  way  as  that  in  which  a recent  author  alludes  to  them  in 
his  work.  He  says  : u Strange  results  of  this  operation  have  been 
brought  to  a culmination  by  a Homoeopathic  practitioner,”  referring 
to  our  Van  Lennep,  and  he  goes  on  further  to  say  that  though  found 
in  curious  company  yet  the  paper  bears  evidence  of  credibility  and 


316 


world’s  homceopathic  congress. 


knowledge.  Such  idiocy  seems  to  me  to  bear  evidence  of  a micro- 
cephalic  condition  that  calls  certainly  for  the  surgeon’s  knife. 

This  operation  is  not  one  of  technique,  but  of  pathological  knowl- 
edge. In  the  early  days  of*  abdominal  surgery  the  question  hinged 
largely  upon  the  manner  of  doing  it.  If  a tumor  existed,  either  the 
tumor  was  removed  or  it  was  not  removed.  Were  it  removed  suc- 
cessfully, the  patient  recovered,  if  unsuccessfully,  likely  he  did  not. 
There  are  two  conditions  to  be  considered  in  the  discussion  of  this 
question.  First,  have  we  made  any  advances  in  the  discovery  of  the 
first  causes  of  epilepsy,  and  second,  what  do  the  practical  results  of 
operations  show  as  to  whether  any  advances  have  been  made.  We 
need  only  to  refer  to  our  text-books  of  not  later  than  ten  years  ago  ; 
for  there  we  find  almost  universal  mention  made  of  the  cause  of 
irritation  being  in  the  spinal  cord  or  in  the  deeper  structures  of  the 
brain.  Although  we  have  not  learned  all  that  is  to  be  learned  about 
epilepsy,  yet  regarding  its  cause  there  is  much  we  do  know  with 
tolerable  certainty.  Now  by  this  operation  are  we  going  to  lessen 
the  frequency  of  the  seizures  of  epilepsy  ? Are  we  going  to  increase 
and  bring  intelligence  in  idiocy  ? As  I say,  we  must  not  pass  one 
of  these  questions. 

When  it  comes  down  to  a practical  consideration  of  the  question 
as  resolved  and  obtained  from  operations,  again  we  must  come  back 
to  the  record.  Having  gone  carefully  over  the  record  we  have  been 
able  to  obtain,  I think,  that  we  have  the  greatest  reason  for  encour- 
agement regarding  this  operation,  that  it  is  practical  and  it  is  going 
to  become  more  so.  Dr.  Shears  has  referred  you  to  the  record  of 
Agnew,  wherein  he  mentions  fifty-four  cases  with  an  improvement 
of  thirty-two,  and  a cure  of  four.  It  seems  to  me  that  that  was  a 
good  result  in  a condition  which  heretofore  has  been  regarded  as 
almost  absolutely  hopeless,  where  even  four  out  of  that  number  have 
been  absolutely  cured  and  at  least  thirty-two  have  been  improved. 
The  valuable  additional  chapter  that  Dr.  Shears  has  given  us  will 
add  greatly  to  our  encouragement  in  this  respect.  He  has  shown, 
by  the  records  of  most  of  the  cases,  that  the  best  results  are  to  be  ob- 
tained from  those  of  a traumatic  history,  for  even  there,  I think  that 
we  will  have  more  encouragement,  notwithstanding  we  find  a strong 
history  of  heredity  attached.  If  that  be  the  case  there  may  yet  be  a 
history  of  traumatism  that  will  give  us  some  encouragement  for  an 
operation.  We  do  know  this,  that  a patient  who  has  a strong  can- 
cerous history  may  receive  an  injury  or  a sudden  irritation  which 
will  result  in  a cancer  which  in  a person  not  so  inclined  will  have 
no  effect  whatsoever.  In  these  cases  if  there  be  an  epileptic  ten- 
dency in  the  family  and  an  injury  however  slight  to  the  brain  is 
occasioned,  it  will  very  likely  result  in  epilepsy.  I think  that  we 
should  not  regard  a case  as  absolutely  hopeless,  even  though  there 
may  be  this  hereditary  history  of  epilepsy. 


THE  TREATMENT  OF  EPILEPSY,  ETC. 


317 


Another  encouraging  feature  the  doctor  has  brought  out  in  the 
recital  of  his  cases  is  that  a number  of  the  cases  have  been  improved, 
even  though  they  are  beyond  the  period  of  childhood.  It  has  been 
generally  considered  that  very  little  is  to  be  expected  in  these  cases 
of  insanity,  and  particularly  of  epilepsy,  if  the  operation  be  under- 
taken in  adult  life.  That,  I say,  is  reason  for  further  encouragement, 
because  all  of  his  cases  were  beyond  the  period  of  childhood  and  yet 
there  was  a decided  improvement. 

So  little  has  been  written  on  the  subject  of  cephalalgia  that  any 
case  in  the  way  of  it  is  received  as  an  eye-opener  and  an  encourage- 
ment for  the  future.  Baker,  in  his  annual  report  of  1892,  says  : “ In 
the  present  light  of  surgical  knowledge  we  need  expect  nothing  in 
the  treatment  of  insanity  from  surgical  means.”  It  seems  to  me  that 
a man  must  be  a good  deal  of  a medical  pessimist  who  would  make 
such  a statement  regarding  any  complication  in  the  present  light  of 
surgical  progress.  Dr.  Shears’s  one  case  shows  that  there  can  be  some 
improvement  made  in  this  most  discouraging  disease.  In  the  condi- 
tion of  microcephalic  idiocy,  as  lie  has  reported,  there  are  twenty- 
five  cases  with  only  one  death.  This  is  certainly  encouraging  to  an 
extreme,  in  a condition  which  we  have  regarded  heretofore  as  abso- 
lutely hopeless  for  there  has  been  no  attempt  whatsoever,  in  these 
conditions  of  idiocy,  to  secure  improvement  by  any  operation  ; and 
now  that  the  surgeon’s  knife  has  attacked  this  disease,  it  seems  to 
me  that  from  the  recital  of  these  twenty-five  cases,  and  the  additional 
cases  of  Dr.  Shears’s  as  presented  in  his  paper,  that  they  also  justify 
a feeling  of  very  great  encouragement. 

Clarence  Bartlett,  M.D.  : The  privilege  of  aiding  the  dis- 
cussion on  the  address  by  Dr.  Shears  is  to  me  a most  pleasant  one, 
being,  as  I am,  in  close  accord  with  the  conclusions  he  adopts.  Al- 
though not  a surgeon  the  treatment  of  epilepsy,  both  medical  and 
surgical,  has  for  some  years  past  been  to  me  a most  interesting  as 
well  as  very  unsatisfactory  one.  A rapidly  increasing  experience 
(during  the  year  past  over  75  cases)  makes  me  very  conservative  in 
stating  whether  or  not  a given  case  has  been  cured.  I cannot  say 
exactly  how  many  cases  of  epilepsy  have  been  operated  upon  by  my 
advice.  I can  say,  however,  that  all  so  far  as  I know  received  more 
or  less  temporary  benefit  from  the  same.  In  some  instances,  the 
seizures  ceased  at  once,  while  in  others  a number  of  convulsions  oc- 
curred for  the  few  days  succeeding  the  operation,  when  they  disap- 
peared. The  permanent  results  from  these  operations  are,  on  the 
other  hand,  far  from  satisfactory.  In  the  majority  of  cases,  seizures 
recur  at  intervals  ranging  from  two  or  three  months  to  as  many 
years.  I believe  with  Seguin  that  no  case  of  epilepsy  can  be 
regarded  as  cured  by  an  operation  until  the  patient  had  passed 
through  a period  of  two  years  without  any  attacks  whatever. 

These  remarks  apply  with  equal  force  to  the  surgical  treatment  of 


318  world’s  homoeopathic  congress. 

traumatic  epilepsy.  It  is  the  generally  accepted  idea  among  the 
profession  that  trephining  in  traumatic  epilepsy  is  tantamount  to 
cure.  This  is  an  error.  A clinical  study  of  these  cases  shows  that 
almost  invariably  the  epilepsy  does  not  develop  for  months  or  years 
after  the  injury.  In  other  words  there  develops  within  the  cranial 
cavity  a something  that  did  not  exist  shortly  after  the  accident,  a 
something  that  is  the  actual  cause  of  the  so-called  traumatic  epilepsy, 
I believe  with  Sachs  that  secondary  changes  in  the  brain  substance 
take  place,  and  thus  occasion  the  epilepsy.  Under  such  circum- 
stances it  is  almost  the  height  of  absurdity  to  expect  a cure  from  any 
operation.  Especially  is  a cure  improbable  in  those  cases,  and  these 
in  my  experience  are  the  majority,  in  which  the  convulsions  are 
general.  If  on  the  other  hand,  the  convulsions  are  localized,  and 
the  seat  of  the  cerebral  lesion  is  evidently  beneath  or  in  the  vicinity 
of  a depressed  fracture,  I should  most  certainly  look  for  a good  re- 
sult. 

A review  of  Dr.  Shears’s  cases  of  epilepsy  treated  surgically 
bears  out  the  views  I have  expressed.  In  Case  I.,  there  was  a re- 
turn of  the  convulsions  following  a debauch.  In  the  majority  of 
cases  it  will  be  found  that  the  first  convulsion  attending  a relapse 
has  an  exciting  cause.  In  Case  II.  there  was  temporary  improve- 
ment when  the  convulsions  returned  in  full  force.  In  Case  III.  there 
was  a very  material  cause  for  the  convulsive  seizures  in  the  abscess 
which  was  so  successfully  evacuated.  Here  I believe  a permanent 
cure  is  to  looked  for.  In  Case  IV.  there  was  an  extra-dural  haemor- 
rhage, the  proper  treatment  of  which  led  to  a cure.  Both  cases  (III. 
and  IV.)  should  not  to  my  mind  have  been  included  as  cases  of  epi- 
lepsy, to  which  disease  they  bear  but  little  resemblance.  In  Case  V. 
the  ultimate  result  must  remain  in  doubt  because  sufficient  time  since 
the  operation  has  not  yet  elapsed. 

The  failure  to  cure  traumatic  epilepsy  by  surgical  means  is  rightly 
attributed  by  the  essayist  to  the  generation  of  the  epileptic  habit.  I 
have  already  reverted  to  another  reason,  the  occurrence  of  organic 
cerebral  changes,  and  I would  now  mention  a third,  the  failure 
on  the  part  of  the  profession  to  give  these  cases  proper  medical 
and  hygienic  treatment,  they  expecting  that  the  operation  will  act 
unaided. 

It  may  seem  to  my  hearers  that  I am  decidedly  iconoclastic  in 
my  sentiments.  I have  reason  to  be.  I have  seen  case  after  case 
remain  free  from  convulsions  for  months,  and  then  relapse  into  its 
former  deplorable  condition.  In  May,  1890,  I reported  a case  of 
dural  epilepsy,  in  which  the  improvement  was  little  short  of  mar- 
vellous, and  I and  my  associated  surgeon  gloried  in  a wonderful  cure. 
Just  thirteen  days  ago  I learned  from  a New  York  neurologist  that 
this  identical  case  had  turned  up  in  his  clinic,  and  was  now  as  bad 
as  before. 


THE  TREATMENT  OF  EPILEPSY,  ETC. 


319 


At  the  present  time  I have  in  mind  the  case  of  a child  but  three 
years  old,  a sufferer  from  epileptic  seizures,  fourteen  or  fifteen  occur- 
ring each  day.  They  were  of  local  commencement.  Trephining 
over  the  appropriate  motor  area  was  performed  by  Dr.  W.  B.  Van 
Lennep,  with  the  expectation  of  excising  the  same  should  it  be 
found  diseased.  It  was  found  to  be  healthy.  Several  convulsions 
occurred  during  the  few  days  succeeding  the  operation,  since  which 
time  the  child  has  been  entirely  free  from  them. 

Again,  a case  was  admitted  to  the  Hahnemann  Hospital  for  study. 
The  actual  number  of  seizures  per  day  being  over  sixty,  if  the  state- 
ments of  her  father  can  be  accepted.  The  child  was  put  on  an  ex- 
clusive milk  diet,  and  for  several  weeks  had  no  attack  of  any  kind. 
Then  she  relapsed,  though  not  as  bad  as  before  her  admission  to 
the  institution.  Then  she  was  seized  with  measles,  during  the 
course  of  which  she  had  numerous  convulsions.  After  convales- 
cence, the  fits  remained  away  until  her  discharge  from  the  hos- 
pital, four  weeks  later.  Concerning  her  subsequent  career,  I am  in 
ignorance. 

The  temporary  improvement  in  epilepsies  by  trephining  I attribute 
to  two  causes.  The  first  of  these,  and  by  far  the  most  active  one, 
is  the  effect  of  operation  per  se.  Although  this  subject  has  been 
formally  introduced  to  the  profession  within  a few  years,  its  import- 
ance has  been  recognized  for  a number  of  years.  It  matters  not 
what  the  operation  be;  it  may  even  be  a severe  traumatism,  a frac- 
ture, or  a burn,  or  a contusion,  and  the  fits  are  temporarily  suspended 
thereby.  One  of  our  Cincinnati  physicians  has  proposed  to  take  ad- 
vantage of  this  fact  in  the  treatment  of  epilepsy.  Even  intercurrent 
diseases,  measles,  as  in  the  case  just  reported,  may  act  as  very  efficient 
anti-epileptic  remedies.  A second  cause  for  the  improvement  is  the 
relief  of  intracranial  tension.  In  the  majority  of  cases  I have  seen 
operated,  the  membranes  have  been  abnormally  tense. 

The  magnificent  results  reported  by  Laurento,  as  quoted  bv  Dr. 
Shears,  namely,  54  per  cent,  cured,  I can  only  account  for  by  reason 
of  insufficient  observation.  This  is  a crying  evil  in  the  surgical  lit- 
erature of  epilepsy.  Standard  critical  journals,  as  the  British  Medi- 
cal and  the  Lancet , contain  the  reports  of  many  cures,  which  in  reality 
are  not  cures,  for  they  often  are  reported  even  before  the  wound  of 
the  operation  has  healed. 

The  excision  of  cortical  centres  for  the  cure  of  Jacksonian  epilepsy 
has  borne  some  good  fruit  in  the  shape  of  amelioration,  but  the  cures 
are  in  the  minority.  In  all  of  my  cases  relapse  has  occurred.  Many 
of  these  cases  have  as  their  origin  the  so-called  spastic  hemiplegia  of 
epilepsy,  the  pathological  conditions  at  the  foundation  of  which  are 
of  a varied  as  well  as  of  a most  serious  character.  It  is  hard  to  ex- 
pect a cure  under  such  circumstances. 

The  question  of  the  removal  of  irritable  cicatrices  has  been  raised 


320 


world's  homoeopathic  congress. 


by  Dr.  Shears.  I think  it,  very  wise  indeed  to  remove  any  such 
source  of  irritation  ; at  the  same  time  I must  warn  against  too  ready 
an  acceptance  of  the  idea  that  a cure  will  certainly  result.  In  my 
case  of  dural  epilepsy  a very  irritable  cicatrix  existed,  and  this  was 
removed. 

The  surgical  treatment  of  insanity  is  worthy  of  close  study.  Tem- 
porary improvement  in  cases  of  general  paralysis  of  the  insane  has 
been  effected  by  a few  English  operators. 

The  cases  subsequently  relapsed.  It  has  been  urged  by  some  that 
these  reports  teach  nothing,  for  the  course  of  general  paralysis  of  the 
insane  is  remarkable  for  the  spontaneous  improvements  which  may 
ensue.  Numerous  insanities  have  been  known  to  recover  under  the 
influence  of  a severe  traumatism.  Trephining  may  act  curatively 
and  is  a wise  measure,  substituting  a scientifically  performed  for  an 
accidental  and  bungling  traumatism. 

The  surgical  treatment  of  abscess  of  the  brain  admits  of  no  dis- 
cussion. If  pus  exists  in  the  brain,  it  must  be  removed,  or  the  pa- 
tient will  die.  Our  course  must  be  guided  by  the  reliability  of  our 
diagnosis. 

Dr.  Shears,  in  closing  his  paper,  makes  a very  important  point, 
so  important,  indeed,  that  I desire  to  emphasize  it  as  much  as  may 
be  in  my  power  to  do.  He  pleads  for  an  early  and  efficient  treat- 
ment of  cranial  injuries.  For  years  the  profession  has  been  guided 
by  a doctrine  that  I regard  as  decidedly  antiquated,  if  not  actually 
inhuman,  that  of  concussion  of  the  brain.  It  has  been  customary, 
whenever  cerebral  symptoms  persisted  for  any  length  of  time  and 
there  is  no  external  evidence  of  bone  injury,  to  attribute  the  trouble  to 
cerebral  concussion.  No  more  dangerous  theory  exists  in  medicine  to- 
day, making,  as  it  does,  the  surgeon  inefficient  by  reason  of  masterly 
inactivity.  In  the  vast  majority  of  such  cases,  proper  methods  will 
show  that  fracture,  intra-cranial  hsemorrhage,  meningitis,  or  other 
gross  lesions  exist.  So  far  as  relying  upon  a depressed  fracture,  I 
believe  in  almost  invariably  making  an  exploratory  incision ; if  a 
fracture  is  discovered,  then  trephine,  whether  there  be  a depression 
or  not.  Many  times  small  extra-dural  haemorrhages  will  be  discov- 
ered, the  removal  of  which  is  unquestionably  good  surgery.  Such 
cases  make  far  more  rapid  recoveries  than  do  the  head  injuries  in 
which  operation  is  refused.  I have  in  care  at  the  present  time  two 
of  the  latter  class : oue  a case  in  which  the  location  of  the  lesion  is 
undoubted,  and  which  has  pursued  a very  slow  course;  the  other  a 
basal  fracture,  which  has  improved,  though  after  a tedious  conva- 
lescence. In  both  instances  permanent  mental  changes  will  probably 
ensue. 

My  colleague,  Dr.  Van  Lennep  and  myself  have  been  working 
on  this  line,  the  radical  treatment  of  head  injuries,  for  some  time 
past.  The  results  thus  far  have  been  all  that  the  most  fastidious 


321 


THE  TREATMENT  OF  EPILEPSY,  ETC. 

could  desire.  Every  case  of  head  injury  is  examined  from  a twofold 
standpoint,  that  of  the  neurologist  and  the  surgeon.  Many  cases 
that  would  have  died  under  a conservative  or  expectant  (more  prop- 
erly speaking)  treatment,  have  made  most  satisfactory  recovery.  In 
the  early,  in  the  thorough  primary  treatment  of  head  injuries,  lies  the 
proper  treatment  of  traumatic  epilepsy,  i.e .,  its  prevention. 

While  speaking  thus  pessimistically  concerning  the  results  from 
the  surgical  treatment  of  epilepsy,  I still  advise  operation  in  a se- 
lected few  cases.  All  traumatic  cases  with  localized  seizures  should 
be  operated.  No  case  should  be  treated  surgically  unless  there  is  an 
indication  for  such  treatment.  In  every  instance  the  patient  and  his 
friends  should  be  made  to  distinctly  understand  that  the  operation 
must  be  supplemented  by  proper  hygienic  and  medicinal  measures. 
This,  I am  sorry  to  say,  is  rarely  done;  indeed,  it  is  well-nigh  im- 
possible to  impress  its  importance  on  the  lay  mind. 

As  to  microcephalus  and  craniectomy,  it  is  yet  too  early  to  speak 
positively.  The  operation  is  a serious  one,  more  serious  the  longer 
the  time  occupied  in  its  performance.  Successful  ultimate  results 
can  only  be  expected  when  the  operation  is  supplemented  by  proper 
educational  methods.  The  bulk  of  the  evidence  at  present  at  our 
disposal  goes  to  show  that  but  little  will  result,  although  in  the  last 
case  in  which  I was  associated  there  was  apparently  considerable 
improvement  during  the  patient’s  stay  in  the  hospital.  Cases  se- 
lected for  operation  should  be  individualized  most  carefully.  There 
should  be  no  doubt  concerning  the  smallness  of  the  head  and  the 
closure  of  the  sujtures,  and  the  patient  should  be  reasonably  young. 
In  none  of  the  cases  in  which  I have  been  associated  has  the  patient 
been  more  than  five  years  of  age. 

If  in  these  remarks  I have  painted  the  results  in  too  sombre  hue, 
it  is  not  because  I believe  there  is  no  future  for  cerebral  surgery,  but 
rather  to  check  a reckless  enthusiasm.  I sincerely  trust  that  I have 
induced  my  hearers  to  favor  early  efficient  treatment  of  recent  inju- 
ries, while  they  spare  their  enthusiasm  in  the  treatment  of  the  old 
ones. 

W.  F.  Knoll,  M.D. : In  the  last  few  years  I have  made  brain  sur- 
gery quite  a study,  and  I have  now  quite  a number  of  cases  which  I 
could  report  if  I had  them  properly  tabulated.  But  I want  to  say 
that  I am  very  thankful  to  Dr.  Shears  for  what  he  has  said  in  regard 
to  operations  upon  the  brain.  There  has  been  a complete  change  in 
the  ideas  of  neurologists,  and  what  a while  ago  was  considered  to  be 
an  uncontrollable  irritation  has  to-day  a reasonable  and  scientific  ex- 
planation, and  that  which  has  given  us  this  reasonable  and  scientific 
explanation  is  surgery.  The  experiments  which  have  been  made  by 
the  vivisectionists  and  the  results  which  have  come  from  their  past 
examinations  have  laid  the  foundation  for  practical  surgical  investi- 
gation and  operations,  and  to-day  we  have  enough  cases  tabulated  of 

21 


322 


world’s  homoeopathic  congress. 


nervous  diseases  to  show  that  the  brain,  in  a large  number  of  cases, 
is  the  seat  of  disease,  and  that  it  can  be  reached  successfully  by  the 
knife.  Now  there  is  no  doubt  whatever  that  a large  per  cent,  of  the 
cases  of  epilepsy  are  purely  traumatic  in  nature,  in  their  origin  ; in- 
deed, the  largest  part  of  them.  We  rarely  ever  find  a case  of  epi- 
lepsy which,  when  followed  from  first  to  last,  has  not  a traumatic 
history  in  it  somewhere.  A large  per  cent,  of  the  cases  of  micro- 
cephalic  disturbances  also  have  traumatism  as  a starting-point.  It 
is  either  traumatism  received  during  birth,  or  it  is  traumatism  re- 
ceived after  birth.  A large  per  cent,  of  the  cases  that  we  have  of 
cephalalgia  are  the  result  of  traumatism,  and  I believe  that  those 
cases,  in  time,  will  be  attainable,  and  we  will  have  such  reliable  cases 
to  go  by  that  a diagnosis  can  be  made  in  the  majority  of  them,  and 
in  the  cases  that  are  of  a surgical  nature  surgical  means  will  be  ap- 
plied successfully. 

One  point  especially  that  I wish  to  speak  about  is  in  regard  to  the 
different  methods  of  operating  and  of  removing  the  bone  from  the 
skull — the  ease  with  which  it  can  be  done  and  the  safety  with  which 
an  operation  can  be  made.  I have  here  some  instruments,  a descrip- 
tion of  which  has  appeared  in  print,  for  removing  the  skull-bone 
after  a primary  opening  has  been  made  through  the  skull  with  a 
chisel  and  hammer.  I have  brought  these  instruments  with  me  this 
evening  so  that  I can  show  you  how  easily  an  examination  can  be 
made. 

(Dr.  Knoll  then  illustrated  the  use  of  the  instruments  to  the  au- 
dience in  detail  and  answered  several  questions  put  to  him  by  va- 
rious members  of  the  Congress,  concluding  his  remarks  with  the 
statement  that  he  did  not  believe  in  trephining.) 

Dit.  Shears:  I have  nothing  to  take  back  that  I have  said,  and 
I don’t  know  that  I have  anything  to  say  that  is  very  different  from 
what  has  been  said.  Dr.  Knoll  and  I will  never  agree  upon  the 
subject  of  trephining  and  the  chisel.  We  have  had  that  out  before; 
that  is,  to  our  own  satisfaction.  We  have  trotted  it  out  for  society 
meetings,  and  the  Doctor  has  trotted  it  out  again  upon  this  occasion. 
Now  I want  to  say  that,  notwithstanding  the  statement  that  the 
Doctor  has  made,  I believe  the  trephine  is  a much  more  useful  in- 
strument, and  a safer  instrument,  and  a more  rapidly-working  in- 
strument than  is  the  chisel,  and  I believe  also  in  the  hands  of  others, 
possibly  in  those  who  are  not  so  skillful.  There  is  no  need  whatever 
of  cutting  the  dura  when  you  are  using  the  trephine,  if  you  use  it 
properly.  There  is  not  that  jar  to  the  brain  that  there  is  when  the 
chisel  and  hammer  are  used.  Now  I know  it  is  a Germau  fad  to 
use  the  chisel  and  the  hammer,  and  I have  seen  it  used  and  tried  it, 
and  I can  make  a hole  through  the  skull  with  some  celerity,  but  I 
don’t  propose  to  use  it,  and  I am  not  going  to  recommend  it  to  any- 
body else. 


323 


THE  TREATMENT  OF  EPILEPSY,  ETC. 

So  far  as  removing  the  bone  is  concerned,  of  course  we  all  use 
these  cutting  forceps  in  various  forms  and  shapes,  yet  I assure  you, 
that  when  you  have  your  patient  down  upon  the  table  and  are  not 
able  to  get  the  bone  up  in  a position  where  you  can  get  your  forceps 
on  it,  that  it  does  not  get  out  with  that  same  ease  that  it  does  here. 

Now  that  is  not  a criticism  on  Dr.  Knoll.  He  gets  it  out  easily 
and  readily  and  rapidly,  but  I use  the  trephine  first,  and  that  is  a 
very  nice  little  instrument.  I think,  however,  that  in  a large  num- 
ber of  instances  you  want  a larger  groove  than  that  cut  in  this  in- 
strument. 

I had  hoped  that  something  might  be  said  here  concerning  pre- 
ventive measures  in  the  treatment  of  epilepsy  resulting  from  trau- 
matic causes.  My  paper,  which  was  not  concluded,  had  something 
to  say  about  the  preventive  measures.  I am  inclined  to  advise  very 
radical  measures  in  the  treatment  of  fractures  of  the  cranium,  and  I 
believe  if  more  radical  measures  were  instituted  there  would  be  fewer 
cases  of  epilepsy,  fewer  cases  of  insanity,  etc.,  for  if  every  case  of  com- 
pound depressed  fracture  was  trephined,  if  every  case  of  fracture  of 
the  cranium  was  trephined,  especially  when  it  was  not  compound, 
whether  there  wras  depression  or  not,  there  would  be  fewer  cases  of 
insanity.  I don’t  know  that  I should  advise  every  case  to  be  tre- 
phined, but  I certainly  should  advise  all  compound  cases,  whether 
there  were  symptoms  of  compression  present  or  not. 


324 


world’s  homoeopathic  congress. 


A REPORT  ON  ORIFICIAL  SURGERY , INCLUDING 
AN  ANALYSIS  OF  1000  CASES. 

By  E.  H.  Pratt,  M.D.,  Chicago,  Iliu. 


The  preceding  generations  of  medical  men,  in  their  struggles  with 
pathological  conditions,  have  almost  invariably  attacked  them  at 
the  points  of  manifestations.  The  testimony  of  the  body  itself  has 
been  taken  as  authentic,  and  its  points  of  discomfort,  wherever 
located,  have  been  considered  the  proper  places  for  the  application 
of  remedial  measures.  If  the  head  ached,  the  head  was  carefully 
examined,  and  the  story  which  the  head  had  to  tell  for  itself  was 
patiently  listened  to  and  considered  and  remedial  measures,  internal 
or  external,  were  directed  headward.  The  same  is  true  of  the  heart, 
lungs,  liver,  stomach,  and  other  organs. 

The  coming  generations  of  doctors  will  do  better  work,  because 
they  comprehend  more  clearly  not  only  the  nature  of  pathology,  but 
also  its  underlying  principles.  Our  predecessors  have  struggled 
merely  with  effects;  our  successors  will  manipulate  causes.  In  the 
past  much  suffering  has  been  relieved  ; in  the  future  relief  will  be 
more  general  and  sure,  and,  at  the  same  time,  the  age  of  prevention 
will  be  ushered  in. 

There  is  now  a class  of  scientific  workers  which,  by  dissections 
and  the  aid  of  the  microscope,  is  seeking  to  solve  the  riddles  of  dis- 
ease on  the  theory  of  physical  causation.  There  is  also  another  class  of 
workers  which,  by  an  opposite  process,  preferring  telescopes  to  micro- 
scopes, synthesis  to  analysis,  is  scanning  the  realms  of  force  for  an 
explanation  of  matter.  The  analysts  have  discovered,  classified, 
and  are  seeking  to  annihilate  the  hordes  of  microbes  which  swarm 
all  air,  and  water,  and  food,  and  which  await  upon  the  decay  of  the 
body  as  birds  of  prey  hover  about  a carcass,  premeditating  and  ac- 
complishing its  annihilation.  The  synthesists  are  hunting  for  a God 
and  the  laws  by  which  the  judgments  of  life  and  death  are  prescribed. 

The  first  class  of  students,  in  searching  for  causes  of  disease  have 


A REPORT  ON  ORIFICIAL  SURGERY. 


325 


stumbled  upon  some  wonderful  effects  of  disorganization.  The 
other  class  of  students,  in  contemplating  morbid  conditions  have 
accidentally  discovered  that  the  manifestations  of  disease,  which  for  so 
long  a time  have  been  regarded  as  causes,  are  really  nothing  but 
effects,  and  that  the  causes  of  all  disease  lie  in  deeply  hidden  princi- 
ples which  hitherto  have  been  unobserved.  Both  classes  of  students 
have  served  humanity  well,  for  the  one  has  established  cleanliness, 
and  the  other  has  ushered  in  godliness;  and  with  these  two  advances 
in  medical  practice  the  future  is  made  big  with  hope  that  the  coming 
generations  of  men  may  be  enabled  to  escape  the  pests  and  plagues  of 
their  ancestors  and  enjoy  the  unalloyed  happiness  of  healthful  lives. 

The  orificial  philosophy,  the  subject  of  the  present  report,  is  a 
product  of  synthetic  thought  and  observation.  Its  principles  are 
applicable  in  all  forms  of  chronic  ailments.  The  testimony  of  the 
microscope,  of  the  stethoscope,  of  percussion,  of  the  clinical  ther- 
mometer, of  chemical  analysis,  and  of  all  forms  for  diagnosing  con- 
ditions, are  necessary  as  furnishing  items  for  a general  inventory  of 
the  case.  But  it  matters  not  what  organs  or  tissues  of  the  human 
body  may  be  ill-conditioned,  what  functions  may  be  disturbed,  what 
local  or  general  bodily  discords  may  prevail,  the  possibility  of  their 
existence  is  explained  upon  a basis  of  one  common  predisposing 
cause.  The  orificial  philosophy  does  not  consider  questions  of  in- 
herited or  acquired  tendencies,  of  smouldering  poisons  and  blood 
taints ; it  simply  furnishes  an  explanation  for  the  manifestations  for 
these  as  well  as  for  all  other  possible  forms  of  pathology,  and  suggests 
a remedy. 

The  essential  questions  in  any  case  of  sickness  are  : Is  the  whole 
body  or  any  part  of  it  chronically  diseased  ? Have  other  remedial 
measures  proved  ineffectual?  Is  the  reactive  power  of  the  system 
so  poor  that  it  permits  lingering  illness  in  spite  of  all  efforts  at 
relief?  Is  the  case,  in  other  words,  one  of  the  so-called  incurable 
forms  of  disease?  If  so,  then  there  must  necessarily  exist  (1)  blood 
stasis  or  congestion  ; (2)  weakened  peristaltic  action  ; (3)  wasted 
sympathetic  nerve  power.  Always,  and  without  exception  under 
such  circumstances,  upon  examination  will  there  be  found  pathol- 
ogical conditions  at  the  lower  openings  of  the  body  sufficient  to 
account  for  the  lowered  vitality  which  alone  could  explain  prolonged 
pathology.  The  removal  of  whatever  orificial  irritation  may  be 
encountered  invariably  enhances  sympathetic  nervous  force,  increases 


326  world’s  homoeopathic  congress. 

the  reactive  power  of  the  system,  restores  its  susceptibility  to  the 
action  of  other  remedial  measures,  and  thus  supplements  in  a most 
satisfactory  manner  the  otherwise  ineffective  measures  which  the  pro- 
fession has  had  to  offer  for  the  relief  of  the  chronically  sick. 

The  anatomical  and  physiological  facts  upon  which  this  philos- 
ophy is  based  have  been  so  repeatedly  presented  to  the  profession 
as  to  render  superfluous  an  additional  presentation  of  them  in  the 
preseut  report. 

Let  us  take  it  for  granted,  therefore,  that  these  well-established 
facts  and  theories  are  universally  known  and  recognized,  and  that  in 
all  forms  of  chronic  disease  there  will  always  be  found  orificial  pa- 
thology sufficient  to  account  for  the  sympathetic  nerve  waste  which 
the  existence  of  these  conditions  implies. 

What  we  shall  attempt  on  the  present  occasion,  is  to  present  to 
the  profession,  in  general  terms,  what  is  to  be  expected  from  the 
application  of  orificial  principles  in  the  various  forms  of  chronic  dis- 
eases. Thousands  of  cases,,  which  heretofore  were  regarded  as  in- 
curable, have  now  been  restored  to  health  by  orificial  measures. 
Thousands  of  cases  have  also  failed  to  respond  satisfactorily  to  the 
treatment,  and  many  have  received  lasting  injury.  The  results  of 
the  work  thus  far  obtained  have  proven  beyond  question  (1)  the  uni- 
versality of  the  need  of  orificial  work  in  chronic  diseases ; (2)  the 
unmistakable  power  of  orificial  surgery;  (3)  that  greater  care  must 
be  exercised  in  its  employment,  also  that  its  methods  must  be  so  im- 
proved as  to  add  to  its  efficiency  as  a remedial  measure,  and  to  deprive 
it  of  its  power  for  harm. 

All  remedial  measures  known  to  the  profession  may  be  productive 
of  untold  mischief  when  wrongfully  applied.  Drugs  can  kill  as 
well  as  cure,  so  can  electricity;  so  can  heat  and  cold  ; so  can  exter- 
nal applications,  so  can  mental  forces  ; but  in  the  hands  of  the  skill- 
ful and  competent  even  edged  tools  should  save  life  and  not  cost  it. 
In  spite,  however,  of  the  imperfection  of  present  methods  of  apply- 
ing orificial  principles  to  the  cure  of  chronic  diseases,  and  in  spite  of 
the  too  numerous  mistakes  which  have  arisen  from  ignorance  and 
meddlesome  propensities,  so  much  good  has  already  been  accom- 
plished and  so  little  harm,  that  the  subject  of  orificial  surgery  de- 
mands the  attention  of  the  profession,,  demands  to  be  enrolled  upon 
the  list  of  legitimate  and  scientific  measures,  and  demands  still  far- 
ther to  be  added  to  the  curriculum  of  all  schools  of  medicine. 


A REPORT  ON  ORIFICIAL  SURGERY. 


327 


In  the  practice  of  orificial  surgery,  it  must  be  remembered  that 
the  same  principles  of  pathology  which  prevail  elsewhere  in  the 
body  must  be  recognized  in  examining  its  lower  openings.  The 
surgeon  must  not  only  take  cognizance  of  hypertrophy,  but  must 
also  recognize  atrophy.  He  must  not  only  look  for  abnormal  sten- 
osis, but  also  for  abnormal  dilatation.  He  must  not  only  consider 
hypersesthesia,  but  must  observe  likewise  ansesthesia,  and  whatever 
orificial  work  he  indulges  in  must  be  directed  to  the  successful  cor- 
rection of  whatever  forms  of  pathology  he  may  encounter. 

It  is  now  a well-established  fact,  which  none  but  the  ignorant 
will  deny,  that  in  all  forms  of  chronic  disease,  there  is  invariably 
present  some  form  of  orificial  irritation.  It  is  also  a fact,  just  as 
thoroughly  established,  that  the  removal  of  orificial  pathology 
economizes  the  sympathetic  nerve  force,  equalizes  the  capillary 
circulation,  stimulates  a universal  nutrition,  and  favors  a reaction 
from  morbid  conditions  not  only  in  the  body  generally  but  in  each 
part  of  it  in  particular.  When  the  hands  of  a watch  fail  to  desig- 
nate the  correct  hour  of  the  day,  the  watchmaker  is  immediately 
persuaded  that  there  is  something  wrong  with  the  works  of  the  time- 
piece. So,  too,  when  the  human  body  is  disturbed  in  its  functions, 
when  the  hands  of  this  great  clock  of  time  point  to  a disorded  eye, 
ear,  nose,  throat,  heart,  lungs,  liver,  stomach,  spinal  cord,  skin,  mucous 
membrane,  kidney,  or  any  of  its  other  organs,  the  orificialist  imme- 
diately understands  that  there  is  something  wrong  with  the  interior 
machinery.  The  peristaltic  actions  must  have  been  disarranged, 
sympathetic  nerve  force  must  have  been  disturbed,  and  in  the  con- 
ditions of  the  lower  openings  of  the  body  he  will  find  ample  excuse 
for  the  lowered  vitality  which  has  permitted  the  disorder  to  linger 
as  a lasting  condition. 

What  then  may  we  expect  from  the  application  of  orificial  prin- 
ciples to  chronic  diseases  ? The  proper  answer  to  this  question  is 
another  question.  What  may  we  expect  in  a given  case  from  the 
universally  improved  capillary  circulation  and  the  increased  nutri- 
tion involved?  A dead  body  cannot  be  restored  to  life,  neither  can 
dead  cells.  An  irritable  body  can  be  soothed,  and  so  can  irritable 
cellular  structures.  Sleepy  organisms  can  be  aroused  to  activity,  and 
so  can  torpid  cell-life.  An  engorged  general  system  can  be  reduced, 
and  so  can  congestion  of  tissues.  A hungry  human  being  can  be 
fed,  and  so  can  starved  structures.  The  commerce  of  the  body, 


328 


world’s  homceopathic  congress. 


which  must  have  been  imperfectly  performed  to  permit  the  existence 
of  local  pathology,  can  be  re-established  and  health  restored  just  in 
proportion  to  the  integrity  of  the  cellular  structure  involved  in  the 
existing  disease. 

The  orifieial  philosophy,  therefore,  does  not  merely  introduce 
methods  of  correcting  local  pathology,  but  is  more  ambitious,  and 
aspires  to  no  less  an  achievement  than  the  restoration  of  equilibrium 
to  the  circulation  of  the  blood  in  its  comprehensive  expansion,  thus 
dealing  in  detail  with  the  active  forces  of  life  in  all  the  cellular 
structures  of  which  the  body  is  composed. 

The  methods  at  present  in  vogue  for  correcting  orifieial  pathology 
are  not  a proper  subject  for  consideration  in  this  report,  and  we  must 
refer  those  who  are  not  familiar  with  them  and  who  desire  to  inves- 
tigate the  subject  to  the  orifieial  writings,  which  are  now  sufficiently 
abundant  to  furnish  the  desired  information.  Our  present  object  is 
to  consider  some  of  the  results  of  the  application  of  orifieial  princi- 
ples to  the  various  forms  of  chronic  disease. 

Realizing  then  that  in  applying  orifieial  principles  to  chronic  dis- 
eases we  are  dealing  with  general  nutrition,  affecting  the  depth  of 
respirations,  influencing  the  volume  and  rapidity  of  the  pulse,  stir- 
ring up  dkbris,  and  thoroughly  changing  all  bodily  habits,  we  are 
prepared  for  a rehearsal  of  the  effects  of  the  work  in  the  various 
forms  which  pathology  assumes. 

Affections  of  the  skin  and  mucous  membrane  are  the  quickest  to 
respond  to  orifieial  methods.  Eczema,  even  in  its  most  repulsive 
and  chronic  forms,  is  usually  permanently  cured  in  from  one  to  four 
weeks’  time.  Psoriasis  yields  more  slowly,  and  in  some  cases  is  not 
materially  benefited  by  the  work.  Acne  in  its  various  forms  is 
almost  invariably  cured  in  a few  days’  time.  Chronic  erysipelas  and 
herpes  also  respond  very  satisfactorily  to  orifieial  treatment.  Sec- 
ondary syphilitic  affections  of  the  skin  yield  with  remarkable  rapidity 
to  the  treatment,  especially  when  assuming  the  form  of  ulcerations. 
Urticaria  disappears  rapidly,  but  lupus  and  other  forms  of  malignant 
disease  are  usually  intractable.  The  mucous  membranes  are  the 
next  tissues  affected  by  orifieial  work  in  point  of  time.  Catarrhal 
affections  of  the  different  mucous  membranes  vary  exceedingly  in 
their  persistency  after  orifieial  treatment.  Chronic  ophthalmia,  ul- 
ceration and  opacity  of  the  cornea  usually  yield  speedily,  but  noth- 
ing positive  can  be  promised  in  cases  of  catarrhal  conditions  of  the 


A REPORT  ON  ORIFICIAL  SURGERY. 


329 


eustachian  tube  and  middle  ear.  Many  cases  of  deafness  from  this 
cause  have,  however,  been  cured,  but  there  also  have  been  many 
failures.  Nasal  catarrh  is  usually  benefited  by  the  work,  but  it  is 
generally  necessary  to  supplement  orificial  treatment  by  the  applica- 
tion of  local  measures  and  internal  medication  before  permanent  and 
satisfactory  results  can  be  secured.  Chronic  pharyngitis  and  laryn- 
gitis are  always  benefited,  and  frequently  speedily  exterminated. 
Bronchitis  in  a large  majority  of  cases  very  speedily  disappears. 
Gastric  and  intestinal  catarrh  are  occasionally  obstinate,  especially 
catarrh  of  the  colon,  but  usually  they  succumb  rapidly  to  the  appli- 
cation of  orificial  methods.  Pernicious  vomiting,  even  in  cancer  of 
the  stomach,  usually  responds  quickly  to  the  work  ; and  constipation 
and  diarrhoea  find  in  it  their  panacea,  with,  of  course,  an  occasional 
exception.  Bilious  and  renal  colic,  jaundice,  and  catarrh  of  the 
urethral  tract  are  also  successfully  handled. 

Mere  functional  derangements  of  the  internal  organs,  such  as  the 
brain,  liver,  stomach,  heart,  kidneys,  etc.,  where  the  trouble  lies  in 
passive  congestion  and  the  consequent  functional  derangement,  be- 
fore interstitial  changes  have  taken  place  in  the  organic  tissues,  re- 
spond with  such  marvellous  rapidity  to  orificial  measures  as  to  consti- 
tute the  most  brilliant  cures  in  the  history  of  the  work.  Where 
mal-nutrition  has  been  long  prevalent,  and  serious  structural  changes 
have  resulted,  curative  effects  are  necessarily  much  slower,  and  fre- 
quently a cure  of  such  cases  involves  a complete  change  in  nutrition  ; 
and  it  is  impossible  to  restore  life  to  cells  wdiich  are  dead  and  merely 
waiting  their  burial.  The  work  is  full  of  surprises,  however,  even 
in  this  class  of  cases,  as  many  troubles  wThich  heretofore  have  been 
considered  incurable,  such  as  spinal  sclerosis,  hypertrophy  of  the 
heart  and  liver,  incipient  stages  of  diabetes  and  Bright’s  disease,  etc., 
are  capable  of  repair  to  a greater  extent  than  anybody  has  supposed  ; 
and  in  most  of  these  cases  the  prognosis,  as  recorded  in  the  standard 
text-books,  must  be  rewritten  in  the  light  of  orificial  accomplish- 
ments. 

The  universal  truth  that  the  irritation  of  an  organ  starts  at  its 
mouth,  is  not  only  true  of  the  body  as  a whole,  but  also  of  its  parts 
in  particular.  And  although  in  bad  cases  of  asthma,  catarrhal 
deafness,  conjunctivitis.,  dyspepsia,  laryngitis,  and  so  on,  the  general 
orificial  work  is  first  in  order ; before  a cure  can  be  effected,  local 
attention  will  be  required  to  the  nose,  ear,  pharynx  and  larynx.  In 


330 


world’s  homoeopathic  congress. 


chronic  cellulitis  and  deep-seated  abscesses,  the  results  of  orificial 
treatment,  although  slower  than  those  obtained  in  skin  and  mucous 
membrane  affections,  are  yet  surprisingly  satisfactory.  In  tubercular 
joint  troubles  the  results  of  the  work  are  necessarily  slow  because  of 
the  poor  capillary  supply  of  these  parts.  It  is  a matter  of  common 
experience,  however,  to  obviate  by  the  aid  of  orificial  surgery,  sup- 
plemented by  other  measures  which  influence  capillary  circulation, 
the  necessity  for  many  of  the  major  surgical  operations  which  would 
otherwise  be  required  to  make  life  tolerable  for  such  patients. 

Nodosities  upon  bone  surface,  even  in  syphilitic  and  tubercular 
subjects,  are  usually  absorbed  in  a few  weeks  or  months  after  the 
application  of  orificial  methods.  Conditions  of  necrosis  and  caries 
are  checked  and  stimulated  to  repair,  although  they  usually  call  for 
local  surgical  interference  as  heretofore.  In  such  cases  it  is  well  to 
do  the  general  work,  and  immediately  after  it,  at  the  same  sitting, 
correct  what  orificial  irritation  may  be  found. 

The  condition  of  the  sexual  organs  has  long  been  considered  im- 
portant in  hip-joint  disease,  but  it  is  equally  important  in  affections 
of  all  joints.  Renal  colic  has  been  repeatedly  relieved  by  the  use 
of  urethral  steel  sounds.  The  tendency  to  bilious  colic  has  been 
repeatedly  cured  by  orificial  methods,  but  I am  not  able  to  re- 
port the  action  of  the  work  in  acute  cases.  The  reaction  from 
orificial  methods  in  sciatica,  tic  douloureux,  and  other  forms  of  neu- 
ralgia, varies  greatly  as  to  the  length  of  time.  Some  cases  are 
spontaneously  relieved,  while  in  others  many  months  elapse  before 
a cure  is  effected,  and  in  such  cases  orificial  surgery  seems  but  a basis 
for  other  remedial  measures,  its  action  being  merely  to  increase  the 
reactive  power  of  the  system,  and  render  the  measures  already  stand- 
ard in  the  profession  more  readily  effective. 

Spinal  cord  and  brain  affections  vary,  as  does  the  rest  of  the  body, 
as  to  time  required  for  repair.  When  paralysis  is  due  to  spinal  or 
cerebral  congestion,  speedy  cures  are  effected.  When  due,  how- 
ever, to  structural  changes,  the  action  of  the  work  is  slower,  and  of 
course  frequently  ineffectual.  Paresis  yields  in  most  cases  slowly, 
although  surely.  Nevertheless,  decided  improvement  can  usually 
be  secured  in  from  one  to  three  months.  The  action  of  orificial 
surgery  in  epileptics  is  sometimes  instantaneous  and  permanent, 
sometimes  tardy,  and  sometimes  entirely  ineffective.  A few 
cases  of  blindness  from  atrophy  of  the  optic  nerve,  and  several 


A REPORT  OX  ORIFICIAL  SURGERY. 


331 


from  paralysis  have  been  speedily  restored  to  sight.  Atrophy  and 
paralysis  of  the  auditory  nerve  have  also  been  cured,  but  it  is  not 
safe  to  promise  restoration  of  hearing  or  sight  in  any  case,  as  there 
have  also  been  numerous  failures. 

In  insanity,  orificial  surgery  has  already  done  a great  work,  al- 
though it  is  quite  common  for  such  cases  to  be  aggravated  for  a few 
days  or  weeks  after  submitting  to  the  treatment.  A few  cases  of 
insane  tendency  have  been  precipitated  into  pronounced  insanity  by 
orificial  treatment,  but  there  is  usually  a satisfactory  reaction  in 
such  cases,  and  convalescence  can  be  relied  upon  after  a longer  or 
shorter  period. 

If  there  are  latent  poisons  lurking  in  the  system,  as  malarial  or 
typhoid,  orificial  work  is  very  liable  to  arouse  them  into  activity, 
but  only  for  a short  time,  and  a speedy  convalescence  soon  fol- 
lows. 

In  a cure  by  orificial  surgery,  as  in  any  other  radical  measure, 
chronic  cases  usually  experience  a return  of  their  former  symptoms 
in  inverse  order  to  their  first  appearance. 

When  chronic  syphilis  begins  to  disintegrate  any  portion  of  the 
physical  man,  its  manifestations  are  speedily  checked  by  orificial 
work,  and  a longer  lease  of  life  thus  obtained.  Several  cases  of 
exophthalmic  goitre  have  been  cured,  and  I do  not  now  recall  a 
single  failure.  Tuberculosis  of  glandular  structures  is  usually  an 
intractable  disease.  Orificial  surgery,  however,  has  made  a surpris- 
ingly satisfactory  record  in  pulmonary  tuberculosis.  In  such  cases 
there  is  always  atrophy  of  the  orificial  tissues. 

In  tubercular  subjects,  the  wounds  upon  the  sexual  organs  usually 
heal  satisfactorily,  but  those  of  the  rectum  require  thorough  and 
persistent  treatment  to  prevent  progressive  ulceration,  which,  if  not 
controlled,  would  exercise  a detrimental  influence  upoft  the  patient. 
In  this  class  of  patients,  more  than  in  any  other,  must  the  work  be 
followed  to  a finish  in  order  to  secure  satisfactory  results.  The  reason 
of  this,  in  all  probability,  lies  in  the  fact  that  every  cough  is  accom- 
panied by  a spasmodic  contraction  of  the  anus,  which  keeps  the  parts 
in  motion  and  interferes  materially  with  repair.  The  bad  record 
which  the  operation  for  fistulse  in  consumptives  has  made,  was  prob- 
ably due  to  three  things  : (1)  other  rectal  pathology,  which  is  always 
present  in  such  cases,  was  not  corrected ; (2)  the  methods  of  hand- 
ling the  fistulse  have  been  defective ; and  (3)  no  attention  whatever 


332 


world’s  homoeopathic  congress. 


has  been  paid  to  pathology  of  the  sexual  organs.  As  the  result  of 
an  extended  experience  in  this  class  of  patients,  I have  learned  to 
place  a high  estimate  upon  the  application  of  orificial  principles, 
and  to  have  more  confidence  in  their  operation  than  in  any  other  one 
remedy  yet  suggested  for  pulmonary  tuberculosis. 

In  cancers,  the  work  has  little  action  except  to  reduce  to  a consid- 
erable extent  the  zone  of  congestion  about  the  cancer,  and  to  increase 
the  efficacy  of  other  remedies.  No  permanent  cure  can  be  promised 
in  cases  of  malignant  tumors. 

Sterility,  endometritis,  amenorrhoea,  and  dysmenorrhcea — in  fact, 
the  whole  domain  of  gynaecology — must  look  to  the  application  of 
orificial  principles  for  the  solution  of  its  problems. 

The  action  of  thorough  orificial  work  is  very  profound  upon  every 
part  of  the  human  body,  and  it  requires  a nicety  of  judgment  which 
only  time,  experience,  and  natural  qualifications  on  the  part  of  the 
surgeon,  can  give,  to  decide  in  a given  case  the  form  and  extent  of 
orificial  treatment  that  will  be  required  to  secure  a desirable  degree 
of  reaction  on  the  part  of  the  patient,  and  at  the  same  time  avoid 
the  danger  of  harmful  or  fatal  shock.  The  time  when  satisfactory 
reaction  may  be  expected  varies,  not  only  with  the  tissues  diseased,  but 
also  with  the  individuality  of  the  patients.  Coughs,  headaches,  nau- 
sea, asthma,  and  numerous  other  derangements,  when  merely  func- 
tional, frequently  disappear  instantaneously  ; and,  on  the  other  hand, 
it  is  often  months,  and  sometimes  a year,  or  even  two  years,  before 
the  good  effects  of  orificial  treatment  become  manifest.  In  a large 
percentage  of  chronic  cases,  orificial  surgery  will  be  a sufficient  rem- 
edy, unaided,  for  a complete  restoration  to  health.  But  it  is  a com- 
mon experience  to  secure  no  other  results  from  the  work  than  merely 
a susceptibility  of  the  system  to  other  measures  which  will  be  required 
to  complete  §ie  cure. 

I have  now  applied  the  principles  of  orificial  surgery  to  several 
thousands  of  chronic  cases,  and  the  preceding  statements  are  based 
purely  upon  this  experience. 

In  conclusion,  I beg  leave  to  present  to  you  a brief  analysis  of 
one  thousand  cases  which  I have  operated  upon  between  the  dates  of 
June  1,  1890,  to  October  28,  1892,  with  a view  to  throw  some  light 
upon  the  classes  of  cases  to  which  orificial  surgery  is  applicable,  and 
the  relative  frequency  of  the  various  forms  of  orificial  pathology  as 
they  are  encountered  in  the  ordinary  practice  of  orificial  surgery, 


A REPORT  ON  ORIFICIAL  SURGERY. 


333 


and  of  the  different  methods  employed  for  their  relief.  These  cases 
are  not  selected  ones,  but  taken  consecutively  as  they  applied  for  re- 
lief. 

Of  these  1000  cases,  515  were  men  and  485  were  women.  Twelve 
of  this  number  were  fatal  cases.  A brief  description  and  analysis 
of  these  cases  may  be  of  interest,  especially  as  in  the  light  of  more 
recent  observation  most  of  the  deaths  were  unnecessary. 

Of  the  men  who  died,  the  first  was  suffering  from  progressive 
paralysis,  and  died  a few  days  after  the  American  operation  and  cir- 
cumcision. 

The  second  was  a desperate  case  of  locomotor  ataxia.  He  died  in 
ten  days  after  submitting  to  the  American  operation. 

The  third  man  was  suffering  from  locomotor  ataxia  and  tuber- 
culosis, and  died  in  one  week  after  the  American  operation  and  cir- 
cumcision. 

The  fourth  and  last  case  was  in  the  last  stage  of  locomotor  ataxia, 
and  survived  the  American  operation  and  circumcision,  and  the  re- 
moval of  two  cystic  tumors  from  the  testes,  for  six  days. 

Of  the  female  fatal  cases,  the  first  one  died  of  cellulitis,  after  dila- 
tation of  the  rectum  and  uterine  packing.  She  was  a very  delicate 
case,  suffering  from  chlorosis.  She  had  already  been  considerably 
improved  in  health  under  the  American  operation  and  uterine  pack- 
ing, but  after  the  second  packing,  which  was  undertaken  about  a 
month  after  the  first  operation,  she  was  taken  with  cellulitis  and  died. 

The  second  female  case,  35  years  of  age,  suffering  from  chronic 
cystitis,  had  been  operated  upon  ten  years  previously  for  laceration 
of  the  cervix  by  a skilful  operator  in  a neighboring  city.  She  had 
never  menstruated  since,  and  upon  careful  examination,  the  upper 
half  of  the  uterine  cavity  was  found  completely  glued  together  as  a 
result  of  adhesive  inflammation,  evidently  of  years’  standing.  She 
was  placed  under  an  anaesthetic,  and  her  rectum  operated  upon  by 
the  slit  method,  and  the  false  adhesions  broken  up  in  the  uterine 
cavity  until  it  was  of  its  normal  size.  As  a result  of  this  work  hei 
menstruation  returned,  and  she  attained  an  almost  perfect  degree  ot 
health.  As  her  menstrual  periods,  however,  were  painful,  and  her 
irritation  of  the  bladder  was  not  entirely  relieved,  three  months  after 
the  first  operation  she  was  again  placed  under  an  anaesthetic  and  the 
uterine  cavity  packed.  This  second  work  resulted  in  septicaemia  and 
death. 


334 


world’s  homoeopathic  congress. 


The  third  female  case  was  suffering  from  fibroid  tumor  and  ovarian 
cyst  of  small  size.  After  the  American  operation  and  uterine  pack- 
ing inflammation  and  death  followed.  A post-mortem  revealed  the 
fact  that  one  of  the  cysts  containing  pus  had  ruptured  into  the  peri- 
toneal cavity. 

The  fourth  female  case  was  a subinvoluted  uterus,  measuring  five 
inches  in  diameter,  and  retroflexed  to  an  extreme  degree.  It  was  a 
case  of  nervous  prostration.  She  was  operated  upon  for  laceration 
of  the  cervix.  Her  rectum  was  also  trimmed  and  dilated.  She  died 
of  peritonitis  two  weeks  after  the  operation. 

The  fifth  female  case  was  one  of  mental  depression  and  spinal  irri- 
tation. Uterine  packing  and  rectal  dilatation  were  followed  by  sep- 
ticaemia and  death  five  weeks  after  the  operation. 

The  sixth  female  case  was  one  of  chronic  peritonitis  and  nervous 
prostration.  The  American  operation  and  uterine  packing  resulted 
in  fatal  peritonitis.  The  post-mortem  examination  revealed  an  ab- 
scess of  the  ovary,  which  had  broken  into  the  peritoneal  cavity. 

The  seventh  female  case  was  one  of  extreme  nervous  prostration 
and  of  tubercular  tendency.  She  suffered  from  an  extreme  retro- 
flexion and  prolapsus.  After  the  operation  for  laceration  of  the 
cervix  and  rectal  dilatation  she  was  attacked  with  pernicious  vomit- 
ing, which  was  followed  by  peritonitis  and  death  in  six  days  after 
the  operation. 

The  eighth  and  last  case  was  a case  of  chlorosis,  accompanied  by 
a mild  form  of  anaemia.  After  the  operation  for  laceration  of  the 
cervix  and  rectal  dilatation  she  developed  peritonitis  and  empyema, 
and  the  chronic  anaemia  became  acute.  She  died  seven  days  after 
the  operation. 

In  explanation  of  the  death  of  the  male  patients,  I have  no  com- 
ment to  make  except  that  they  were  all  of  them  extremely  desperate 
cases  and  very  near  their  dissolution,  and  the  operation  was  a forlorn 
hope.  Their  reactive  powers  were  so  feeble  that  they  did  not 
respond  to  the  measures  and  their  lives  were  unquestionably  short- 
ened to  some  extent  as  a result  of  the  operative  interference. 

It  would  undoubtedly  have  been  better  in  the  cases  of  the  men  to 
have  subjected  them  to  the  milder  forms  of  orificial  treatment  before 
the  severer  measures  were  undertaken.  This  precaution  might  pos- 
sibly have  proved  more  satisfactory  and  spared  the  necessity  of  plac- 
ing their  names  on  the  list  of  those  who  have  been  injured  by  the 
work.  The  lesson  is  certainly  a profitable  one. 


A REPORT  ON  ORIFICIAL  SURGERY. 


335 


For  the  death  of  the  female  cases,  however,  there  is  a very  good 
reason,  which  does  not  appear  in  the  statement  of  the  cases.  At  the 
time  these  cases  were  treated,  in  performing  the  toilet  of  the  endo- 
metrium, after  dilating  the  uterus  I was  in  the  habit  of  injecting 
into  the  uterine  cavity  a weak  solution  of  chloride  of  zinc,  and  in 
cases  in  which  the  packing  was  used,  the  packing  was  saturated  with 
glycerin.  Suspecting  that  these  two  substances  had  something  to 
do  with  the  unfortunate  results,  and  hesitating  to  believe  that  curet- 
ting and  cleansing  the  uterine  cavity  and  packing  it  after  free  dila- 
tation was  a measure  dangerous  to  life,  I have  since  omitted  the 
employment  of  the  chloride  of  zinc  solution  and  introduced  an  anti- 
septically  prepared  packing,  perfectly  dry,  employing  bichloride  of 
mercury,  1-4000  solution,  previous  to  the  packing.  In  each  case  I 
am  now  also  in  the  habit  of  packing  the  uterus  twice ; once  to  soak 
up  all  that  remains  in  the  uterus  of  the  bichloride  solution,  and  once 
to  get  the  effect  of  a longer  dilation  than  I could  obtain  from  merely 
the  use  of  sounds. 

I am  very  glad  to  report  that  since  this  change  in  the  treatment, 
which  has  now  been  nearly  a year,  I have  not  only  escaped  the  pain 
of  a fatal  case,  but  have  not  even  induced  either  metritis  or  cellu- 
litis. 

The  seventh  of  the  female  cases  reported  did  not  owe  her  death, 
I am  satisfied,  entirely  to  the  manner  of  treatment,  but  in  part  at  least 
to  the  extreme  retroflexion,  aggravated  by  uncontrollable  vomiting. 
A wiser  judgment  in  this  case  would  have  decided  to  shorten  the 
round  ligaments,  or  by  some  other  procedure  to  have  held  the  uterus 
in  proper  position  while  she  was  recovering  from  the  operations. 
In  the  light  of  what  is  now  known,  therefore,  this  list  of  deaths  of 
the  female  cases  would  probably  have  been  reduced  to  one,  and  pos- 
sibly not  that. 

The  first  and  second  cases  I consider  examples  of  meddlesome 
surgery.  The  cases  were  doing  well  and  should  have  been  let  alone. 
Instead  of  that,  while  in  a sensitive  state  they  were  subjected  to 
severe  secondary  work,  which,  with  the  other  causes  mentioned,  re- 
sulted to  their  harm. 

There  have  been  no  deaths  from  the  employment  of  an  anaesthetic, 
although,  as  will  be  seen  later  on  in  this  report,  it  was  given  indis- 
criminately to  cases  suffering  from  heart,  kidney,  lung,  brain,  and 
spinal  cord  troubles  of  a serious  nature.  In  view  of  these  facts 


336 


world’s  homoeopathic  congress. 

there  is  every  reason  to  hope  that  the  record  of  the  next  1000  cases 
will  not  be  marred  by  the  blemish  of  fatality  even  in  a single  in- 
stance. 

Of  these  1000  cases  107  were  placed  under  an  anaesthetic  a second 
and  sometimes  a third  time  for  what  may  be  called  finishing  work. 
In  chronic  metritis  it  is  very  frequently  impossible  to  secure  satis- 
factory results  from  simply  one  treatment,  even  if  thoroughly  per- 
formed. Granulations  will  reform  and  require  oftentimes  two  or 
three  vigorous  curettings  and  packings  before  a satisfactory  condition 
of  the  endometrium  is  secured. 

After  the  American  operation  in  some  cases  there  is  a tendency 
to  stricture.  This  may  be  overcome  either  by  systematic  and  re- 
peated dilatations  as  they  can  be  borne  by  the  patient,  or  by  one  or 
possibly  two  thorough  dilatations  under  an  anaesthetic. 

It  is  necessary  that  all  orificial  work  should  be  followed  to  a finish 
until  an  ideal  condition  is  attained,  in  order  to  obtain  universally 
satisfactory  results. 

If  those  cases  which  are  reported  as  failures  should  be  examined 
to-day  officially,  they  will  be  found  to  present  an  abnormal  condi- 
tion of  the  orifices,  perhaps  in  a more  extended  form  than  before  they 
were  first  operated  upon.  In  such  cases  this  condition  is  either  the 
result  of  poor  work  or  unfinished  work,  and,  of  course,  should  be 
charged  to  these  accounts  rather  than  reported  as  arguments  against 
the  philosophy. 

After  the  first  work  has  been  performed,  patients  should  never  be 
treated  to  secondary  work  so  long  as  improvement  in  their  condition 
continues.  The  time  of  reaction  from  orificial  work  varies  not  only 
with  the  disease  with  which  the  patient  is  afflicted,  but  also  with 
different  individuals  suffering  from  the  same  disease.  Marvellous 
improvement  will  oftentimes  be  instantaneous,  and  the  list  of  most 
brilliant  cures  conceivable  is  a long  one.  It  is  quite  common,  how- 
ever, for  three,  six,  nine,  and  even  twelve  months,  or  longer,  to  elapse 
before  satisfactory  reaction  takes  place  even  in  cases  which  finally 
recover  as  a result  of  the  work. 

The  following  is  a list  of  chronic  diseases  under  which  these  1000 
cases  have  been  classified.  Many  times  a patient  would  be  suffering 
from  more  than  one  trouble,  but  they  have  been  registered  under  the 
most  prominent  difficulty. 


A REPORT  ON  ORIFICIAL  SURGERY. 


337 


5 cases  of  acne;  all  of  which  were  cured. 

1 case  of  acromegalgia ; which  was  greatly  improved  by  the 
work. 

4 cases  of  amenorrhoea;  3 cured,  1 unaffected. 

18  cases  of  anaemia;  15  cured,  3 improved. 

5 cases  of  aphasia;  2 cured,  2 improved,  1 unaffected. 

20  cases  of  asthma;  12  cured,  6 improved,  2 unaffected. 

5 cases  of  blindness;  3 cured,  1 improved,  1 unaffected. 

5 cases  of  bronchitis;  all  cured. 

43  cases  of  cancer;  some  of  them  improved  for  a time  ; no  cures. 

2 cases  of  caries  of  the  femur;  1 improved,  1 unaffected. 

5 cases  of  chronic  cellulitis;  4 cured,  1 unimproved. 

3 cases  of  chorea;  1 cured,  1 improved,  1 no  better. 

342  cases  of  constipation;  308  cured,  10  improved,  14  unim- 
proved. 

32  cases  of  cystitis;  29  cured,  3 unimproved. 

5 cases  of  deafness;  1 cured,  3 improved,  1 no  better. 

1 case  of  delirium  tremens;  cured. 

5 cases  of  diabetes;  no  cures,  but  all  improved. 

15  cases  of  diarrhoea;  14  cured,  1 unaffected. 

1 case  of  dropped  wrist;  no  better. 

8 cases  of  dropsy;  7 cured,  1 unimproved. 

195  cases  of  dysmenorrhoea ; 174  cured,  10  improved,  9 unim- 
proved. 

123  cases  of  dyspepsia;  all  cured. 

14  cases  of  dipsomania  and  morphia  habit;  all  improved,  but  no 
radical  cures. 

13  cases  of  eczema;  all  cured. 

1 case  of  empyema  ; improved. 

3 cases  of  enuresis  ; cured. 

11  cases  of  epilepsy;  5 cured,  6 improved. 

10  cases  of  fibroids;  3 cured,  7 improved. 

150  cases  of  headaches  ; 135  cured,  10  improved,  5 unaffected. 

14  cases  of  heart  disease;  8 greatly  improved,  6 partially  so. 

302  cases  of  haemorrhoids;  all  cured. 

5 cases  of  hip-joint  disease;  all  improved  and  progressing  to 
recovery. 

16  cases  of  hysteria;  10  cured,  4 improved,  2 unimproved. 

13  cases  of  impotency ; 11  cured,  2 relieved.. 

23  cases  of  insanity;  18  cured,  6 failures. 

22 


338 


world’s  homoeopathic  congress. 


36  cases  of  insomnia;  18  cured,  9 improved,  9 unaffected. 

1 case  of  jaundice;  cured. 

128  cases  of  liver  derangement;  122  cured,  2 improved,  4 unaf- 
fected. 

46  cases  of  locomotor  ataxia;  20  cured,  15  improved,  11  unaf- 

fected. 

1 case  of  lupus;  no  improvement. 

51  cases  of  melancholia;  46  cured,  5 improved. 

1 case  of  meningitis  ; no  improvement. 

10  cases  of  nephritis;  all  improved. 

15  cases  of  nervousness;  10  cured,  5 improved. 

345  cases  of  nervous  prostration;  300  cured,  25  improved,  20 
unaffected. 

29  cases  of  neuralgia;  26  cured,  3 unaffected. 

50  cases  of  ovarian  irritation ; 41  cured,  9 unimproved. 

31  cases  of  paralysis:  16  cured,  10  improved,  5 failures. 

2 cases  of  paralysis  agitans;  both  failures. 

13  cases  of  paresis;  10  cured,  2 improved,  1 unaffected. 

1 case  of  phlebitis;  cured. 

24  cases  of  proctitis;  all  cured. 

6 cases  of  prolapsus  of  the  rectum  ; all  cured. 

8 cases  of  prostatitis;  6 cured,  2 improved. 

5 cases  of  pruritis  ani ; cured. 

2 cases  of  pyaemia;  unaffected. 

17  cases  of  rheumatism;  all  improved. 

48  cases  of  spermatorrhoea;  44  cured,  4 unaffected. 

28  cases  of  spinal  irritation ; 20  cured,  8 improved. 

12  cases  of  sterility;  10  cured,  2 unaffected. 

8 cases  of  stricture  of  rectum;  all  cured. 

2 cases  of  salpingitis;  both  cured. 

47  cases  of  tuberculosis;  40  cured,  3 improved,  4 unaffected. 
The  oldest  patient  operated  upon  was  84  years  of  age ; the 

youngest  was  a child  of  2 years.  As  to  the  methods  employed  in  the 
preceding  cases,  they  were  selected  with  reference  to  the  general 
condition  of  the  patient  rather  than  the  form  of  local  patholoyg 
encountered  ; the  severer  measures  being  employed,  as  a rule,  in  the 
more  desperate  conditions.  As  all  the  cases  were  submitted  to  all- 
around  work,  and  usually,  at  the  same  sitting,  each  patient  was  sub- 
jected, as  a rule,  to  several  operations,  one  upon  the  rectum  and  one 


A REPORT  ON  ORIFICIAL  SURGERY. 


339 


or  more  upon  the  sexual  organs.  The  summing  up  of  the  opera- 
tions, therefore,  will  be  greatly  in  excess  of  the  cases  reported  upon. 
The  following  is  a list  of  the  operations  performed  : 


American  operation, 435 

Circumcision,  . . . . . . . . • • .135 

Laceration  of  the  cervix, 199 

Loosening  of  the  hood  of  the  clitoris,  279 

Slitting  of  the  hood  of  the  clitoris,  . 13 

Removal  of  the  hood  of  the  clitoris, 21 

Fistulse, 33 

Clipping  of  the  frasenum,  351 

Excision  of  haemorrhoids, . 258 

Enlarging  meatus, - 343 

Uterine  packing,  . . . .178 

Removal  of  papillae,  373 

Removal  of  pockets,  ..........  392 

Dilatation  of  the  male  urethra,  ........  237 

Trimming  and  dilatation  of  the  female  urethra,  ....  271 

Cutting  of  the  sphincters,  . 65 

Removal  of  the  hymen, .42 

Hyperspadies,  5 

Varicocele, 21 

Hydrocele,  8 

Secondary  operations,  .107 


One  word  concerning  severing  the  sphincters.  As  this  work  resulted 
in  several  cases  of  incontinence  of  faeces,  which  required  secondary 
operations  to  cure,  and  some  of  which  remain  still  uncured  because 
unwilling  to  submit  to  further  treatment,  I have  abandoned  the 
practice  except  when  operating  for  certain  cases  of  fistulse  in  ano 
and  operating  for  laceration  of  the  perinseum.  Cases  of  inconti- 
nence of  faeces  from  severed  sphincters  can  all  be  restored  to  a nor- 
mal condition  if  patients  are  willing  to  undergo  a secondary  opera- 
tion. But  as  there  is  frequently  difficulty  in  obtaining  their  con- 
sent to  this,  I thought  best  to  rely  solely  upon  dilatation  in  future, 
except  in  the  cases  mentioned.  In  operating  upon  the  cases  of  tu- 
berculosis, heart  disease,  affections  of  the  kidneys,  and  paralysis, 
which  have  been  regarded  as  dangerous  subjects  for  the  employment 
of  anaesthetics,  it  has  been  my  custom  to  precede  the  operation  by 
the  dilatation  of  the  anus  more  or  less  thoroughly,  according  to  the 
effect  which  it  produced  upon  the  respiration.  During  an  operation 
upon  such  cases,  when  the  blood  becomes  dark,  indicating  poor 


340 


world’s  homoeopathic  congress. 


oxygenation,  the  operation  and  the  anaesthetic  were  suspended,  and 
dilatation  was  again  practiced  until  the  blood  was  again  arterialized. 

There  has  not  been  a single  case  in  which  the  anaesthetic  has 
seemed  to  be  productive  of  even  the  slightest  degree  of  harm,  but 
rather  of  benefit.  And  in  view  of  the  marvellous  action  of  rectal 
dilatation  as  a means  of  resuscitation  from  a too  profound  anaes- 
thesia, the  application  of  anaesthetics  in  every  form  of  case  seems 
to  be  perfectly  devoid  of  danger.  The  knowledge  of  this  fact 
should  be  widely  spread,  as  it  will  speedily  put  an  end  to  the  record 
of  deaths  from  chloroform  and  ether. 

The  anaesthetics  employed  have  been  in  fully  95  per  cent,  of  the 
cases  a mixture  of  one  part  chloroform  to  two  parts  ether.  It  has 
been  necessary,  especially  in  cases  of  spinal  sclerosis,  insanity,  and 
those  addicted  to  the  morphine  and  liquor  habits,  to  employ  pure 
chloroform  instead  of  the  mixture.  It  has  never  proved  necessary, 
even  in  heart  trouble,  to  employ  ether  alone.  In  kidney  troubles 
chloroform  has  been  preferred  as  an  anaesthetic. 

The  large  percentage  of  the  cases  operated  upon  have  been  ex- 
tremely difficult  ones,  and  oftentimes  desperate.  And  it  has  been 
no  fault  of  the  cases  that  the  death-rate  has  not  been  greater  and 
the  percentage  of  failures  a much  larger  one.  As  a rule,  patients 
have  been  subjected  to  the  operation  without  any  previous  line  of 
treatment,  in  order  to  immediately  stop  the  nerve  waste,  flush  the 
capillaries,  and  increase  the  re-active  power  of  the  system.  The 
after-treatment  of  these  cases  has  been  not  only  local  but  general, 
and  all  means  of  cure  at  my  command  have  been  employed  to  aid 
in  securing  satisfactory  results.  These  measures  have  included  the 
pneumatic  cabinet,  eleetricity,  massage,  sun  baths,  Turkish  baths, 
skin  frictions,  spinal  cuppings,  Swedish  movement  cure,  dieting,  ab- 
dominal respirations  and  light  calisthenics  combined,  mental  thera- 
peutics, and  as  skillful  prescribing  as  I was  capable  of.  The  local 
after-treatment  has  consisted  of  douches,  ointments,  the  local  appli- 
cation of  drugs,  and  general  measures  useful  in  the  healing  of 
wounds,  and  in  the  subsequent  use  of  rectal  dilators  and  male  and 
female  urethral  and  uterine  sounds,  colon  flushings,,  bladder  and 
uterine  douchings,  as  they  seemed  to  be  required.  The  local  treat- 
ment, except  that  for  the  healing  of  the  wounds,  has  not  been 
routine,  but  based  upon  the  reactive  power  of  the  patients,  always 
giving  the  case  ample  time  for  reaction  between  treatments. 


A REPORT  ON  ORIFICIAL  SURGERY. 


341 


It  would  be  a great  advantage  in  many  of  the  cases,  if  it  were 
possible,  to  subject  them  to  preparatory  treatment  before  they  were 
operated  upon,  even  where  operative  treatment  is  essential  to  re- 
covery. The  reason  that  this  practice  has  not  been  followed  more 
extensively  has  been  because  of  the  patients  themselves.  Their  im- 
patience of  delay,  their  impetuosity,  their  inability  to  spend  the 
requisite  amount  of  time  and  money  which  such  a procedure  im- 
plies, has  seemed  to  demand  an  early  and  radical  interference. 
Almost  all  of  the  patients  have  been  under  treatment  of  some  kind 
for  a series  of  years,  and  have  lost  faith  not  only  in  doctors  but  in 
humanity,  and  they  are  not  in  a frame  of  mind  to  brook  delay. 
They  must  see  an  immediate  change  or  they  speedily  become  dis- 
satisfied. 

As  the  death -record  which  we  have  presented  to-day  was  almost 
entirely  the  result  of  faulty  methods,  which  I have  since  cor- 
rected, I cannot  condemn  the  practice  of  proceeding  at  once  with 
whatever  operation  is  required  as  soon  as  it  is  decided  to  be  neces- 
sary. 

This  report,  which  I now  submit  for  your  consideration,  presents 
the  subject  of  orificial  surgery  in  the  light  purely  of  a last  resort. 
In  these  cases  it  has  simply  been  employed  after  all  other  tried 
measures  have  failed.  The  methods  called  for  in  such  cases  have 
necessarily  been  extremely  severe,  but  should  never  be  dangerous  if 
proper  judgment  is  exercised  in  selecting  cases  and  methods  of  oper- 
ation. 

If  orificial  surgery  can  cure  and  relieve  such  large  percentages  of 
the  abandoned  cases  of  professional  practice,  it  will  certainly  demand 
consideration  at  the  hands  of  the  profession  as  a means  of  preven- 
tion. The  measures  which  it  has  to  offer  for  this  purpose  are  so 
much  milder  as  to  escape  the  censure  of  those  who  are  prejudiced 
against  surgical  measures  as  aids  to  the  health  and  happiness  of 
mankind.  What  can  be  cured  can  be  prevented,  and  when  the  first 
or  predisposing  causes  of  chronic  disease  once  becomes  thoroughly 
appreciated  by  the  medical  profession,  they  will  speedily  busy 
themselves  more  energetically  in  making  use  of  whatever  is  calcu- 
lated to  save  the  communities  under  their  charge  from  the  discom- 
fort, unhappiness,  agony,  and  premature  dissolution  which  results 
from  ignorance  or  neglect  of  the  causes  which  slowly  but  surely  sap 
vitality,  undermine  constitutions,  destroy  reactive  power,  and  pre- 


342 


world’s  homoeopathic  congress. 

dispose  humanity  generally  to  its  numberless  varieties  of  unnatural 
disaster. 

This  report  is  now  respectfully  submitted  for  your  consideration  : 


5 Acne, 

Cured. 
Per  cent. 
. 100 

Improved. 
Per  cent. 

Unimproved. 
Per  cent. 

1 Acromegalgia, 

100 

4 Amenorrhoea,  . 

75 

25 

18  Anaemia, . 

83£ 

16§ 

5 Aphasia, . 

40 

40 

20 

20  Asthma,  . 

60 

30 

10 

5 Blindness, 

60 

20 

20 

5 Bronchitis, 

100 

43  Cancer,  . 

Some 

improved. 

2 Caries  of  femur, 



50 

50 

5 Cellulitis, 

80 

20 

3 Chorea,  . 

33J 

33£ 

33| 

342  Constipation,  . 

90 

6 

4 

32  Cystitis,  . 

90 

10 

5 Deafness, . 

20 

20 

20 

1 Delirium  tremens,  . 

100 

5 Diabetes, . 



100 

15  Diarrhoea, 

93 

7 

1 Dropped  wrist, 

No  improvement. 

8 Dropsy,  . 

88 

12 

195  Dysmenorrhoea, 

90 

5 

5 

123  Dyspepsia, 

100 

14  Insomnia,  Morphia, 

100 

13  Eczema,  . 

100 

1 Empyema, 

100 

3 Enuresis,. 

100 

1 1 Epilepsy, 

45 

55 

10  Fibroids,. 

30 

70 

150  Headaches, 

90 

6f 

H 

14  Heart  disease,  . 



57 

43 

312  Haemorrhoids, 

100 

5 Hip-joint  disease,  . 

100 

16  Hysteria, 

62£ 

25 

12j 

13  Impotency, 

84J 

15J 

23  Insanity,  . 

74 

26 

36  Insomnia, 

50 

25 

25 

1 Jaundice, 

100 

128  Liver  derangement, 

95 

2 

3 

46  Locomotor  ataxia,  . 

43J 

32 

25 

1 Lupus, 

100 

51  Melancholia,  . 

90 

10 

1 Meningitis, 


100 


A REPORT  ON  ORIFIC1AL  SURGERY. 


343 


Cured. 

Improved. 

Unimproved. 

Per  cent. 

Per  cent. 

Per  cent. 

10  Nephritis, 

. 100 

15  Nervousness,  . 

. 66f 

m 

345  Nervous  prostration, 

. 87 

7 

6 

29  Neuralgia, 

. 90 

10 

50  Ovarian  irritation,  . 

. 81 

19 

31  Paralysis, 

. 51 

33 

16 

2 Paralysis  agitans,  . 

100 

13  Paresis,  . 

. 77 

9 

4 

1 Phlebitis, 

. 100 

24  Proctitis, . 

. 100 

6 Prolapsus  of  rectum, 

. 100 

8 Prostatitis,  . * 

. 75 

25 

5 Pruritus  ani.,  . 
2 Pyaemia,  . 

17  Rheumatism,  . 

. 100 

100 

100 

48  Spermatorrhoea, 

• 91| 

ihIco 

GO 

28  Spinal  irritation, 

. 72 

18 

12  Sterility,. 

. 83i 

16§ 

8 Stricture  of  rectum, 

. 100 

2 Salpingitis, 

. 100 

47  Tuberculosis,  . 

. 85J 

6 

9 

2357 

84.85 

9.46 

5.69 

Discussion. 

W.  E.  Green,  M.D.,  of  Little  Rock,  Ark. : It  is  with  considerable 
misgiving,  that  I undertake  to  discuss  a paper  of  such  great  im- 
portance, and  written  by  so  distinguished  a clinician  as  the  one  just 
heard.  This,  like  every  other  article  that  emanates  from  the  pen  of 
Dr.  Pratt,  is  full  of  solid  fact  that  will  be  instructive  to  the  entire 
profession.  Every  member  of  this  body,  who  has  practiced  orificiai 
surgery  to  any  extent,  can  verify  from  personal  experience  the  truth- 
fulness of  his  teaching,  and  thousands  of  patients,  who  have  been 
cured  by  its  methods,  will  speak  praises  in  its  behalf.  It  is  a mode 
of  treatment  based  upon  the  theory  of  reflexes,  and  deals  with  dis- 
eases surgically.  A successful  orificialist  must  be  an  accomplished 
physician  of  good  judgment,  and  a likely  operator;  he  should  not 
alone  be  able  to  clip  away  pockets  and  papillae,  but  he  should  be 
competent  to  execute  dexterously,  and  manage  the  most  important 
surgical  operations.  He  should  be  able  to  decide  at  once,  when 
operating,  the  demands  of  every  case  and  perform  well  the  operation 
that  will  give  the  best  results.  It  will  not  answer  to  treat  the 
rectum  and  leave  a lacerated  cervix,  or  to  dilate  the  cervix,  and  neg- 
lect an  endometritis;  repair  a perinseum  and  overlook  a cystocele. 
Nor  will  it  answer  to  do  a trachelorrhaphy  when  an  amputation  of 


344 


world’s  homceopathic  congress. 


Ihe  cervix  is  demanded.  Neither  should  a patient  be  submitted  to 
an  excision,  if  a less  formidable  procedure  will  answer  as  well. 

Sometime  ago,  I was  called  to  see  a lady,  who  had  been  ailing  for 
months:  she  remarked  that  she  had  undergone  orificial  treatment; 
both  her  womb  and  rectum  had  been  operated  upon  (the  womb  di- 
lated and  pockets  removed  from  the  rectum),  but  without  benefit. 
Her  trouble  was  neuralgia  of  the  stomach.  Upon  an  examination, 
I found  a badly  lacerated  cervix,  with  the  lips  everted,  thickened 
and  eroded  ; there  was  a severe  endometritis  and  consequent  uterine 
enlargement;  a profuse,  glairy  discharge  issued  from  the  os,  besides 
a bad  hsemorrhoidal  condition  existed.  I anaesthetized  her,  dilated 
and  curetted  the  uterus,  repaired  the  cervix,  dilated  the  urethra  and 
cut  away  excrescences  from  about  the  meatus  and  did  an  excision  of 
the  bowel.  The  recovery  was  prompt  and  satisfactory. 

I know7  of  no  class  of  operations  wThere  more  is  required  of  the 
surgeon,  and  there  are  none  where  experience  counts  for  more.  A 
perplexing  feature  of  the  practice,  is  to  know  in  just  what  cases  it 
will  prove  curative;  at  best,  we  are  often  doomed  to  dismal  disap- 
pointment, for  as  long  as  the  human  mind  is  prone  to  mistakes,  ac- 
curate knowledge  in  this  particular,  cannot  be  acquired.  However, 
with  study  and  experience,  we  can  hope  to  approximate  a reasonable 
degree  of  certainty. 

The  orificialist  cannot  ignore  pathology.  The  more  thorough  our 
knowledge  of  pathology,  the  more  perfect  our  powers  of  diagnosis, 
and  the  more  extensive  our  experience  the  more  confident  will  we  be 
of  our  results.  For  in  diseases  and  conditions  known  to  be  incura- 
ble, orificial  surgery  would  certainly  not  be  applicable;  though, even 
in  some  of  these  cases  it  will  often  prove  palliative.  I was  recently 
called  to  see  a case  of  advanced  uterine  cancer.  The  patient  was 
suffering  so  intensely,  that  large  doses  of  morphine,  f to  one 
grain,  were  necessary  to  quiet  her  pains;  she  had  also  bad  haemor- 
rhoids, so  I did  an  orificial  operation  upon  her  rectum.  Her  suffer- 
ing was  so  greatly  relieved  from  it,  that  she  quit  the  morphine  and 
gained  in  both  flesh  and  strength. 

The  influence  of  a properly  conducted  orificial  treatment  reaches 
remote  organs  through  its  action  upon  the  sympathetic  nervous  sys- 
tem, and  its  ganglionic  connection,  stimulating  capillary  circulation, 
thereby  relieving  congestion  of  parts,  improving  nutrition  and  in- 
ducing tissue  changes  necessary  to  recovery.  Through  this  means, 
a failing  heart  will  take  on  fresh  vigor  bv  being  relieved  of  the 
burden  imposed  through  a sluggish  circulation.  In  the  same  way, 
congested  and  hypertrophied  organs  will  be  relieved,  and  healthy 
action  restored ; but  functional  disturbances  yield  most  readily  to  its 
influences. 

For  the  benefit  of  the  oculists  that  are  present,  I will  relate  a case 
of  hyperphoria  that  I cured  by  an  orificial  operation.  Hanssel  con- 


A REPORT  ON  ORIFICIAL  SURGERY. 


345 


eludes,  after  careful  clinical  study,  “ that  this  is  a real  affection,  and 
that  in  highly  sensitive  subjects  reflex  functional  disorders  may  be 
produced  by  it.”  May  he  not  be  reasoning  from  effect  to  cause? 
The  patient,  a maiden  lady,  of  about  35,  was  suffering  from  a most 
severe  headache  of  long  standing,  with  great  disturbance  of  vision. 
After  treating  her  for  some  time  without  success,  I referred  her  to 
an  oculist,  who  diagnosed  hyperphoria  and  recommended  tenotomy 
for  its  relief.  As  there  was  evident  uterine  and  rectal  disorders,  I 
proposed  an  orificial  operation,  which  was  conceded.  After  anaes- 
thetizing her,  I dilated  the  vagina,  removed  the  hymen,  dilated  the 
urethra,  slit  up  the  hood  of  the  clitoris,  dilated  and  curetted  the 
uterus,  removed  pockets  and  papillae  and  haemorrhoids  from  the 
rectum  and  dilated  the  sphincter  ani  muscles.  She  promptly  re- 
covered from  both  the  headache  and  eye  affection  ; besides,  a con- 
gested and  sensitive  condition  of  the  tubes  and  ovaries  was  relieved. 
She  is  now  strong  and  well. 

Though  I am  a firm  believer  in  orificial  surgery,  there  are  some 
conditions  in  which  my  experience  does  not  carry  me  to  such  a state 
of  enthusiasm  as  does  Dr.  Pratt’s.  Should  I see  permanent  benefit 
derived  from  an  operation  upon  a patient  suffering  from  advanced 
paresis,  atrophy  of  the  optic  nerve,  locomotor  ataxia,  cancer  and 
some  other  diseases  mentioned,  I would  simply  conclude  that  I was 
mistaken  in  my  diagnosis.  Nor  have  I ever  seen  a latent  typhoid 
or  malarial  condition  develop;  I have  always  designated  such  cases, 
septic. 

Three  or  four  years  ago,  I reported  a case  of  locomotor  ataxia 
greatly  and  permanently  improved  by  an  orificial  operation.  Some 
time  ago,  after  again  indulging  in  excessive  drink,  the  severity  of 
symptoms  were  redeveloped.  Upon  a more  careful  and  systematic 
investigation,  I decided  the  trouble  was  not  locomotor  ataxia  but 
multiple  neuritis.  I have  in  the  past  two  years  operated  upon  other 
cases  of  undoubted  locomotor  ataxia,  without  permanent  benefit  in 
any  case.  I deem  it  of  as  much  importance  to  report  failures  as 
successes. 

Atrophied  tissue,  where  the  structure  has  been  entirely  destroyed, 
certainly  cannot  be  relieved.  While  I concede  that  some  cases  of 
nasal  catarrh  may  be  benefited,  or  even  cured,  I do  not  believe  that 
operations  upon  the  lower  orifices  will  remove  hypertrophic  rhinitis, 
especially  where  there  is  ecchondrosis  or  much  thickening  of  the 
turbinated  bones.  I would  bespeak  greater  certainty  in  effect  were 
the  conditions  attached  in  situ.  But  why  exclude  operations  upon 
the  nose  and  throat  from  the  domain  of  orificial  surgery  ; are  they 
not  as  much  orifices  of  the  body  as  are  the  lower  openings?  I am 
quite  certain  that  I have  seen  just  as  magical  results  follow  the  re- 
moval of  diseased  conditions  here,  as  I ever  have  from  operations 
upon  the  rectum,  uterus  or  penis.  I have  frequently  witnessed  an 


346 


world’s  homoeopathic  congress. 


entire  restoration  to  health  after  removing  hypertrophied  tonsils  or 
relieving  a stenosis  of  the  nasal  passage.  I have  often  had  children 
brought  to  me  that  were  dwarfed  both  mentally  and  physically, 
brighten  up  and  grow  strong,  after  suclT  treatment.  Headaches, 
asthma,  coughs,  bronchitis,  pulmonary  troubles,  visual  disturbances, 
neuralgia,  vertigo,  tinnitus  aurium,  deafness,  dyspepsia  and  anaemia, 
in  fact,  almost  every  disorder  that  may  be  produced  through  the  re- 
flexes. 

If  our  efforts  are,  to  correct  malnutrition  caused  by  vaso-motor 
disturbances,  why  neglect  this  source?  If  a perverted  rhythm,  or 
peristalsis  as  the  doctor  says,  implies  disease,  and  this  rhythmical  part 
of  man’s  existence  is  governed  by  the  sympathetic  system,  why  may 
not  the  trophic  lesion  be  located  in  the  nose  as  well  as  the  anus? 
Anatomy  teaches  us  that  these  parts  are  supplied  with  sensory  fila- 
ments that  connect  through  their  ganglionic  relations  with  every 
other  part  of  the  human  organism.  May  not  a motor  impulse  for 
good  or  bad,  started  here,  extend  its  energy  to  all  distant  organs  ? 
Take  up  the  sympathetic  nervous  system  from  above,  and  trace  it 
through  its  various  plexes  to  the  different  ganglia  and  see  what  your 
conclusions  will  be.  You  will  find  that  a perverted  force  may  be 
transmitted  to  the  eyes,  face,  throat,  ear,  brain,  heart,  lungs,  abdomi- 
nal viscera,  etc. 

It  is  a cardinal  principle  in  orificial  surgery,  to  let  no  diseased 
orifice  escape.  The  work  must  be  “all  round”  and  thorough. 


REPORT 


OF  TEE 

SECTION  IN  OPHTHALMOLOGY  AND 
OTOLOGY. 


Chicago,  Wednesday,  May  31,  1893. 

The  Section  in  Ophthalmology  and  Otology  assembled  in  Hall 
No.  VIII.  of  the  Art  Building,  at  3 o’clock  p.m. 

The  Section  was  called  to  order  by  A.  B.  Norton,  M.D.,  of  New 
York,  N.  Y.,  Chairman,  who  then  delivered  the  Sectional  Address. 

At  the  suggestion  of  the  Chair,  a motion  was  offered  and  adopted, 
providing  that  those  papers  whose  authors  are  present  at  the  meeting 
be  first  presented  and  discussed  in  the  order  in  which  they  appear  on 
the  published  order  of  business,  and  that  the  remaining  papers  be 
then  presented  and  considered  so  far  as  time  might  permit. 

Dr.  E.  H.  Linnell,  of  Norwich,  Conn.,  read  a paper  on  “ Exoph- 
thalmic Goitre.” 

At  the  conclusion  of  the  reading,  the  Chair  asked  for  a decision 
by  the  Section  regarding  the  time  to  be  allowed  for  the  reading  of 
each  paper,  and  for  each  member  taking  part  in  the  discussion. 

On  motion  of  Dr.  Wm.  B.  King,  of  Washington,  D.  C.,  the 
time  for  the  reading  of  a paper  was  limited  to  twenty  minutes,  with 
ten  minutes  for  each  of  those  appointed  to  lead  in  the  discussions, 
and  five  minutes  for  other  speakers. 

Dr.  Linnell’s  paper  was  then  discussed  by  Drs.  J.  H.  BufFum,  of 
Chicago,  111.,  and  F.  Parke  Lewis,  of  Buffalo,  N.  Y. 

Dr.  Thomas  M.  Stewart,  of  Cincinnati,  O.,  read  a paper  entitled 
“The  Refraction  of  the  Eye.”  It  was  discussed  by  Drs.  Charles  H. 
Helfrich,  of  New  York,  N.  Y.,  D.  A.  MacLachlan,  of  Ann  Arbor, 
Mich.,  Myron  H.  Chamberlin,  of  Council  Bluffs,  la.,  Harold  Wil- 
son, of  Detroit,  Mich.,  E.  H.  Linnell,  of  Norwich,  Conn.,  E.  Elmer 
Keeler,  of  Syracuse,  N.  Y.,  Wm.  R.  King,  of  Washington,  D.  C., 
and  by  the  author  of  the  paper. 

Dr.  King  moved  that  when  the  meeting  adjourn,  it  be  to  meet  at 
8 o’clock  this  evening,  in  order  that  the  papers  remaining  unread  at 


348 


WORLD  S HOMCEOPATHIC  CONGRESS. 


the  close  of  the  present  session  may  then  be  considered.  The  motion 
was  adopted. 

The  next  paper  read  was  by  Dr.  Elmer  J.  Bissell,  of  Rochester, 
N.  Y.  It  was  on  the  subject  of  “Ophthalmic  Surgery/’  and  was 
discussed  by  Drs.  B.  B.  Veits,  of  Cleveland,  O.,  C.  H.  Vilas,  of 
Chicago,  111.,  A.  F.  Randall,  of  Port  Huron,  Mich,  Harold  Wilson, 
of  Detroit,  Mi  eh.,  F.  Parke  Lewis,  of  Buffalo,  N.  Y.,  A.  B.  Nor- 
ton, of  New  York,  N.  Y.,  and  Dr.  Bissell,  the  author  of  the  paper. 

The  session  then  adjourned  until  8 o’clock  p.m. 

The  Section  reconvened  at  8 o’clock — Dr.  Norton  in  the  chair. 

Dr.  Harold  Wilson  then  presented  a paper  on  “ The  Study  and 
Correction  of  Heterophoria.”  He  read  portions  of  the  essay,  and 
gave  a brief  resume  of  the  remaining  portions.  A discussion  fol- 
lowed, participated  in  by  Drs.  John  H.  Payne,  of  Boston,  Mass, 
(whose  remarks,  in  the  absence  of  Dr.  Payne,  were  read  bv  the 
Secretary),  E.  PI.  Linnell,  of  Norwich,  Conn.,  Wm.  R.  King,  of 
Washington,  D.  C.,  Thomas  M.  Stewart,  of  Cincinnati,  O.,  M.  H. 
Chamberlain,  of  Council  Bluffs,  la.,  and  by  the  author  of  the  paper. 

Dr.  Henry  F.  Garey,  of  Baltimore,  Md.,  read  an  essay  on  the 
“ Efficacy  of  the  Vibrometer  in  Applying  Vibratory  Massage  in 
Aural  Disease.”  Its  discussion  was  by  Drs.  Wm.  R.  King,  E.  H. 
Linnell,  Harold  Wilson,  Henry  C.  Houghton,  of  New  York  City, 
and  by  the  Section  Chairman,  Dr.  A.  B.  Norton. 

The  Chair  suggested  that  the  paper  by  Dr.  C.  F.  Sterling,  of  De- 
troit, Mich.,  on  “The  Homceopathy  of  Aural  Therapeutics,”  should 
now  be  taken  up.  In  the  absence  of  its  author,  Dr.  H.  C.  Hough- 
ton, of  New  York  City,  gave  a careful  abstract  of  the  essay,  with 
brief  comments  thereon.  The  paper,  together  with  a written  dis- 
cussion of  the  subject  by  Dr.  Hayes  C.  French,  of  San  Francisco, 
Cal.,  was  then  accepted  and  referred  for  publication. 

Dr.  Houghton  then  read  his  paper  on  “Aural  Therapeutics,” 
which  (he  said)  was  adapted  to  follow  the  paper  of  Dr.  Sterling. 

A paper  by  Dr.  Howard  P.  Bellows,  of  Boston,  Mass.,  enti- 
tled “ Some  Recent  Advances  in  Otology,”  together  with  a written 
discussion  of  the  subject  by  Dr.  Francis  B.  Kellogg,  of  Tacoma, 
Wash.,  was  then  presented  by  title  and  accepted.  Also  a paper  by 
Dr.  James  A.  Campbell,  of  St.  Louis,  Mo.,  on  “Ocular  Reflex 
Neuroses.” 

The  Sectional  meeting  then,  on  motion,  adjourned. 


INAUGURAL  ADDRESS. 


349 


INAUGURAL  ADDRESS. 

By  A.  B.  Norton,  M.D.,  New  York,  N.  Y.,  Chairman. 


Mr.  President , Members  of  the  Congress : 

My  first  duty  is  to  express  my  sincere  appreciation  of  the  high 
honor  conferred  upon  me  in  selecting  me  to  preside  over  such  an 
important  section  as  that  of  Ophthalmology  and  Otology.  The  de- 
liberations of  this  body,  composed  as  it  is  of  the  brightest  lights  in 
our  special  department  of  medicine,  are  destined  to  redound  to  the 
credit  of  our  school,  and  to  the  benefit  of  humanity.  The  sessions 
of  this  section  will  be  devoted  to  the  study  of  two  of  the  smallest 
yet  most  important  organs  of  the  human  body,  for  none  are  of  more 
value,  none  more  useful,  and  none  capable  of  conveying  keener 
emotions  of  pleasure  to  the  soul,  than  the  eye  and  ear.  How  fitting, 
therefore,  that  this  should  have  been  the  first-born  of  the  specialties 
in  medicine;  and  what  advances  it  has  made  since  the  late  Dr.  E. 
Williams,  of  Cincinnati,  the  pioneer  among  the  specialists  of  this 
country,  less  than  forty  years  ago  commenced  the  exclusive  practice 
of  the  diseases  of  the  eye  and  ear.  At  that  time  the  discovery  of 
the  ophthalmoscope,  which  was  the  real  stepping-stone  to  our  pres- 
ent-day knowledge  of  the  eye,  and  which  has  done  more  toward  the 
preservation  and  restoration  of  sight  than  any  one  other  discovery 
either  before  or  since,  had  just  been  made  by  the  renowned  Helmholtz, 
and  heralded  throughout  the  world  by  all  interested  in  this  speci- 
alty. At  about  this  same  period  the  works  of  Von  Graefe,  Helm- 
holtz, Donders,  and  others,  gave  an  impetus  to  the  study  of  ophthal- 
mology which  is  still  felt  and  can  never  be  checked. 

While  our  Old-School  friends  can  claim  to  have  been  the  pioneers 
in  the  exclusive  practice  of  this  specialty,  Homoeopathy  was  but  a 
few  years  behind  them,  and  it  seems  to  me  appropriate  to  briefly 
refer  at  this  time  to  the  early  history  of  this  special  department  of 
medicine  in  our  own  school.  Following  close  upon  the  footsteps  of 


350 


world’s  homceopathic  congress. 


Drs.  Williams,  Agnew  and  others,  who  commenced  the  exclusive 
practice  of  diseases  of  the  eye  and  ear,  from  1855  to  1860,  we  find 
that  Dr.  C.  H.  Angell,  of  Boston,  was  the  first  man  in  our  school  to 
commence  the  exclusive  practice  of  this  specialty. 

Dr.  Angell  graduated  from  the  Homoeopathic  Medical  College  of 
Pennsylvania,  in  1852,  and  first  located  in  Salem,  later  in  Lynn, 
Mass.,  and  in  1857  removed  to  Boston.  In  1861  he  visited  Europe, 
and  studied  with  Profs.  Arlt  and  Jaeger,  of  Vienna,  Yon  Graefe,  of 
Berlin,  and  in  the  eye  clinics  of  both  Paris  and  London.  He  returned 
in  1864,  and  since  then  has  practiced  exclusively  as  an  oculist  and 
aurist.  In  1870,  Dr.  Angell  brought  out  the  first  work  upon  Dis- 
eases of  the  Eye  from  the  standpoint  of  a Homoeopathic  oculist ; the 
fame  of  this  work,  and  consequently  of  its  author,  is  simply  told  in 
the  fact  that  it  has  reached  its  eighth  edition.  Dr.  Angell,  as  Pro- 
fessor of  Ophthalmology  in  the  Boston  University  School  of  Medi- 
cine, still  continues  to  teach  the  value  of  Homoeopathy  in  diseases  of 
the  eye. 

Dr.  C.  Th.  Liebold,  who,  with  Dr.  Angell,  were  the  earliest  ex- 
clusive specialists  in  our  school,  commenced  to  devote  his  exclusive 
study  to  diseases  of  the  eye  and  ear  in  the  old  Bond  Street  Dispen- 
sary, in  New  York,  soon  after  the  close  of  the  war,  during  which  he 
had  served  with  honor  as  a general  surgeon.  In  1867,  he  was  ap- 
pointed surgeon  to  the  New  York  Ophthalmic  Hospital,  where  he 
remained  in  continuous  faithful  and  skillful  service  until  his  death 
in  December,  1885.  In  1870,  Dr.  Liebold  was  made  Professor  of 
Ophthalmology  in  the  New  York  Homoeopathic  Medical  College, 
which  chair  he  still  filled  at  the  time  of  his  death.  As  an  ophthal- 
mic surgeon  Dr.  Liebold  was  equalled  by  few  and  excelled  by  none, 
while  as  a Homoeopathic  physician  his  knowledge  of  and  reliance 
on  the  action  of  drugs  saved  many  an  eye  that  would  have  otherwise 
been  lost. 

In  1867,  the  Board  of  Directors  of  the  New  York  Ophthalmic 
Hospital  placed  the  medical  control  of  that  institution  in  the  hands 
of  Homoeopathic  physicians,  Drs.  T.  F.  Allen  and  C.  Th.  Liebold 
constituting  its  surgical  staff.  The  New  York  Ophthalmic  Hospital 
of  to-day,  treating  upwards  of  14,000  patients  annually,  bears  a 
living  testimony  of  the  value  of  Homoeopathy  in  the  diseases  of  the 
eye  and  ear,  and  of  the  thoroughness  with  which  its  work  was  in- 
augurated by  Drs.  Allen  and  Liebold. 


INAUGURAL  ADDRESS. 


351 


Dr.  Henry  C.  Houghton,  graduating  at  the  New  York  University 
Medical  College,  in  1867,  became  at  once  interested  in  the  ear  as  a 
specialty.  He  has  been  associated  with  the  New  York  Ophthalmic 
Hospital  since  its  opening  as  a Homoeopathic  institution,  and  is  to- 
day the  senior  surgeon  as  well  as  a director  of  that  hospital.  In 
1873,  Dr.  Houghton  commenced  to  practice  exclusively  as  an  aurist, 
and  in  1882  was  made  Professor  of  Otology  in  the  New  York  Ho- 
moeopathic Medical  College.  His  work  on  Clinical  Otology , issued 
in  1885,  is  to-day  the  standard  text-book  of  our  school. 

Dr.  W.  H.  Woodyatt,  graduating  in  1869,  immediately  went  to 
New  York  to  make  a special  study  of  diseases  of  the  eye  and  ear, 
spending  his  time  at  the  New  York  Ophthalmic  Hospital,  at  Dr. 
Knapp’s  clinic,  and  the  clinics  of  the  Manhattan  Eye  and  Ear  Hos- 
pital, and  the  New  York  Eye  and  Ear  Infirmary.  In  1871  he  lo- 
cated in  Chicago,  and  was  appointed  Professor  of  Ophthalmology 
and  Otology  in  the  Hahnemann  College,  and  subsequently  in  the 
Chicago  Homoeopathic  Medical  College.  Dr.  Woodyatt  was  one  of 
the  ablest  men  in  our  specialty,  a thorough  diagnostician,  a skilled 
surgeon,  a true  homoeopath.  His  untimely  death  in  January,  1880, 
robbed  our  professon  of  one  of  its  brightest  men. 

Dr.  George  S.  Norton,  graduating  at  the  New  York  Homoeopathic 
Medical  College,  in  1872,  and  the  same  year  at  the  New  York  Oph- 
thalmic Hospital,  was  immediately  appointed  resident  surgeon, 
later  becoming  a surgeon,  senior  surgeon,  and  director  to  the  New 
York  Ophthalmic  Hospital,  was  the  next  one  in  our  school  to  enter 
into  the  exclusive  practice  of  eye  and  ear  diseases.  In  1876  Dr. 
Norton,  in  conjunction  with  Dr.  T.  F.  Allen,  brought  out  the  Oph- 
thalmic Therapeutics , the  second  edition  of  which,  issued  in  1881,  was 
by  Dr.  Norton  alone.  In  1886  Dr.  Norton  succeeded  Dr.  Liebold 
as  Professor  of  Ophthalmology  in  the  New  York  Homoeopathic 
Medical  College,  and  in  1889  commenced  the  publication  of  the  first 
special  journal  of  our  school,  The  Journal  of  Ophthalmology , Otol- 
ogy , and  Laryngology . In  addition  to  these,  Dr.  Norton  was  also  at 
the  time  of  his  death,  January  30,  1891,  consulting  ophthalmic  sur- 
geon to  several  hospitals  and  institutions. 

Following  in  rapid  order,  our  corps  of  exclusive  specialists  was, 
within  a few  years,  increased  and  strengthened  by  such  men  as 
Campbell,  of  St.  Louis;  Phillips,  of  Cleveland;  Winslow,  of  Pitts- 
burgh; Vilas  and  BufFum,  of  Chicago;  McDermott,  of  Cincinnati; 


352 


world’s  homoeopathic  congress. 


Boynton,  of  New  York;  Lewis,  of  Buffalo;  and  so  on,  until  to  day 
we  find  in  every  large  city,  and  many  of  the  smaller  ones,  one  or 
more  Homoeopathic  oculists  and  aurists.  Those  of  us  who  have 
more  recently  commenced  the  practice  of  this  specialty  should  be, 
and  I believe  are,  grateful  to  our  predecessors  for  the  work  they 
have  done,  They  laid  the  foundations  on  which  we  are  building, 
and  we  do  them  honor  for  the  thoroughness  in  which  that  work  was 
done  under  the  many  difficulties  of  the  time.  We  who  have  to-day 
our  special  ophthalmic  colleges,  journals,  and  text-books  from  which 
we  can  learn  the  special  applications  of  our  Homoeopathic  reme- 
dies in  diseases  of  the  eye  and  ear,  little  realize  the  difficulties 
experienced  by  the  pioneers  in  the  field  who  had  to  discover  and 
make  a special  Materia  Medica  for  the  varying  diseases  of  the  eye 
and  ear. 

The  status  of  the  Homoeopathic  specialist  of  to-day,  in  this  de- 
partment at  least,  is  certainly  equal  to,  and  we  believe  in  the  ma- 
jority of  cases  excels,  that  of  the  Old  School.  I say  this  because 
the  majority  of  the  Homoeopathic  oculists  and  aurists  of  to-day  are 
graduates  of  a special  college  giving  a legal  degree  as  eye  and  ear 
surgeon  to  physicians  only,  and  that  after  a most  thorough  didactic 
and  clinical  course  of  six  months.  In  the  Homoeopathic  School  is 
the  only  special  college  in  this  country  having  a right  to  grant  the 
legal  degree  as  eye  and  ear  surgeon,  while  the  very  large  majority 
of  the  Old-School  specialists  are  such  after  a course  of  from  six 
weeks  to  three  months  only,  apparently  believing  that  skilled 
specialists  can  be  made  in  this  short  time.  Therefore  I claim  that 
our  Homoeopathic  eye  and  ear  specialists  are  better  and  more  thor- 
oughly educated  as  a body  than  are  those  of  any  other  school  in  this 
country. 

To  the  question,  What  has  Homoeopathy  accomplished  in  this  de- 
partment of  medicine?  we  would  answer,  a great  many  more  things 
than  time  will  allow  us  to  refer  to  on  this  occasion;  hence,  we  must 
content  ourselves  with  the  mere  general  mention  of  a few.  First,  in 
cataract,  that  most  important  of  all  the  diseases  of  the  eye,  of  which 
the  simple  mention  of  its  name  calls  up  visions  of  blindness  to  us 
all.  Experience  teaches  us  that  in  the  early  stages  of  senile  cata- 
ract, upon  which  every  authority,  with  possibly  one  exception,  agrees 
that  if  left  to  itself  will  inevitably  progress,  and  sooner  or  later  lead 
to  blindness,  it  can  be  held  in  check  by  the  use  of  Homoeopathic 


INAUGURAL  ADDRESS. 


353 


remedies,  and  the  vision  be  held  intact  for  years,  thus  avoiding  the 
necessity  of  the  knife.  In  suppurative  inflammations  of  the  uveal 
tract  our  remedies,  especially  Rhus  tox.,  have  proven  of  incalculable 
♦ value.  In  some  cases  that  seemed  destined  to  total  destruction  of 
the  eye,  both  its  structure  and  function  have  been  restored  to  normal 
again  by  the  administration  of  this  drug.  In  nearly  all  the  inflam- 
mations of  the  eye,  especially  of  the  cornea,  conjunctiva,  and  iris,  the 
use  of  Homoeopathic  remedies  will  cut  short  the  disease  several  days 
earlier  than  the  most  approved  Old-School  treatment  of  the  present 
day.  In  the  ear,  every  Homoeopathic  specialist  has  seen  cases  of 
acute  inflammation  of  the  middle  ear,  and  even  threatened  involve- 
ment of  the  mastoid,  cut  short  and  prevented  by  such  remedies  as 
Ferrum  phos.,  Capsicum,  Bellad.,  Hepar,  etc.  In  chronic  catarrhal 
deafness,  improvement  in  the  hearing  is  often  secured  by  the  admin- 
istration of  the  Calcareas,  Kalis,  Mercuries,  etc.,  and  frequently  in 
cases  that  have  been  through  the  hands  of  our  Old-School  friends 
with  no  benefit.  The  value  of  Homoeopathy  in  the  treatment  of  dis- 
eases of  the  eye  and  ear  is  easily  demonstrated  to  any  unbiassed  ob- 
server who  will  give  our  remedies  a fair,  conscientious  trial.  Take, 
for  example,  the  different  varieties  of  keratitis  or  conjunctivitis;  let 
a given  number  be  treated  under  the  most  approved  local,  operative, 
and  constitutional  treatment  of  the  Old  School  of  to-day,  and  then 
by  comparing  the  average  duration  of  the  diseases  with  a similar 
number  of  cases  of  each  disease  treated  by  the  administration  of 
Homoeopathic  remedies  alone,  and  the  results  will  certainly  show  a 
greater  saving  of  time  to  the  patient  under  Homoeopathy.  The  same 
is  true  in  iritis  and  other  diseases  of  the  eye.  In  iritis  the  use  of  a 
mydriatic  to  overcome  the  mechanical  effects  of  the  adhesions  is,  of 
course,  necessary  under  all  modes  of  treatment,  but,  in  addition  to 
the  employment  of  the  mydriatic,  the  use  of  Homoeopathic  remedies 
will  control  an  attack  of  iritis  in  from  one  to  ten  days  earlier  than 
by  any  other  method  of  treatment ; or,  instead  of  using  narcotics  to 
control  the  severe  pains  of  iritis,  let  one  but  see  the  effects  of  the 
properly  selected  Homoeopatlrc  remedy  in  relieving  those  pains  in  a 
few  cases,  and  any  unprejudiced  observer  must  necessarily  be  con- 
vinced of  the  value  of  Homoeopathy  in  eye  diseases.  As  Homoeo- 
pathic oculists  and  aurists,  we  do  not  claim  to  cure  all  diseases  of  the 
eye  or  ear  by  the  administration  of  the  Homoeopathic  remedy  alone. 
Not  one  member  of  our  ranks  would  think  of  treating  an  iritis  with- 


354 


world’s  homceopathic  congress. 


out  a mydriatic,  glaucoma  without  a myotic  or  an  iridectomy,  ma- 
tured cataract  without  extraction,  or  mastoid  disease  without  opening 
the  mastoid;  but  as  scientific  men,  as  well  as  Homoeopathic  physi- 
cians, we  claim  it  to  be  our  right,  privilege,  and  duty  to  employ  all* 
other  scientific  methods  used  by  any  school  for  the  safe  and  speedy 
cure  of  our  patient.  We  base  our  claims  of  superiority  as  Homoeo- 
pathic oculists  and  aurists  on  the  fact  that  in  addition  to  all  other 
scientific  methods  for  the  prevention  of  blindness  and  deafness, 
we  employ  the  only  scientific  law  for  the  administration  of  drugs. 

We  must  also  at  this  time  again  deplore  the  fact  that  our  knowl- 
edge of  the  action  of  drugs  upon  the  healthy  eye  and  ear  is  still  so 
limited,  and  must  emphasize  the  necessity,  in  order  to  perfect  our 
materia  medica  in  this  department,  of  thorough  examination  of  the 
eye  2nd  ear  by  competent  specialists  in  all  future  provings,  both 
before,  during  and  after  the  proving.  Take  for  example  the  symp- 
tom of  dimness  of  vision  which  we  find  recorded  as  existing  in  the 
provings  of  209  different  drugs,  or  vision  lost  in  121  drugs.  Now 
how  can  these  symptoms  be  of  the  slightest  possible  value  in  any 
given  case  when  we  know  that  there  are  over  100  different  diseases 
of  the  eye  in  which  there  may  be  more  or  less  dimness  of  vision. 
To  be  sure  we  have  found  clinically  that  Kali  bich.  is  the  remedy 
in  the  dimness  of  vision  of  descemetitis,  Gelsem.  in  serous  iritis, 
Bellad.  and  Duboisia  in  retinitis,  Aurum  mur.  and  Kali  iod.  in 
choroiditis,  etc.  We  believe  that  these  drugs,  if  given  to  a person 
in  health,  will  produce  pathological  changes  in  the  eye  that  will 
result  in  some  impairment  of  vision,  but  with  one  exception  we  know 
of  no  proving  where  pathological  changes  have  been  seen  during 
the  proving  by  a competent  oculist,  merely  because  the  eyes  have 
not  been  under  the  careful  examination  they  should  have  been.  So 
with  the  symptom,  hearing  impaired,  which  occurs  under  109  differ- 
ent drugs,  or  hearing  lost  which  is  found  under  61  drugs.  How 
have  these  remedies  caused  this  deafness?  By  their  action  on  the 
membrana  tympani,  the  middle  or  internal  ear  or  upon  the  auditory 
nerve  itself?  In  this  direction  there  lies  a great  field  for  future 
investigation  and  the  path  leading  to  a more  exact  and  more  scien- 
tific administration  of  drugs  for  the  various  diseases  of  the  eye  and 
ear.  We  trust  that  hereafter  no  proving  of  a new  drug  or  reprov- 
ing of  an  old  one  will  be  made  except  under  the  direction  or  ex- 
amination by  the  oculist  and  aurist  as  well  as  by  the  other  specialists 
in  medicine. 


INAUGURAL  ADDRESS. 


355 


At  the  present  day  much  is  being  said  and  written  of  the  over- 
doing of  specialties  in  medicine,  and  that  the  specialist  is  crowding 
out  the  general  practitioner.  Representing  as  I do  one  of  the 
specialists,  I desire  at  this  time  to  enter  my  protest  against  this 
popular  clamor.  Let  one  halt  for  a moment  and  look  around  at  the 
other  departments  of  science,  arts,  mechanics,  etc.,  and  he  will  very 
quickly  find  that  medicine  is  no  more,  if  as  much,  subdivided  into 
specialties  as  are  the  many  other  professions.  I can  no  better  illus- 
trate the  tendency  of  the  age  in  this  respect  than  by  a brief  quotation 
from  Mr.  Grant  Allen  who  in  an  appreciative  article  on  “ Specialists 
in  Science,”  gives  a bit  of  a conversation  with  Bates  of  the  Ama- 
zons which  illustrates  the  modern  tendency  towards  specialization. 
Said  that  scientist:  “ When  I was  a young  man  I wanted  to  be  a 
naturalist;  but  very  soon  I saw  the  days  of  naturalists  were  past 
and  that  if  I wanted  to  do  anything,  I must  specialize.  I must  be 
an  entomologist.  A little  later  I saw  the  days  of  entomologists,  as 
such,  were  numbered,  and  that  if  I wanted  to  do  anything,  I must 
be  a coleopterist.  By  and  by,  when  I got  to  know  more  of  my  sub- 
ject, I saw  no  man  could  understand  all  the  coleoptera,  and  now  I 
am  content  to  try  and  find  out  something  about  the  longicorn 
beetle.”  Specialization  is  a necessity,  but  it  needs  a broad  founda- 
tion, or  the  individual  runs  into  a very  narrow  type.  Who  are  the 
men  that  are  advancing  the  science  of  medicine  in  its  various 
branches?  Is  it  the  general  practitioner?  No,  it  is  the  surgeon, 
the  neurologist,  the  gynaecologist,  the  ophthalmologist,  etc.  The 
necessity  for  the  oculist  and  aurist  we  believe  will  be  fully  demon- 
strated by  the  essays  and  discussions  to  be  presented  at  the  sessions 
of  this  section,  as  the  scope  of  the  work  in  this  department  has  been 
so  arranged  and  divided  as  to  cover  as  much  as  possible  of  the  sub- 
ject within  the  limits  set  by  the  Congress.  Much  within  the  do- 
main of  ophthalmology  and  otology  should  and  does  fall  within  the 
scope  of  the  general  practitioner.  Professor  Helmholtz  once  said, 
“ that  if  an  optician  were  to  send  him  an  instrument  with  so  many 
easily  avoidable  defects  as  the  human  eye  has,  he  would  feel  bound 
to  censure  him  severely.”  Many  of  these  slight  defects  and  the 
more  external  or  superficial  forms  of  inflammation  of  the  eye  should 
be  treated  by  the  family  physician  and  could  be  were  he  to  devote 
as  much  time  and  study  to  this  branch  as  he  does  to  the  other 
specialties  in  medicine,  but  where  is  the  specialist  even,  who  can  to- 


356 


world’s  homoeopathic  congress. 


day  say  that  he  knows  all  the  hidden  mysteries  of  sight  and  hear- 
ing? And  yet  this,  the  first-born  of  the  specialties  in  medicine,  is 
now  nearly  forty  years  old.  If  then,  the  life  of  these  the  smallest 
organs  of  the  body  cannot  be  absolutely  solved  in  forty  years,  who 
can  expect  in  one  short  lifetime  to  master  all  the  functions  of  the 
human  body?  Therefore  we  say  give  us  more  and  better  specialists 
in  all  the  departments  of  medicine. 


OPHTHALMIC  THERAPEUTICS. 


357 


OPHTHALMIC  THERAPEUTICS. 

By  E.  H.  Linnell,  M.D.,  Norwich,  Conn. 


It  is  quite  unnecessary,  as  it  would  be  inappropriate,  for  me  to 
present  to  this  audience,  composed  as  it  is  of  representative  Homoe- 
opathic physicians  gathered  from  all  parts  of  the  civilized  world, 
any  arguments  to  prove  the  superiority  of  Homoeopathic  therapeutics 
over  all  other  methods  of  healing.  On  the  other  hand,  in  this  Co- 
lumbian year,  when  all  religious,  educational,  and  scientific  bodies 
are  holding  congresses,  it  is  fitting  that  we  should  show  to  the  world 
what  Homoeopathy  has  accomplished,  and  what  it  has  to  offer  in 
contrast  to  Old-School  teaching  and  practice. 

It  has  devolved  upon  me  to  prepare  a review  of  Homoeopathic 
therapeutics  in  our  special  department,  that  of  ophthalmology.  So 
much  has  been  written  lately  upon  this  topic,  that  it  is  with  diffi- 
dence I venture  to  discuss  a subject  so  ably  treated  by  others,  and  I 
crave  your  indulgence  if  much  that  I have  to  say  seems  trite. 

This  is  an  age  of  exact  scientific  investigation.  Men  demand 
facts,  and  not  theories ; and  I propose  to  give  you  the  facts  of  oph- 
thalmic therapeutics,  Homoeopathically  considered,  as  compared  with 
the  treatment  of  the  Old  School. 

It  will  not  be  inappropriate  on  this  occasion  for  us  to  inquire 
what  Homoeopathy  has  accomplished  in  this  special  department,  and 
whether  it  offers  any  advantages  over  other  methods.  If  Homoeop- 
athy is,  as  the  illustrious  Dunham  expressed  it,  the  “ Science  of 
Therapeutics, ” then  the  Homoeopathic  specialist  should  be  more  sci- 
entific in  the  choice  and  application  of  curative  agents  than  one  who 
relies  simply  upon  traditional,  or  physiological  and  empirical  uses 
of  drugs  ; and  he  should  be  correspondingly  more  successful.  Does 
experience  demonstrate  this  to  be  true?  Our  first  duty  is  to  our 
patients  ; our  first  motive  is  to  cure  them  as  speedily  and  as  surely 
as  possible.  We  should  “ prove  all  things,  and  hold  fast  that  which 
is  good.”  We  want  the  best.  Is  Homoeopathy  the  best?.  If  not,. 


358 


WORLDS  IIOMCEOPATHIC  CONGRESS. 

let  us  know  it.  And  if  it  is,  then  let  us  demonstrate  it  so  conclu- 
sively as  to  compel  universal  acknowledgment.  It  would  be  inter- 
esting and  instructive  to  compare  the  results  of  the  treatment  of  an 
equal  number  of  cases  of  a given  disease  under  the  two  systems, 
were  reliable  statistics  available.  We  can  contrast  the  ordinary 
treatment  of  eye-disease,  as  recommended  in  recent  Old-School 
treatises,  with  the  Homoeopathic  treatment  outlined  in  the  latest 
and  best  work  on  the  subject — Dr.  Norton’s  Ophthalmic  Diseases 
and  Therapeutics. 

That  we  may  intelligently  discuss  the  question,  let  us  first  clearly 
understand  what  we  mean  by  Homoeopathic  therapeutics  as  applied 
to  ophthalmic  affections.  If  we  mean  only  the  application  of  those 
drugs  for  the  cure  of  morbid  conditions  which  have  actually  caused 
similar  functional  disturbances  and  pathological  lesions,  then  our 
resources  are  very  much  restricted;  although  in  this  limited  inter- 
pretation of  the  subject,  we  have  a number  of  valuable  remedies. 
There  are  several  reasons  why  our  armamentarium  is  so  much  cur- 
tailed in  this  particular.  In  the  first  place,  the  records  of  poisoning 
furnish  us  with  but  few  specific  effects  upon  the  eye,  and  our 
provings  have  not,  in  many  cases,  been  pushed  to  the  extent  of  pro- 
ducing actual  tissue  changes.  But  the  most  important  reason  is  the 
lack  of  skilled  and  accurate  observation,  which  is  apparent  in  the 
pathogeneses  of  drugs.  Most  recorded  eye-symptoms  are  subjective, 
and  frequently  unreliable,  because  not  rightly  interpreted.  Had 
every  prover  been  subjected  to  a careful  examination  by  a competent 
^and  experienced  oculist,  before  and  after  a proving,  and  the  condition 
of  refraction,  ophthalmoscopic  appearance  of  fundus,  etc.,  been  ac- 
curately recorded,  the  provings  would  have  been  infinitely  more 
valuable  to  the  specialist.  The  proving  of  Duboisin  by  Dr.  Deady, 
published  in  the  Trans,  of  Am.  Horn.  0.  and  0.  Society , 1880,  is  a 
model  worthy  of  imitation,  although  we  cannot  help  wishing  that 
the  eyes  of  the  provers  had  been  previously  examined,  and  conditions 
noted.  Eye-diseases  are  rarely  purely  local,  especially  those  serious 
affections  which  endanger  vision  ; but  are  usually  the  result  of  some 
systemic  disorder,  and  require  constitutional  treatment.  Similarly 
drugs  do  not  affect  the  eye  alone,  but  produce,  in  connection  with 
eye-symptoms,  indications  of  disturbance  of  remote  organs  and 
general  constitutional  effects.  If,  then,  certain  morbid  conditions 
of  the  eve  disappear  under  the  exhibition  of  a remedy  prescribed 


OPHTHALMIC  THERAPEUTICS. 


359 


in  strict  conformity  with  the  law  of  “ Similia,”  for  general  con- 
stitutional symptoms  or  for  affections  of  other  organs,  is  it  not  fair 
and  logical  to  accept  these  eye-symptoms  as  reliable  indications 
for  that  remedy  in  another  similar  case,  even  if  the  constitutional 
symptoms  of  the  first  case  are  lacking?  Is  it  not  also  probable 
that  such  a remedy,  if  fully  proved  in  suitable  doses,  would  cause 
the  symptoms  which  it  cures ; and  is  not  a verified  symptomatology, 
acquired  in  the  way  suggested,  a logical  basis  of  Homoeopathic  ther- 
apeutics ? 

With  this  understanding  of  our  topic,  and  I think  it  is  a rea- 
sonable one,  we  have  an  extensive  armamentarium  of  specific  rem- 
edies. Allen  and  Norton’s  Ophthalmic  Therapeutics  was  compiled 
in  this  way  from  verified  and  trustworthy  symptoms,  and  w’e  owe 
an  immense  debt  of  gratitude  to  the  authors  and  to  the  other  faithful 
and  skillful  surgeons  of  the  New  York  Ophthalmic  Hospital,  to 
whose  labors  we  are  largely  indebted  for  the  development  of  the 
resources  of  our  school  in  this  special  department.  In  the  posses- 
sion of  these  specific  remedies  the  Homoeopathic  oculist  has  a great 
advantage  over  one  of  the  Old  School;  but  a thorough  knowledge 
of  drug  effects  upon  the  whole  system , is  a requisite  for  successful 
prescribing,  as  well  as  a familiarity  with  general  diseases.  We  can- 
not successfully  prescribe  for  eye-symptoms  alone,  nor  can  we  ignore 
the  relationship  between  ocular  affections  and  diseases  of  other  or- 
gans, or  the  frequent  dependence  of  eye-diseases  upon  constitutional 
dyscrasife.  For  this  reason  an  extended  experience  in  general  practice 
is  very  desirable  before  undertaking  special  work.  The  Homoeo- 
pathic oculist,  with  these  added  means  of  cure  at  his  command, — I 
say  “ added”  for  of  course  all  resources  of  the  healing  art,  from 
whatever  source,  are  his  to  choose  or  to  refuse, — can  achieve  results 
impossible  without  them.  When  all  mechanical,  local,  and  surgical 
measures  are  powerless,  the  suitable  Homoeopathic  remedy  will  often 
preserve  or  restore  sight  and  cure  disease,  when  Old-School  medicine 
is  confessedly  of  no  avail.  Many  an  operation  can  be  obviated,  and 
many  an  unfortunate  sequence  of  operation  be  averted.  Pain,  in 
the  large  majority  of  cases,  can  be  controlled  without  the  use  of 
narcotics,  with  their  attendant  unpleasant  and  sometimes  dangerous 
effects,  and  the  course  of  many  diseases  be  materially  shortened. 

I promised  to  give  you  facts  rather  than  theories,  and  in  order  to 
prove  the  truth  of  my  assertions,  let  us  critically  examine  and  com- 


360 


world’s  homoeopathic  congress. 


pare  the  therapeutic  measures  of  the  two  schools  in  various  affec- 
tions. First,  What  does  Old-School  medicine  offer  for  the  relief 
and  cure  of  eye  diseases  ? 

In  order  to  answer  this  question  intelligently,  I have  carefully 
read  and  reviewed  a recent  text-book  by  a recognized  authority — 
Noyes’s  Diseases  of  the  Eye — and  noted  every  remedy  recommended, 
with  the  indications  for  its  employment.  I have,  of  course,  not 
noted  local  or  surgical  treatment,  or  the  correction  of  refractive  or 
muscular  errors.  The  purely  therapeutic  resources,  as  therein  out- 
lined, comprise  forty-three  remedies,  almost  all  of  which  are  pre- 
scribed upon  the  most  general  principles,  and  where  specific  indica- 
tions are  given,  they  are  most  meagre  in  contrast  with  our  methods 
of  careful  individualization.  To  particularize  : “ appropriate  ” gen- 
eral or  constitutional  treatment,  such  as  alteratives,  derivatives, 
stimulants,  etc.,  are  sometimes  advised  without  explicit  mention, 
and  in  other  cases  Cod-liver  oil,  Iron,  Quinine,  Arsenic,  Malt  and 
Hypophosphites,  especially  in  ansemic  debility,  scrofulosis,  etc. 

The  following  table  shows  a list  of  other  medicines  mentioned, 
and  the  diseases  for  which  they  are  recommended. 

Diuretics  and  Purgatives , especially  Rhubarb  and  Soda,  Sal  soda, 
Rochelle  salts. — Phlyctenular  keratitis,  scleritis  rheumatica,  iritis, 
cataract,  retinitis  (apoplectica  and  albumiuurica),  amotio-retinse,  neu- 
ritis, neuro-retinitis. 

Salicylate  of  Soda,  Lithates,  Liquor  potassce  and  other  alkalies. — 
Rheumatic  and  gouty  affections  generally,  particularly  in  iritis,  neu- 
ritis, neuro-retinitis,  periostitis,  tenonitis,  acute  phlegmonous  eczema 
of  the  lids,  staphyloma  of  the  sclera. 

Antifebrine,  Antipyrine , Sulphonal,  Morphia , Opium,  Bromides, 
Chloral  and  Phenacetine. — To  relieve  pain. 

Iodide  of  potash. — Spasm  of  orbicularis,  episcleritis,  iritis,  to  arrest 
development  of  cataract,  to  clear  opacities  of  the  vitreous,  choroi- 
ditis, retinitis  apoplectica  et  syphilitica,  neuritis,  neuro-retinitis,  retro- 
bulbar neuritis,  atrophy  of  the  optic  nerve,  periostitis  orbitse,  tenon- 
itis, generally  in  syphilitic  and  rheumatic  affections. 

Mercury.  — Syphilitic  affections,  diphtheritic  conjunctivitis,  inter- 
stitial keratitis,  iritis,  opacities  of  vitreous,  sympathetic  ophthalmia, 
choroiditis,  acute  and  chronic,  retinitis  albuminurica,  neuritis,  neuro- 
retinitis, atrophy  of  the  optic  nerve. 

Arsenic,  Zina,  Argentum  nitricum,.  Phosphorus. — Various  affections 
of  the  nerve  and  retina. 


OPHTHALMIC  THERAPEUTICS. 


361 


Strychnia. — Neuroparalytic  ophthalmia,  cataract,  retinitis  pig- 
mentosa, amblyopia,  amaurosis  (genuine  and  hysterical),  exophthal- 
mic goitre. 

Digitalis , Phosphoric  acid , Ergot , Atropia , Strophanthus , Tonics 
and  Sedatives. — Exophthalmic  goitre. 

Digitalis. — Diseases  characterized  by  feeble  circulation  and  weak 
heart,  such  as  ischaemia  retinae,  retinitis  albuminurica,  with  vascular 
degeneration  (also  calling  for  Carbonate  of  ammonia),  amblyopia, 
amaurosis. 

Muriate  of  pilocarpine , Infusion  of  jaborandi. — Amotio-retinae, 
staphyloma  of  sclera  (in  gouty  patients),  iritis,  sympathetic  ophthal- 
mia, acute  choroiditis,  neuritis,  neuro-retinitis. 

Quinine. — To  check  threatened  inflammation  after  cataract  opera- 
tions, cellulitis,  iritis. 

Aconite , Gelsemium , Conium. — Blepharospasm. 

Bromo-cqffein. — Hysterical  amblyopia. 

Nitro- glycerine  in  gr.  doses. — Retinitis  apoplectica  with  high 

arterial  tension. 

Mineral  acids. — Cellulitis  orbitae. 

Turpentine , Colchicum. — Iritis. 

Phosphoric  acids , Phosphates. — Cataract. 

I believe  this  to  be  a fair  and  impartial  resume  of  ophthalmic 
therapeutics  from  the  Old-School  point  of  view.  It  is  not  difficult 
to  recognize  the  unconscious  Homoeopathicity  of  many  of  their  more 
specific  applications ; at  least,  we  use  the  same  drugs  in  attenuated 
doses,  with  success,  in  the  same  diseases,  only  studying  the  particu- 
lar and  minute  indications  for  them  according  to  the  law  of  “similia.” 
The  essential  difference  between  their  therapeutics  and  ours  is  no- 
ticed here  as  in  all  departments  of  medicine,  viz.,  they  prescribe  for 
diseases  while  we  prescribe  for  the  individual.  Which  is  the  more 
scientific? 

In  contrast  with  this  array,  I will  «imply  call  attention  to  the 
detailed  and  specific  symptomatology  of  the  one  hundred  and  forty 
remedies  mentioned  in  the  latest  and  best  Homoeopathic  treatise,  that 
of  Dr.  Norton,  already  mentioned.  While  this  list  does  not  com- 
prise all  the  resources  of  our  school — for  almost  every  remedy  in  the 
Materia  Medica  may  be  found  curative  of  eye  diseases  under  appro- 
priate conditions — I offer  it  as  a fair  exponent  of  Homoeopathic  treat- 
ment in  contrast  with  the  resume  of  Old-School  therapeutics  just 


362 


world’s  homoeopathic  congress. 


given.  It  is  not  a compilation  of  theoretical  and  empirical  indica- 
tions, but  is  made  up  of  thoroughly  trustworthy  and,  for  the  most 
part,  verified,  indications.  Experience  has  demonstrated  them  to  be 
reliable  guides  for  the  choice  of  the  remedy.  But  it  may  be  argued 
that  this  is  mere  assumption  on  my  part.  It  certainly  would  be 
presumptuous  to  expect  any  one  to  accept  such  an  assertion  without 
satisfactory  evidence,  and  while  I cannot  demonstrate  to  the  skeptic 
here  and  now  the  truth  of  my  statement  by  adducing  overwhelming 
evidence  in  proof  of  the  value  of  remedies  prescribed  upon  such  a 
basis,  yet  I can  affirm  what  the  Homoeopathic  treatment  of  eye  dis- 
eases has  accomplished,  what  it  is  accomplishing  every  day  in  hospi- 
tal and  private  practice,  and  what  can  be  demonstrated  to  the  satis- 
faction of  any  fair-minded  investigator  who  cares  to  give  the  matter 
sufficient  time  and  thought. 

What,  then,  are  some  of  the  verities  of  Homoeopathic  ocular  thera- 
peutics? 

I.  — The  action  of  constitutional  remedies,  such  as  Ars.,  Graph., 
Calc.,  Sulph.,  Nat.  mur.  and  Sil.  in  hereditary  or  acquired  conditions 
of  malnutrition  and  in  the  various  dyscrasise. 

II.  — The  action  of  Aeon.,  Bell.,  Apis,  Verat.  vir.  and  Rhus  in 
controlling  inflammatory  conditions,  erysipelas,  cellulitis,  etc. 

III.  — The  action  of  Hepar,  Sil.  and  Rhus  in  suppuration,  of  Gels, 
in  serous,  and  of  Bry.  in  plastic  exudations. 

IV.  — The  action  of  Arnica,  Crotalus,  Ham.,  Lach.  and  Ledum  in 
arresting  and  absorbing  haemorrhages. 

V.  — The  action  of  Sil.,  Calc.,  Aururn,  Kali  iodide,  etc.,  in  dis- 
eases of  bone  and  orbit,  morbid  growths,  periostitis,  etc. 

VI.  — The  action  of  Amyl  nit.,  Ferrum,  Lycopus,  Spongia,  Nat. 
mur.  and  Ars.  in  exophthalmic  goitre. 

VII.  — The  action  of  Puls.,  Apis,  Alum.,  Merc.,  Ars.,  Euphrasia, 
Argent,  nit.,  Rhus,  etc.,  in  catarrhal  conjunctivitis,  ophthalmia  neo- 
natorum, specific  blenorrhoea,  etc.,  arresting  inflammation,  moderat- 
ing discharge,  preventing  corneal  complications  and  averting  many 
cases  of  blindness. 

VIII.  — The  action  of  Aurum,  the  Iodides,  Baryta,  the  Kalis, 
Sil.,  Graph.,  Hepar  and  Merc,  on  corneal  tissue,  healing  ulcers, 
resolving  infiltrations,  clearing  nebulae,  and  thus  often  avoiding 
minor  operations,  such  as  scraping  of  ulcers  and  phlyctenules,  the 
use  of  caustics  and  the  galvanic  cautery,  and  of  paracentesis. 


OPHTHALMIC  THERAPEUTICS. 


363 


IX.  — The  influence  of  Merc.,  Bry.,  Cedron,  Rhus,  Clem.,  Col., 
Spigelia  and  Potash  in  iritis,  shortening  very  much  its  course  under 
Old-School  methods,  averting  sequelse  and  rendering  narcotics  un- 
necessary. 

X.  — The  undoubted  influence  of  Caust.,  Sulph.,  Sepia,  Phos., 
Sil.  and  Iodoform  in  arresting  and  delaying  the  development  of 
cataract,  and  even  clearing  opacities  of  cortex. 

XI.  — The  influence  of  Bell.,  Bry.,  Gels.,  Aurum,  Phos.,  Merc., 
Kali  mur.  and  Kali  iod.  in  various  forms  of  choroiditis  and  retinitis. 

XII.  — The  beneficial  effects  of  many  remedies,  especially  of  Nux 
and  Phos.,  in  inflammatory  affections  of  the  optic  nerve  and  in 
atrophic  conditions,  cerebral  and  spinal. 

These  are  some  of  the  solid  facts  of  Homoeopathic  therapeutics 
which  cannot  be  controverted. 

As  our  knowledge  of  Materia  Medica  increases,  especially  as  the 
pathogeneses  of  drugs  are  more  accurately  and  scientifically  devel- 
oped, our  success  will  be  measurably  increased.  There  is  some  evi- 
dence as  to  the  efficiency  of  Gels.,  Bry.,  Col.  and  other  remedies  in 
glaucoma,  but  the  well-known  influence  of  eserine  and  iridectomy 
makes  it  unjustifiable  to  withhold  them  in  the  majority  of  cases. 
The  symptomatology  of  Osmium  gives  us  a very  suggestive  picture 
of  glaucoma.  It  ought  to  be  helpful,  though  I am  not  conversant 
with  any  positive  clinical  evidence  in  proof  of  its  efficacy.  When  a 
careful  record  of  the  tension,  of  the  acuity  and  of  the  field  of  vision 
and  of  the  ophthalmoscopic  appearance  of  the  fundus  appears  in  our 
provings,  then  we  may  hope  to  dispense  with  myotics  and  iridectomy 
in  the  treatment  of  this  disease. 

The  influence  of  some  of  our  remedies  in  checking  the  develop- 
ment of  cataract,  and  of  materially  improving  vision  by  the  resolu- 
tion of  cortical  opacities  has  been  abundantly  proved,  and  affords  a 
striking  instance  of  the  superiority  of  Homoeopathic  ocular  thera- 
peutics. Where  do  we  find  any  such  results  from  Old-School 
treatment  as  those  published  in  recent  years  by  some  of  our  special- 
ists of  recognized  ability,  whose  statements  are  trustworthy,  and 
whose  diagnoses  are  beyond  question  ? The  experience  of  Dr.  Wm. 
R.  King,*  of  Washington,  with  Iodoform  is  especially  noteworthy. 

The  treatment  of  cataract  with  remedies  must,  of  course,  rest  upon 


* See  Journal  of  0.,  0.  and  L.,  April,  1891. 


364 


world’s  homoeopathic  congress. 


a constitutional  basis.  Eye-symptoms  alone  do*not  afford  sufficient 
data  for  the  choice  of  a drug.  The  underlying  condition  is  the  im- 
portant point  to  consider. 

An  interesting  illustration  of  the  value  of  such  a method  of  pre- 
scribing, and  also  of  the  fact  previously  noted,  that  a remedy  may 
cure  an  eye-affection  when  indicated  by  constitutional  symptoms, 
even  though  its  pathogenesis  contains  nothing  to  indicate  its  special 
action  on  the  eye,  is  afforded  by  a case  of  ptosis  cured  with  Bromine 
6x  by  Dr.  Bissel,  of  Rochester,  reported  in  the  Journal  of  0.,  0. 
and  L.,  for  October,  1889.  Bromine  was  selected  on  account  of 
diarrhoea,  eructations,  pain  like  needles  at  the  epigastrium  and  physo- 
metra. 

Bisulphide  of  carbon  is  worthy  of  trial  in  retrobulbar  neuritis. 
Cases  of  poisoning  suggest  it  Homoeopath ically  to  this  affection.  It 
has  produced  in  several  cases,  “ diminution  of  vision,  central  scotoma, 
vision  better  in  the  evening,  loss  of  appreciation  of  color,  central 
scotoma  for  colors,  and  narrowing  of  eccentric  field,”  without  oph- 
thalmic changes  in  the  fundus  oculi.  Hirshberg  described  in  one 
case  “ an  alteration  of  the  macula  characterized  by  the  presence  of 
whitish  nodules.”  These  visual  disturbances  are  associated  with 
nervous  symptoms,  such  as  muscular  weakness  of  the  limbs,  cramps 
in  the  legs  and  abdomen,  diminution  of  hearing  and  headache.* 

Malignant  growths  of  the  eye  and  lids  have  seldom  been  materi- 
ally influenced  by  remedies,  yet  we  now  and  then  see  a gleam  of 
light  in  this  direction  which  encourages  us  to  hope  for  better  results 
in  the  future.  Such  hints  from  accurate  observers  should  be  care- 
fully noted  and  remembered,  and  therefore  I desire  to  call  your 
attention  to  the  report  of  a case  of  sarcoma  by  Dr.  W.  S.  Searle,  of 
Brooklyn. f A blind  eye  had  been  removed,  and  microscopical 
examination  demonstrated  the  correctness  of  a previous  diagnosis  by 
Dr.  H.  Knapp,  viz.,  spindle-celled  sarcoma  of  the  choroid.  Ten 
days  after  removal,  a secondary  growth  “ of  the  size  of  a chestnut  ” 
was  removed  from  the  orbit,  and  Phos.  and  Tarantula  cubensis 
were  prescribed.  The  former  was  chosen  on  account  of  general  con- 
stitutional indications,  and  the  latter  from  its  reputation  in  inflam- 
matory affections  of  connective  tissue,  especially  in  boils  and  car- 
buncles. After  their  use  there  was  no  return  for  nine  months. 

* See  article  by  H.  H.  Crippen  in  0.,  0.  and  L.,  April,  1891. 

f Journalof  0.,  O.and  L.,  February,  1892. 


OPHTHALMIC  THERAPEUTICS. 


365 


Then  the  growth  again  returned  to  a slight  extent,  but  under  a re- 
newal of  the  former  prescription  the  nodule  shrivelled  and  dropped 
off  within  a week,  and  the  doctor  wrote  me  recently  that  there  had 
been  no  recurrence  of  the  disease  up  to  the  present  time,  a period  of 
two  years  since  the  second  operation. 

These  remedies  are  worthy  of  trial  in  similar  cases,  and  I would 
also  remind  you  of  the  published  experience  of  the  late  Dr.  George 
S.  Norton  and  of  Dr.  French  in  the  treatment  of  glioma  retinae  with 
Ceanthus  Americanus,  the  fluid  extract  of  red  clover  blossoms.* 

The  value  of  Cinnabar  as  a remedy  for  ciliary  neuralgias  has  been 
often  demonstrated,  where  the  indication  of  “pain  extending  from 
the  inner  canthus  around  the  brow  ” is  present,  but  we  owe  to  Dr. 
H.  C.  French  a confirmation  of  the  following  indication  for  its 
employment,  viz.,  aa  full,  heavy  feeling  in  the  whole  head,  tempo- 
rarily lessened  by  pressure.”  “ Dull  pain  in  the  forehead  over  the 
eyes,  increased  by  use.”  “Shooting  pains  in  the  forehead.”  “Stick- 
ing and  itching  in  both  canthi  and  in  the  forehead.”  The  patient 
had  been  under  Old-School  treatment  for  two  years,  and  Dr.  French 
gave  him  great  relief  in  a few  hours,  and  cured  him  in  less  than 
three  weeks  with  Cinnabar. 

The  curative  influence  of  Agaricus  in  spasmodic  affections  of  the 
lids  and  ocular  muscles  has  long  been  recognized,  but  its  influence 
in  amaurosis  and  hysterical  amblyopia  was  first  suggested  to  me  by 
an  article  by  Dr.  Rounds,  f Some  slight  impairment  of  vision  is 
suggested  in  the  proving  of  the  remedy,  but  that  a total  blindness  of 
both  eyes — “only  slight  perception  of  strong  light  remaining” — 
should  be  entirely  cured,  and  perfect  vision  restored  after  the  patient 
had  been  blind  for  several  years,  is  certainly  surprising  and  worthy 
of  note.  The  sight  of  the  right  eye  was  suddenly  lost  after  a blow 
upon  the  head  four  years  before  treatment  was  commenced,  and  that 
of  the  left  eye  as  suddenly  and  completely  failed  after  exposure  to 
rain.  For  two  years  she  could  not  tell  night  from  day.  The  only 
other  treatment  employed  was  galvanism,  and  as  this  was  used  with- 
out avail  for  two  months  before  prescribing  Agaricus  it  seems  reason- 
able to  attribute  the  recovery  in  large  measure  to  the  medicine, 
although  electricity  was  continued  at  irregular  and  increasing  inter- 
vals during  the  time  of  treatment.  Nystagmus,  nictitation  and  other 

* See  0.,  O.andL .,  April,  1890,  and  Trans.  Am.  Inst , 1884. 

f See  Journal  of  0.,  0.  and  L.,  October,  1891. 


366 


world’s  homceopathic  congress. 


nervous  and  hysterical  symptoms  led  to  the  choice.  The  ophthal- 
moscopic examination  was  negative.  Fifteen  drops  of  the  tincture 
of  Agaricus  were  taken  daily  in  divided  doses  for  a period  of  eight 
months,  when  the  patient  was  discharged  with  perfect  vision  in  each 
eye,  and  entirely  free  from  nystagmus,  etc.  She  has  since  earned 
her  own  living  as  a stenographer  and  typewriter. 

Experience  has  repeatedly  proved  the  efficacy  of  Gelsemium  in 
various  diseases  of  the  eye,  especially  where  serous  exudation  exists, 
and  in  paretic  affections  of  the  muscles,  but  its  Homoeopathicity  to 
amaurotic  affections  is  suggested  by  the  following  observation  of  Dr. 
W.  A.  Phillips.  In  a certain  patient,  5 gtts.  doses  of  the  tincture 
invariably  produced  the  characteristic  symptoms  of  giddiness,  head- 
ache and  heaviness  of  the  lids,  followed  by  almost  total  loss  of  vision. 
At  one  time  the  accommodation  failed  first,  while  at  another  the 
sensibility  to  retinal  impressions  seemed  to  precede  the  loss  of  adjust- 
ment. In  forty  minutes  after  the  five  drops  were  taken  the  vision 
was  reduced  to  It  could  not  be  improved  by  lenses,  and  this 

diminution  continued  from  five  to  fifteen  minutes.  Normal  vision 
returned  in  from  one-half  to  two  hours.  No  ophthalmoscopic  changes 
were  observed.* 

Paris  quadrifolia  is  a valuable  remedy  in  certain  cases  of  asthen- 
opia. The  sensation  “as  if  the  eyes  were  being  drawn  back  into 
the  head  by  cords”  is  a reliable  indication  for  its  employment,  and 
led  the  writer  to  select  it,  and  to  effect  a gratifying  cure  of  chronic 
headache.  Dr.  French  cured  with  Paris  a paralysis  of  the  external 
rectus  where  this  symptom  was  present.  He  also  emphasizes  the 
following  as  trustworthy  guides  for  its  use,  viz.,  “ inability  to  fix  the 
eyes  steadily  upon  anything;  eyes  seem  swollen,  as  if  their  orbits 
were  too  small,  so  that  the  eyes  could  not  be  easily  moved. ”f 

Kalmia  is  helpful  in  certain  cases  of  asthenopia.  Dr.  Boyle  has 
had  gratifying  success  with  it  in  episcleritis  and  tenonitis, J where 
the  patient  complained  of  “soreness  of  the  eyeballs  to  touch  and 
motion  ” “Injection  of  the  conjunctiva,  chemosis  around  the  cor- 
nea.” “ Feeling  of  stiffness  of  the  muscles.” 

The  pathogenesis  of  Cannabis  sat.  and  Cannabis  ind.  exhibit  a 
striking  similarity  to  pterygium,  and  they  ought  to  be  curative  of 

* See  0.  and  0.,  April  1,  1890. 

f See  Journal  of  0.,  0.  and  L .,  January,  1889. 

| See  Trans.  N.  Y.  State  Soc.}  1891. 


OPHTHALMIC  THERAPEUTICS. 


367 


that  condition.  They  have  been  curative  in  vascular  conditions  of 
the  cornea,  and  Dr.  Wanstall  cured  with  Cannabis  ind.  a case  of 
pustular  keratitis,  with  pterygium-like  injection  of  the  conjunctiva.* 

Chrysophanio  acid  should  be  remembered  in  cases  of  chronic  ciliary 
blepharitis,  especially  in  scrofulous,  ill-nourished  children.  The 
writer  on  one  occasion  prescribed  an  ointment  composed  of  eight 
grains  of  the  acid  to  an  ounce  of  vaseline,  to  be  cautiously  used  on 
the  edges  of  the  lids.  The  patient,  thinking  if  a little  was  good  a 
great  deal  was  better,  applied  it  freely  over  all  the  lids  and  conjunc- 
tiva. A very  violent  inflammation  followed,  but  the  blepharitis  was 
permanently  cured. 

The  Homoeopathicity  of  Colocynth  to  iritis  characterized  by  burn- 
ing, sticking,  cutting  pains,  extending  from  the  eyes  into  the  head, 
increased  at  night  and  by  stooping,  lessened  by  pressure  and  walk- 
ing in  a warm  room,  was  exemplified  by  an  experience  of  the  writer, 
where  the  disease,  if  not  primarily  caused  as  there  seemed  reason  to 
believe,  was  without  doubt  markedly  aggravated  by  the  use  of  a hair 
wash  containing  Colocynth. j* 

The  successful  use  of  Hypericum  in  injuries  of  parts  rich  in 
nerves,  and  in  pains  from  old  cicatrices,  led  Dr.  Moffat  to  prescribe 
it  with  benefit  in  pain  arising  from  anterior  synechiae  after  the 
patient  had  suffered  several  years. 

In  conclusion,  let  me  again  emphasize  the  need  of  careful  exam- 
inations of  the  eyes  of  persons,  and  the  accurate  record  of  variations 
of  tension,  of  visual  disturbances,  of  muscular  conditions,  of  ophthal- 
moscopic changes  and  so  forth,  by  skilled  specialists,  in  order  that 
subjective  symptoms  may  be  correctly  interpreted,  and  our  sympto- 
matology be  more  scientific  and  reliable.  Every  committee  of 
provers,  every  Materia  Medica  laboratory  should  have  a competent 
oculist. 

Let  me  urge  upon  our  specialists  the  duty  of  careful  prescribing, 
of  painstaking  detailed  records,  and  of  publication  of  successes  and 
of  failures  with  remedies  Homoeopathically  prescribed,  that  we  may 
attain  greater  accuracy  in  prescribing,  that  our  knowledge  of  the 
positive  effects  of  drugs  may  be  extended,  and  that  we  may  achieve 
greater  success  in  the  treatment  of  eye-affections  according  to  the  law 
of  “ Similia  Similibus  Curantur,”  and  relegate  operative  measures 


* See  Norton’s  Ophthalmic  Diseases  and  Therapeutics. 
f See  North  Am.  Journal  of  Homoeopathy,  1887. 


368 


world’s  homoeopathic  congress. 


and  local  treatment  more  and  more  to  positions  of  a secondary  im- 
portance. The  day  is  surely  coming  when  Homoeopathy  will  be 
universally  recognized  as  the  “Science  of  Therapeutics,”  and  when 
the  Homoeopathic  specialist  will  be  the  exponent  of  the  highest  de- 
gree of  scientific  and  skillful  treatment. 

Discussion. 

J.  H.  Buffum,  M.D.  : Dr.  Linnell  has  presented  to  the  Congress 
an  able  epitome  of  the  present  status  of  ophthalmic  therapeutics, 
which  must  carry  with  it  the  conviction  of  truth.  Perhaps,  in  no 
department  of  medicine  have  such  advances  been  made  in  diagnosis, 
prognosis,  and  pathology,  as  in  that  of  ophthalmology,  until  it  has 
now  become  one  of  the  most  exact  and  scientific  in  the  domain  of  the 
healing  art. 

Small  as  the  organs  of  sight  are,  as  compared  with  other  organs 
of  the  human  body,  their  relation  to  the  whole  animal  economy  is 
such  as  to  carry  with  it  need  for  a full  knowledge  of  not  only  the 
anatomy,  physiology,  and  pathology,  of  all  organs,  but  also  their 
dependence,  in  health  or  disease,  to  the  various  affections  of  the  eye. 
On  the  other  hand,  the  ophthalmologist  has  been  able  to  determine 
the  exact  relation  which  certain  conditions  of  the  eye,  either  physio- 
logical or  pathological,  bear  to  various  diseases  which  are  termed  re- 
flex and  general. 

As  Homoeopathic  ophthalmologists,  we  should  carry  our  Homoe- 
opathy into  our  practice,  not  only  as  followers  of  the  wisdom  and 
philosophy  which  emanated  from  Hahnemann,  who  gave  us  a uni- 
versal law  of  cure,  but  also,  because  we  owe  it  to  our  clients  who 
confide  their  cases  to  us  and  expect  to  be  cured  homoeopathically, 
primarily,  and  secondarily  only,  when  we  have  failed  from  a want 
of  knowledge  of  our  Maieria  Medica  Pura. 

The  ophthalmic  practitioner  of  our  school  has  had,  until  the  last 
few  years,  but  little  to  aid  or  encourage  him  in  his  adherence  to  the 
tenets  of  his  faith,  owing  to  the  fact  that  the  basis  of  his  knowledge 
of  drugs  in  their  active  relation  to  eye  diseases  has  been  uncertain, 
as  too  often  the  pathogenesis,  as  set  forth  in  the  provings  of  the 
remedies  was  found  thoroughly  unreliable  when  applied  to  the  treat- 
ment of  the  eye. 

Hence,  the  older  ophthalmic  surgeons  of  our  school  have  had  to 
acquire  from  close  study  and  observation  of  the  clinical  effects  of  our 
drugs,  a system  of  ophthalmic  therapeutics  derived  from  our  knowl- 
edge of  our  Materia  Medica,  and  their  own  clinical  observation, 
which  is  now  rapidly  being  augmented  by  the  increased  number  of 
workers  in  this  department.  Eventually,  in  the  coming  years,  when 
the  true  laborers  in  the  field  of  Homoeopathic  ocular  therapy 
have  brought  in  the  harvest  of  pathogenetic,  clinical,  and  curative 


OPHTHALMIC  THERAPEUTICS. 


369 


symptoms,  we  shall  find,  when  the  grain  is  separated  from  the  chaff, 
that  but  little  remains  to  desire,  save  the  proper  application  of  this 
accumulated  knowledge  to  the  scientific  Homoeopathic  cure  of  all 
ophthalmic  diseases. 

It  is  difficult  to  supplement  the  careful  rbsurn'e,  of  the  verified  ac- 
tion and  indications  of  the  Homoeopathic  remedies  which  have  so 
ably  been  demonstrated  in  the  paper  which  is  before  us  for  discus- 
sion. Dr.  Linnell  has,  with  the  utmost  care,  culled  from  our  litera- 
ture the  most  valuable  verifications  of  Homoeopathy  as  applied  to 
the  treatment  of  ocular  diseases.  It  remains,  then,  only  for  me  to 
add  what  may  have  come  to  my  knowledge  as  a result  of  my  own 
individual  experience  and  observation  in  ophthalmic  practice;  am- 
plifying here  and  there,  and  presenting  perhaps,  now  and  then,  a 
grain  of  pure  gold,  which  years  of  study  and  observation  have  en- 
abled me  to  separate  from  the  dross  which  surrounded  it. 

The  poverty  of  the  armamentarium  medicum  of  the  Old-School 
in  its  application  to  ocular  therapeutics  is  manifested,  not  so  much 
in  its  lessened  number  of  drugs  for  internal  medication,  as  in  the 
want  of  specific  indications  for  their  use.  The  richness  of  our  drug 
armament  stands  out  in  glittering  contrast,  not  perhaps  by  the 
greater  number  of  remedies,  but  by  the  knowledge  of  our  Homoeo- 
pathic law  which  enables  us  to  prescribe  these  drugs  with  an  assurance 
of  the  curative  results  which  inevitably  must  follow  their  proper 
administration. 

It  is  not  necessary  to  discuss  seriatim  the  list  of  verities  of  Ho- 
moeopathic ocular  therapeutics  which  Dr.  Linnell  has  presented,  as 
they  are  no  longer  in  doubt.  We  should  all  endeavor,  as  soon  as 
possible,  to  increase  their  number  by  adding  to  those  mentioned 
others  rich  in  possibilities,  but  which  yet  lack  that  confirmation  which 
must  come  from  repeated  trials. 

In  the  list  presented  I desire  to  emphasize  the  actions  of  Homoe- 
opathic so-called  constitutional  remedies  in  lessening  and  dissipating 
the  various  dyscrasias  mentioned,  and  thus  enabling  us  to  cure  the 
alternate  effects  as  exhibited  in  the  eye. 

The  actions  of  those  remedies  mentioned  as  controlling  inflam- 
matory effects  of  the  eye,  we  all  daily  prove  the  truth  of  in  our  prac- 
tice. 

In  reference  to  the  action  of  Rhus  tox.  in  promoting,  controlling, 
and  limiting  various  traumatic  and  surgical  inflammations,  perhaps 
little  need  be  said,  but  for  Hepar  sulph.  which  has  exhibited  such 
marvellous  action  in  controlling,  limiting,  and  absorbing  pus  within 
the  eye,  too  much  praise  cannot  be  given.  With  these  two  remedies 
eyesight  and  eyeball  have  been  saved  time  and  again,  when  no  other 
known  treatment  could  possibly  have  controlled  the  inflammation, 
lessened  the  pain,  saved  tissue,  and  caused  the  absorption  of  the 
products  of  inflammatory  attacks.  To  watch  the  action  of  either, 

24 


370 


world’s  homoeopathic  congress. 


when  indicated  in  these  affections  of  the  eye  makes  one  feel  that  our 
remedies  have  an  action  only  short  of  the  miraculous. 

In  iritis  the  action  of  Terebinth,  which,  in  the  Old  School,  finds 
a place  of  value,  is  with  us  too  often  neglected,  as,  like  Asafoetida, 
it  has  a specific  action  upon  the  inflamed  iris,  and  both  not  only 
lessen  the  ciliary  neuralgia  but  shorten  and  cure  the  attack. 

In  controlling  the  inflammatory  and  degenerative  changes  in  the 
lens  which  result  in  cataract,  the  action  of  our  remedies  presents 
often  in  my  experience  the  further  proof  of  the  Homoeopathic  law 
of  cure. 

In  the  lens,  as  well  as  in  the  cornea,  iris,  vitreous,  retina,  and  cho- 
Toid,  we  can  watch  from  day  to  day  the  limiting,  absorption,  and 
sight-restoring  effects  of  our  remedies. 

Glaucoma,  when  presenting  a mechanical  obstruction  of  the  excre- 
tion of  the  fluids  of  the  eye,  cannot  come  under  the  domain  of  medi- 
•cine.;  but  for  those  glaucomatous  conditions  which  are  dependent 
upon  the  hypersecretions  resulting  from  neurotic  irritations,  the  reme- 
dies mentioned  by  Dr.  Linnell  often  afford  us  brilliant  results.  In 
simple  non-inflammatory  glaucoma  of  chronic  type,  Sulphur,  Nux 
vomica,  and  Phosphorus  have  controlled  the  disease  and  saved  the 
vision  in  cases  where  neither  iridectomy,  sclerotomy,  or  myotomy 
had  been  allowed,  and  also  in  cases  where  some  or  all  of  these 
operations  had  been  made  without  control  of  this  sight-destroying 
disease. 

In  addition  to  those  that  have  been  mentioned  in  the  paper,  there 
are  some  affections  of  the  eye  and  the  therapeutic  means  for  their  re- 
lief to  which  I desire  to  call  attention  as  exhibiting  the  desired  action 
of  our  remedies. 

Hyperiemia  of  the  retina,  while  usually  symptomatic,  is,  I believe, 
more  often  idiopathic  than  we  are  inclined  to  think.  While  this  con- 
dition is  difficult  of  diagnosis,  owing  to  the  variableness  of  the  cir- 
culation of  the  retina  within  physiological  limits  of  the  individuals, 
and  in  cases  where  such  immediate  causes  as  refractive  errors,  foreign 
bodies,  or  inflammation  of  the  contiguous  tissues  of  the  choroid  and 
iris  have  been  excluded,  we  are  justified  in  making  such  a diagnosis. 
I find  that  taking  the  increased  capillary  circulation  of  the  optic  disk 
as  an  indication,  rather  than  that  of  the  retinal  vessels,  together  with 
the  subjective  symptoms  of  asthenopia,  a safe  guide  to  the  diagnosis 
of  a condition  which  often  presents  a series  of  symptoms  extremely 
annoying  to  the  patient  and  often  difficult  of  relief,  unless  we  find  in 
such  remedies  as  Belladonna,  Cactus,  Cimicifuga,  Duboisia,  Amyl  nit., 
and  Phosphorus  the  similimum. 

Cases  of  temporary  amblyopia  which  arise  from  spasm  of  the 
retinal  arteries  or  result  from  vaso-motor  irritation  of  the  cerebro- 
retinal  circulation,  and  thus  temporarily  disturb  the  nutrition  of 
the  optic  nerve  and  retina  and  destroy  its  function,  more  fre- 


OPHTHALMIC  THERAPEUTICS. 


371 


quently  come  to  the  notice  of  the  general  practitioner  than  to  the 
ophthalmologist. 

Such  amblyopias,  while  often  temporary  and  symptomatic  of  the 
cephalalgia  which  follows,  sometimes  tend  to  be  persistent,  and  even 
when  the  amblyopia  has  disappeared  we  may  find  scotomas,  which 
become  sources  of  discomfort  or  causes  of  subjective  symptoms, 
which  make  difficult  the  diagnosis  of  the  eye  condition. 

In  these  cases,  where  there  is  found  a migraine  history,  recent 
or  remote,  there  are  three  remedies  which  cover  a multitude  of 
discomforting  symptoms,  namely,  Gelsemium,  Physostigma,  and 
Strychnia  phos. 

For  the  amblyopia  which  precedes  the  attacks  of  headache,  and 
which  itself  is  often  preceded  by  symptoms,  more  or  less  marked,  of 
irritation  of  the  retina,  perhaps  no  remedy  is  more  valuable  than 
Amyl  nitrite  by  inhalation,  which,  while  shortening  the  attack  as  far 
as  the  disturbance  of  the  vision  is  concerned,  yet  lessens  not  the  ten- 
dency to  recurrence  nor  removes  the  cause.  As  an  example  of  what 
may  be  accomplished  by  remedies  which,  as  far  as  we  know,  have 
shown  in  their  pathogenesis  no  direct  action  upon  such  conditions  yet 
exhibit  their  curative  powers  in  a remarkable  degree,  I take  from  my 
case- book  the  following  record  of  Miss  P.,  set.  23,  who  consulted  me 
in  1888,  with  a history  of  temporary  amblyopia,  which  usually  oc- 
curred only  in  the  right  eye,  but  occasionally  in  the  left,  the  attacks 
coming  on  in  the  morning  after  breakfast  or  on  awakening,  if  she  had 
suffered  from  insomnia.  During  the  years  before  consulting  me  she 
had  had  six  attacks,  whose  duration  lasted  from  an  hour  to  four  or 
five.  At  the  time  I saw  her  a central  scotoma  of  the  right  eye  was 
evident,  but  a diagnosis  of  circulatory  changes  in  the  eye  was  doubt- 
ful. In  the  inception  of  the  attack,  a point  of  light  was  observed  by 
her  on  the  temporal  side,  which  increased  until  it  became  a wave  of 
light.  In  some  of  the  attacks  the  waving  of  the  light  became  rapid 
and  caused  vertigo.  The  attacks  were  modified  by  lying  down.  Her 
eyes  were  emmetropic  and  the  vision  normal.  Has  no  special  head- 
aches. Bryonia  was  prescribed,  and  there  was  no  return  of  the  trouble 
for  a year,  when  she  again  had  a recurrence  of  the  trouble,  and  came 
for  some  more  of  the  remedy.  In  the  four  years  since  there  has  been 
no  return  of  the  trouble. 

Some  sixteen  years  ago,  after  reading  the  experience  of  Bell  and 
Kiihne  in  their  efforts  to  demonstrate  the  retinal  purple,  I was  im- 
pressed with  the  fact  that  Muscavine  and  Pilocarpine  seemed  to  have 
the  peculiar  property  of  increasing  the  secretions  of  the  light  dis- 
coloring matter  which  is  formed  about  the  base  of  the  rods  of  the 
retina.  Acting  upon  the  suggestions  thus  presented  by  the  physio- 
logical provings  of  these  drugs,  I have  used  them  for  many  years 
with  success  in  cases  of  amblyopia,  where  I have  been  able  to  deter- 
mine by  exclusion  of  other  causes  that  the  deficient  vision  was  de- 


372 


world’s  homoeopathic  congress. 


pendent  upon  a probable  functional  derangement  of  the  retina  and 
optic  nerve.  While  I have  already  reported  the  good  results  follow- 
ing the  administration  of  Agaricus  and  Jaborandi  in  restoring  the 
vision  in  many  cases  of  what  might  be  termed  torpor-retinae  or  func- 
tional anaesthesia,  I have  also  observed  that  Agaricus  has  a curative 
result  in  cases  of  hyperaesthesia  retinae.  In  regard  to  the  action  of 
Agaricus  in  optic  nerve  atrophy,  I regret  to  say  that  I have  been 
unable  to  get  an  improvement  in  the  vision  from  its  use.  Some  cases 
of  toxic  amblyopia  arising  from  nicotine  poisoning,  where  the  atrophy 
was  only  partial,  have  certainly  been  benefited  by  it.  Such  remedies 
as  Gelsemium,  Ignatia,  Phosphorus,  Sulphur,  arid  many  others  might 
also  be  mentioned  as  having  directly  or  indirectly  a marked  action 
in  improving  the  functional  activity  of  the  retina.  In  hypersesthe- 
tic  conditions  of  the  retina,  where  all  local,  refractive,  and  reflex 
causes  have  been  removed,  the  action  of  the  Homoeopathic  attenuated 
drugs,  such  as  Macrotin,  Hyoscyamine,  Atropine,  Conium,  Agaricus, 
Nux  vomica,  and  Ignatia,  are  often  marvellous  in  the  rapidity  of 
their  action.  The  results  obtained  from  the  proper  administration 
of  the  indicated  remedies  in  these  cases  where  the  failure  from  the 
more  general  treatment  of  the  opposing  school  of  medicine  is  com- 
mon, are  the  more  remarkable,  and  tend  to  give  one  new  effort  and 
a desire  to  place  again  and  again  fresh  laurels  upon  the  already  well 
crowned  head  of  Hahnemann. 

The  results  obtained  by  the  Homoeopathic  administration  of 
Physostigma,  Jaborandi,  Gelsemium,  Agaricus,  in  cases  of  spasm  of 
the  accommodation  associated  with  refractive  errors,  have  enabled  me 
for  the  last  ten  years  to  do  away  with  the  use  of  Atropia,  Homa- 
tropin,  Hyoscyamine,  and  other  mydriatics  which  are  commonly 
considered  necessary  for  the  paralysis  of  the  accomodation  in  the 
prescription  of  glasses.  It  has  been  my  experience  that  the  results 
of  my  prescriptions  for  correcting  lenses  have  been  much  more  sat- 
isfactory than  when  I have  used  mydriatics,  and  where  the  reflex 
symptoms  arising  from  eye-strain,  such  as  neuralgia  and  headaches 
and  other  more  remote  neuroses,  were  often  relieved  before  the  glasses 
were  prescribed. 

Again,  it  may  be  said  that  these  and  other  remedies  relieve  the 
eye  strain  of  both  the  intrinsic  and  extrinsic  muscles  of  the  ball, 
as  reflexes,  when  the  total  optical  defect  has  been  corrected  by  the 
prescription  of  glasses,  based  upon  the  supposed  complete  paralysis 
of  the  accomodation  under  Atropia  or  some  other  drug  similar  in 
action. 

In  the  insufficiencies  of  the  recti  muscles,  whether  the  cases  ex- 
hibit an  exophoria,  esophoria,  or  a hyperphoria,  we  find  that  a close 
study  of  our  cases  with  the  prescription  of  such  remedies  as  Argent, 
nit.,  Nat.  mur.,  Gels.,  Senega,  Physostigma,  Agaricus,  Mercurius, 
and  Phosphorus,  we  are  able  time  and  again  not  only  to  relieve  the 


OPHTHALMIC  THERAPEUTICS. 


373 


discomfort  attendant  upon  the  muscular  deficiency,  but  also  to  avoid 
the  aftermath  of  graduated  tenotomies  which  daily  confront  us  in 
search  of  relief  which  even  our  Homoeopathic  law  cannot  repair. 
Thanks  to  the  increasing  intelligence  of  the  medical  profession  the 
fad  of  to-day,  whether  in  our  department  of  medicine  or  in  any 
other,  is  dead  to-morrow,  but  while  our  colleagues  in  general  medi- 
cine and  surgery  may  bury  their  dead,  ours  too  often  with  practically 
useless  organs  of  sight  confront  us  with  their  tale  of  woe  in  their 
tenotomized  and  be-prismed  eyes. 

Careful  study,  the  painstaking  prescription  of  the  Homoeopathic 
remedy  in  our  department  of  medicine,  not  only  gives  us  the  satis- 
faction of  cure  where  other  methods  have  failed,  but  also  enables 
us  to  thus  make  a more  enduring  monument  to  Hahnemann  than 
that  of  bronze  which  we  design  to  erect  to  him. 

F.  Parke  Lewis,  M.D. : Mr.  President , Ladies  and  Gentlemen : 
Everything  that  Dr.  Linnell  writes  is  written  with  care.  I never 
yet  have  seen  anything  from  his  pen  that  was  not  truly  worth  read- 
ing. It  follows,  as  a matter  of  course,  that  the  summary  of  the 
value  of  drugs  which  he  has  given  us  is  one  which  has  a very  definite 
and  distinct  value.  The  thesis  of  this  paper,  however,  is  one  in 
which  in  an  interrogatory  way  he  asks  us  if  we  may  not  accept.  It 
is  this:  He  says:  “Knowing  that  certain  constitutional  symptoms 
are  accompanied  with  morbid  conditions,  and  having  cured  this  con- 
dition by  the  exhibition  of  the  similimum,  are  we  not  justified  in 
saying  that  any  subsequent  case,  in  which  the  morbid  condition  of 
the  eye  alone  appears,  we  may  assume  that  had  the  drug  in  the  prov- 
ing been  given  long  enough  the  condition  of  the  eye  would  have  dis- 
appeared, and  that  we  may  take  that  as  a basis  for  subsequent 
prescriptions  of  that  drug?”  Can  we?  I wish  I could  believe 
absolutely  that  that  were  true,  because  it  would  give  us  a basis  for  the 
exhibition  of  our  Homoeopathic  remedies,  a very  true  and  very  sure 
one.  In  other  words,  if  it  were  always  possible  to  say  that  because 
certain  conditions  have  been  cured  by  the  exhibition  of  a certain 
remedy,  we  may  assume  that  when  these  conditions  of  the  eye  ap- 
pear independent  of  the  constitutional  conditions  that  appear  in  the 
first  place,  that  we  will  also  cure  that  disease.  I think  we  would 
have  a certainty  in  the  application  of  our  Materia  Medica  that 
would  be  very  desirable,  a certainty  in  prescribing,  which  I am  sorry 
to  say  I do  not  always  feel,  and  I question  whether  we  may  accept 
in  its  entirety  the  thesis  of  Dr.  LinnelPs  paper.  The  case  he  cites, 
for  instance,  of  Dr.  BisseFs,  is,  it  seems  to  me,  a classical  one.  Bro- 
mium  was  given  for  certain  constitutional  troubles,  accompanied  by 
ptosis — the  ptosis  disappeared.  We  had  a definite  Homoeopathic 
prescription,  followed  by  a cure;  but  are  we  justified  in  presuming 
that,  should  ptosis  appear  without  these  constitutional  symptoms, 
Bromium  is  going  to  cure  that  ptosis?  I do  not  believe  that 


374 


world’s  homoeopathic  congress. 


we  can  alwa)Ts  do  that.  The  consequence  is  that  we  have  in  our 
Materia  Medica  a great  many  symptoms  which  we  accept  as  verifi- 
cations, about  which,  in  my  mind,  there  is  question.  Immensely 
valuable  suggestions,  immensely  valuable  to  us  in  our  prescriptions, 
but  not  symptoms  upon  which  we  can  pin  our  faith  with  absolute 
reliance.  For  instance,  I have  frequently  given  Gelsemium  in  iritis, 
and  have  not  cured  my  case;  therefore  I have  concluded  that  Gel- 
semium is  not  the  remedy  for  iritis.  It  may  be,  but  it  is  not  always. 
The  reason  I believe  that  we  have  such  a small  proportion  of  definite 
symptoms  connected  with  the  eye  in  our  Materia  Medica,  is  only 
partially  due  to  the  fact  that  we  have  not  had  skilled  specialists  to 
make  examinations  of  these  conditions ; it  is  only  partially  due  to 
that.  I come  more  and  more  to  believe  that  the  eye  is  not,  in  a very 
large  proportion  of  cases,  directly  and  specifically  acted  upon  by 
drugs  administered  internally.  I wish  to  be  understood  in  this 
matter.  I am  not  in  any  degree  under-estimating  the  immense  value 
of  Homoeopathic  therapeutics  in  diseases  of  the  eyes  ; I am  simply 
questioning  the  application  of  this  therapeutics.  I am  by’  no  means 
criticising  the  results  which  have  been  obtained  in  the  hands  of  our 
careful  prescribers.  That  those  results  have  been  obtained,  I also 
have  no  doubt;  but  I do  believe  that  a large  proportion  of  the  dis- 
eases of  the  eye  (if  we  exclude  traumatism,  refractive  and  muscular 
troubles — I mean  traumatism  of  bright  sunlight  on  the  retina) — are 
the  results  of  diseases  of  some  of  the  other  organs  of  the  system  ; some 
of  the  great  organs  of  the  nervous  system,  or  of  the  circulatory  syrstem. 
And  unless  we  take  into  account  the  power  which  each  of  these 
conditions  may  have  upon  the  disease  of  the  eye,  I am  inclined  to 
think  that  we  lessen  ratherthan  increase  our  knowledge  of  the  thera- 
peutic action  of  drugs  upon  the  eye.  I hope  I make  myself  clear 
in  that,  because  I have  such  an  unbounded  faith  in  Homoeopathic 
remedies  in  diseases  of  the  eye  that  I do  not  wish  to  be  wrongly 
understood  in  the  matter.  But  as  to  the  methods  we  sometimes 
adopt  in  determining  the  action  of  drugs  upon  the  eye,  I think 
there  is  room  for  frequent  error.  It  is  unnecessary  to  talk  to  those 
who  are  thoroughly  informed — as  thoroughly  informed  as  those 
are  to  whom  I am  speaking — in  regard  to  the  nature  of  diseases  of 
the  eye,  and  the  necessity  of  exact  diagnosis  ; and  yet  I believe 
that  in  the  administration  of  drugs  therapeutically,  an  exceedingly 
exact  diagnosis  must  be  made,  otherwise  we  are  apt  to  be  led  into 
error.  To  explain  what  I mean  more  particularly  : I remember 
trying  for  a long  time  to  treat  a peculiar  form  of  cataract  (a 
dotted  condition  of  the  lens,  which  I have  seen  in  several  instances), 
and  without  any  appreciable  effect.  I subsequently  found  that 
there  was  present  in  that  case  a refractive  condition,  which  had  been 
overlooked,  a slight  difference  in  the  foci  of  the  two  eyes,  and  the 
correction  of  which  absolutely  corrected  the  whole  difficulty.  In 


OPHTHALMIC  THERAPEUTICS. 


375 


other  words,  it  relieved  the  strain  on  the  ciliary  muscle,  it  relieved 
the  nutrition  of  the  eye,  and  the  eye  cleared  in  consequence.  I don’t 
mean  to  say  that  that  kind  of  cataract  comes  inevitably  as  a result 
of  muscular  or  ciliary  strain,  but  I do  mean  to  say  that  in  a 
very  large  proportion  of  these  cases  the  correction  of  muscular 
and  of  refractive  errors  will  eliminate  the  necessity  for  the  exhibition 
of  internal  medication. 

I am  very  much  interested  in  what  Dr.  Buffum  has  said  in  regard 
to  the  action  of  drugs  in  relieving  and  curing  ciliary  spasm.  I was 
very  much  interested  twelve  or  fifteen  years  ago  when  Dr.  Woodyatt 
announced  the  value  that  he  had  obtained  from  Argentum  nitricum 
in  those  troubles,  possibly  because  I have  not  had  opportunity  of 
following  those  cases  as  I would  like  to ; but  I never  have  had 
the  entirely  satisfactory  results  in  internal  medication,  in  focal  and 
refractive  troubles,  which  others  seem  to  have  had.  Where  there 
is  a muscular  condition  which  is  not  benefited,  I have  almost  always 
found  those  conditions  return  for  further  treatment. 


376 


world’s  homoeopathic  congress. 


THE  REFRACTION  OF  THE  EYE. 

By  Thomas  M.  Stewart,  M.D.,  Cincinnati,  O. 


By  invitation  from  the  Chairman  of  the  Section  of  Ophthalmol- 
ogy to  prepare  the  paper  on  the  general  topic  of  “ refraction  ” we  are 
acquitted  of  any  undue  assumption  in  coming  before  you.  While 
the  chairman  is  thus  responsible,  both  for  our  presence  here  and  our 
topic,  we  must  say  that  it  would  have  been  difficult  to  select  a ques- 
tion in  the  whole  range  of  ophthalmology  more  important  than  that 
of  how  to  deal  with  errors  of  refraction,  for,  after  all,  this  is  the 
practical  basis  of  the  general  topic  which  it  is  our  privilege  to  dis- 
cuss at  this  time. 

To  treat  this  subject  satisfactorily  two  things  are  requisite: 

The  one  is,  an  understanding  of  the  conditions  of  accurate  vision  ; 
the  other,  an  understanding  of  the  appliances  for  estimating  the  re- 
fraction of  the  eye.  What,  then,  are  the 

Conditions  of  Accurate  Vision? 

Two  conditions  must  be  fulfilled  in  order  to  see  an  object  dis- 
tinctly.* 

In  the  first  place,  an  inverted  but  well-defined  image  of  the  object 
must  be  formed  on  the  layer  of  the  rods  and  cones  of  the  retina.  In 
the  second  place,  the  local  irritation  here  excited  must  be  conveyed 
to  the  fibres  of  the  optic  nerve,  communicated  to  the  brain,  and  again, 
in  an  inverted  direction,  projected  outwards. 

We  may  say,  therefore,  that  every  disturbance  of  vision  depends 
upon  a derangement  in  one  of  these  two  conditions,  or  both  together. 
If  the  projection  outward  be  deranged  by  disturbances  in  the  retina,  in 
the  optic  nerve,  or  in  the  brain,  the  affection  belongs  to  the  domain 
of  amblyopia  or  amaurosis.  If  no  image  be  formed,  or  if  the  image 
be  distorted  through  diffusion  of  light  in  the  eye,  obscurities  in  the 
way  of  the  radiation  of  light  through  the  organ  are  the  foundation 


* Refraction  and  Accommodation  of  the  Eye.  Donders,  London,  1864. 


THE  REFRACTION  OF  THE  EYE. 


377 


of  the  mischief.  Finally,  if  the  image  of  objects  placed  at  the  ordi- 
nary distances  of  distinct  vision  be  not  formed  on  the  layer  of  rods 
and  cones,  or  even  if,  through  abnormal  curvature  of  the  surfaces  of 
cornea  or  lens  no  defined  image  is  on  the  whole  produced,  anomalies 
of  refraction  or  of  accommodation  are  developed. 

In  order,  then,  to  proceed  in  some  systematic  manner  to  do  justice 
to  this  subject  in  the  light  of  modern  methods  and  instruments,  we 
will  suppose  that  we  have  an  eye  in  which  vision  is  impaired.  From 
the  foregoing  we  have  one  of  these  three  kinds  of  disturbance  with 
which  to  deal.  The  opthalmoscope  and  the  oblique  illumination 
will  at  once  show  whether  obscurity  of  the  light  refracting  media  or 
some  pathological  change  in  the  nerve  or  retina  be  present  or  not. 
If  such  be  not  found,  we  may  infer  the  existence  of  either  amblyopia 
or  of  a disturbance  in  refraction  and  accommodation.  If  now  with 
the  aid  of  the  different  methods  of  estimating  the  refraction  of  the 
eye,  perfectly  defined  vision  can  at  no  distance  be  obtained,  the  case 
is  one  of  amblyopia.  If,  on  the  other  hand,  vision  is  clearly  defined 
at  one  distance  or  another,  we  have  to  deal  with  an  anomaly  of  re- 
fraction or  accommodation. 

It  is  understood  that  the  anomalies  of  refraction  are  to  be  sought 
in  the  form  and  structure  of  the  eye  with  the  accommodation  at  rest. 
The  anomalies  of  accommodation  have  their  basis  in  the  abnormal 
action  of  the  internal  and  external  muscular  system,  for  accommo- 
dation and  convergence  are  associated  functions;  neither  is  to  be 
ignored  if  the  best  results  are  to  be  secured.  In  dealing  with  the 
anomalies  of  refraction  we  must  take  note  of  the 

Appliances  for  Estimating  the  Refraction  of  the  Eye. 

In  addition  to  the  trial  lenses  and  the  ophthalmoscope,  we  now 
have  the  ophthalmometer  and  Dr.  Lambert’s  discs  of  lenses  for  use 
in  retinoscopy.  The  full  consideration  of  these  instruments,  their 
range  and  application  in  the  service  for  which  they  have  been  de- 
vised, would  alone  carry  us  far  beyond  the  time  appropriate  for  the 
presentation  of  the  subject  of  this  paper  for  your  discussion. 

The  determination  of  the  state  of  refraction  by  the  glass  giving 
the  most  distinct  vision  at  twenty  feet,  with  uniform  illumination, 
is  the  method  with  intelligent  patients,  less  open  to  objections  than 
any  other,  the  possibility  of  the  physician’s  bias  being  likely  to  in- 
vite criticism  in  ophthalmoscopic  and  other  objective  tests. 


378 


world’s  homceopatiiic  congress. 


But  before  we  make  use  of  any  one  or  all  of  the  appliances  herein 
mentioned  we  must  dispose  of  the  subject  of 

Mydriatics. 

The  question,  whether  or  not,  the  ciliary  muscle  of  the  eye  should 
be  paralyzed  in  estimating  the  refraction  is  still  an  open  one.  The 
reasons  for  this  are  many:  first,  the  time  taken  to  thoroughly  sus- 
pend accommodation  ; second,  the  doubtful  efficacy  of  Homatropine 
as  a substitute  for  Atropine;  thirdly,  the  questioned  value  of  the 
ophthalmometer  in  measuring  corneal  astigmatism ; fourthly,  the 
questionable  value  of  the  direct  and  indirect  ophthalmoscopic  exam- 
inations. 

To  solve  the  question  requires  a knowledge  of  that  which  a my- 
driatic is  supposed  to  do,  together  with  the  reasons  and  necessity  for 
doing  it;  this  knowledge  must  be  supplemented  by  an  apprehension 
of  the  relative  merits  of  the  different  mydriatics,  together  with  the 
principles,  mathematical  and  optical,  underlying  the  uses  of  the  oph- 
thalmometer and  the  ophthalmoscope. 

It  is  fair  to  assume  that  a mydriatic  exercises  three  functions : 
first,  to  paralyze  the  ciliary  muscle,  because  accommodation  is  equiv- 
alent to  increased  refraction;  secondly,  to  dilate  the  pupil,  and  hence 
to  facilitate  a thorough  examination  of  the  refractive  media  and  the 
periphery  of  the  eye  ground  ; and  thirdly,  to  place  the  eye  at  com- 
plete physiological  rest,  so  that  the  lesions  so  commonly  present  as 
the  result  of  eye-strain  may  subside — not  alone,  we  take  it,  merely 
because  there  is  physiological  rest,  but  a distinct  sedative  influence 
exercised  by  the  drug. 

The  following  table,  compiled  from  private  and  published  records 
from  1888  to  1893,  of  2000  eyes  examined  without  mydriasis,  and 
the  ametropia  thus  found  compared  to  the  ametropia  of  the  same 
eyes  examined  under  full  mydriasis,  is  an  object-lesson  relative  to 
this  question. 

Without  With 

Mydriasis.  Mydriasis. 

Per  Cent.  Per  Cent. 


Emmetropia,  .... 

. 16* 

1 

Myopia, 

. 9 

4 

Hyperopia,  .... 

. 10* 

31* 

Simple  hyperopic  astigmatism, 

. 15* 

5 

“ myopic  “ 

. 23 

2 

Compound  hyperopic 

. 10* 

41 

“ myopic  “ 

. 12 

10 

Mixed  astigmatism, 

. 3 

5* 

100 


100 


THE  REFRACTION  OF  THE  EYE. 


379 


Therefore,  in  answer  to  the  question,  is  it  necessary  to  paralyze  the 
accommodation  in  order  to  prescribe  the  most  suitable  glasses,  I 
answer,  yes. 

The  second  point  for  solution — the  best  agent  to  use  for  the  pur- 
pose of  paralyzing  the  accommodation — is  also  in  dispute. 

Iiydrobromate  of  homatropine,  because  of  its  rapid  action  and 
transitory  effect,  is  the  favorite  mydriatic  for  refractive  purposes. 
Its  efficiency  is  questioned  ; ophthalmologists  of  equal  eminence  hold 
diametrical  opinions  upon  the  subject.  Those  who  think  it  sufficient 
to  produce  complete  paralysis  of  the  accommodation  state  that  it 
should  be  instilled  every  five  or  ten  minutes,  and  three  or  four  in- 
stillations practiced,  and  that  the  examination  should  be  made  within 
one  or  two  hours.  Using  it  in  this  way,  and  following  it  by  another 
mydriatic  without  alteration  in  the  result,  are  the  statements  of  such 
reliable  observers  as  Dr.  Edward  Jackson,  of  Philadelphia,  Dr. 
Henry  Gradle  and  Dr.  F.  C.  Hotz,  of  Chicago.  Those  observers 
who  oppose  the  efficacy  of  homatropine  to  properly  suspend  the  ac- 
commodation, do  not,  it  seems  to  me,  use  it  as  directed.  Their  pub- 
lished statements  say,  “ Frequently  used  a 4 per  cent,  solution  of 
Homatropine  from  twice  to  four  times  in  an  hour,  and  by  the  sub- 
sequent use  of  Atropine  determined  accommodation  had  not  been 
completely  abolished ; for  a greater  degree  of  hyperopia  appeared 
under  the  latter.” 

A series  of  twenty-five  cases  examined  as  follows:  At  the  first 
consultation  the  usual  record  was  made  of  the  condition  of  the  eyes 
and  appendages,  apparent  refraction,  vision,  and  whether  the  latter 
could  be  improved  by  lenses  or  not.* 

The  eyes  were  then  subjected  to  the  influence  of  Homatropia. 
For  this  purpose  a fresh  l per  cent,  solution  was  employed,  and  of 
this  one  drop  was  instilled  into  each  eye  five  times  in  the  course  of 
fifty  minutes,  and  the  examination  begun  in  an  hour  from  the  time 
of  the  first  instillation.  A record  was  made  of  the  time  of  each  in- 
stillation and  of  the  time  of  commencing  the  examination.  Then  a 
record  was  made  of  the  state  of  refraction,  and  the  patient  directed 
to  return  the  next  day.  In  the  meantime  a drop  of  a 1 per  cent, 
solution  of  Sulphate  of  atropine  was  to  be  instilled  in  the  eye  every 
three  hours.  It  was  so  planned  that  at  least  four  instillations  of 
Atropine  should  be  secured. 


* Eye  Records,  Pulte  Medical  College,  Cincinnati,  1892. 


380 


world’s  homceopathic  congress. 


When  practicable,  the  Atropia  solution  was  continued  for  two  or 
three  days,  with  daily  notings  of  the  condition  of  refraction,  and  in 
some  cases  where  there  were  other  indications  for  Atropia  this  was 
continued  for  several  weeks. 

In  each  case  the  state  of  refraction  was  determined  by  the  glass 
giving  the  most  distinct  vision  at  twenty  feet,  with  good  and  uniform 
illumination.  Control  tests  by  ophthalmoscopic  and  keratoscopic 
methods  were  also  employed. 

In  the  analyses  of  the  cases  they  were  divided  into  four  groups: 

1.  Those  in  which  there  was  no  difference  in  the  effect  produced 
by  Homatropia  and  Atropia — fourteen  cases  of  the  twenty-five,  or  5d 
per  cent. 

2.  Those  in  which  the  use  of  Atropia  for  twenty-four  hours 
showed  a diminution  of  refraction,  without  further  change  by  longer 
continuance  of  Atropia — two  cases,  or  8 per  cent.  The  addition  of 
a -f.25  D.  cylinder  was  required  for  the  right  eye  in  one  case. 

3.  Those  in  which  the  use  of  Atropia  for  twenty-four  hours  showed 
no  change  from  the  relaxation  produced  by  Homatropia,  but  in  which 
change  developed  by  longer  use  of  Atropia — three  cases,  or  12  per 
cent.  These  three  cases  were  of  simple  hyperopia,  and  required  from 
.25  D.  to  .50  D.  stronger  convex  glasses. 

4.  Those  in  which  there  was  change  from  Homatropia  to  Atropia 
used  twenty-four  hours,  but  in  which  there  was  also  additional  change 
by  longer  use  of  Atropia — four  cases,  or  16  per  cent.  Three  of  these 
four  cases  were  of  mixed  astigmatism,  the  changes  in  the  glasses  being 
represented  by  one  of  the  strength  of  0.25  D. ; the  fourth  case  was 
of  hypermetropia  requiring  convex  lenses  of  0.50  D.  stronger  than 
shown  under  the  test  of  twenty-four  hours. 

The  use  of  atropia  after  homatropia  and  the  use  of  atropia  be- 
yond the  period  of  twenty- four  hours  shows  the  additional  refraction 
revealed  to  have  ranged  between  0.25  I).  and  0.50  D. 

The  records  of  thirty-two  eyes  carefully  analyzed  by  the  author, 
in  which  the  examination  under  homatropia  was  made  with  a four 
per  cent,  solution  used  four  times  in  an  hour,  followed  by  atropia 
used  at  least  three  times  in  twenty-four  hours,  gives  the  following : 

1.  The  ages  varied  from  16  to  26  years. 

* 2.  Refraction,  hyperopia  or  hyperopic  astigmatism. 

3.  No  difference  in  the  refraction  under  homatropia  as  compared 
with  atropia,  two  eyes,  or  6J  per  cent. 


THE  REFRACTION  OF  THE  EYE. 


381 


4.  A diminution  in  refraction  under  atropia  after  the  use  of 
homatropia  noted  in  all  of  the  remaining  thirty  eyes,  or  93}  per 
cent. 

5.  The  additional  refraction  revealed  ranged  between  0.25  D.  and 
0.75  D. ; in  one  case  the  difference  was  1.50  D. 

Comparative  tests  of  atropine  and  hyoscyamine  have  shown  the 
latter  to  paralyze  the  accomodation  in  from  twenty  to  thirty  minutes, 
strength  of  solution  one  part  to  one  hundred  of  distilled  water,  one 
drop  in  each  eye.  In  five  cases  the  methods  employed  were  as  fol- 
lows, apparent  refraction  ascertained  ; hyoscyamine  instilled,  in 
thirty  minutes  near  point  found  to  coincide  with  far  point,  refraction 
ascertained  by  trial  lenses  and  control  tests;  atropia  used  three  times 
in  twenty-four  hours,  refraction  ascertained  as  before.  In  all  of  the 
five  cases  the  results  coincided.  The  effects  of  the  Hyoscyamine,  in 
another  series  of  five  cases,  were  found  to  pass  off  in  from  three  to 
eight  days;  the  accommodation  was  interrogated  to  determine  this 
point  accurately.  In  none  of  the  cases  were  disagreeable  symptoms 
noticed.  The  ages  ranged  between  12  and  29  years. 

The  second  point,  the  mydriatic  best  adapted  for  general  use, 
seems  to  be  hyoscyamine  because  of  its  rapid  action,  the  readiness 
with  which  the  ciliary  muscle  recovers  its  power,  and  the  uniformity 
of  results  in  comparison  with  atropia. 

Risley  (S.  D.)  on  Hyoscyamine  as  a Mydriatic. — The  superiority 
of  the  solution  of  the  white  salt  of  Hyoscyamine  as  a mydriatic 
over  the  other  solanacese  is  so  great  that  the  writer  uses  it  for  all 
refractive  work  except  in  selected  cases.  The  reason  why  many  are 
disappointed  in  its  use  is  a lack  of  care  in  selection  of  the  specimens 
of  the  salt.  In  all  cases  where  its  use  was  followed  by  smarting  and 
too  long  persistence  of  mydriasis,  it  was  found,  where  the  history 
of  manufacture  could  be  followed,  that  it  had  been  made  from  the 
amorphous  semi-fluid  salt,  and  not  from  the  white,  dry  crystals. 
Hyoscyamine  is  isomeric  with  Atropine  and  Duboisine,  and  so  is 
very  closely  related  to  the  others.  Indeed,  W.  Will  has  shown  that, 
under  certain  conditions  only,  Hyoscyamine  can  be  extracted  from 
Belladonna,  and  then  turned  into  Atropine  by  simply  heating  to  the 
melting  point,  treating  with  an  alkali,  or  heat  in  the  presence  of 
hydrochloric  acid.  One  grain  of  a 10  per  cent,  solution  of  Hyoscya- 
mine was  completely  converted  into  Atropine  by  one  drop  of  soda 
solution  in  two  hours.  The  writer  concludes,  first,  that  for  ophthal- 


382 


world’s  homoeopathic  congress. 


mological  purposes  only  the  pure  crystals  of  Hyoscyamine  skillfully 
prepared  should  be  used;  second,  that  in  dispensing  it  the  solution 
should  be  strictly  neutral,  that  only  moderate  degrees  of  heat,  if  any, 
should  be  used,  and,  when  filtered,  this  should  be  done  through 
neutral  paper. — Annals  OphthaL  and  Otol. , Kansas  City,  Janu- 
ary, 1892. 

In  all  cases  requiring  the  use  of  a mydriatic  it  is  well  to  follow 
Dr.  Edward  Jackson’s  advice;  that  is,  to  place  the  drop  on  the  upper 
part  of  the  cornea,  allowing  it  to  flow  down  over  its  surface;  prevent 
the  lids  from  closing,  and  thus  carrying  part  of  the  drug  away,  and 
to  prevent  the  drug  from  entering  the  puncta  lachrymale. 

The  Ophthalmometer.* 

It  is  just  a century  since  the  English  philosopher,  Thomas 
Young,  observed  the  asymmetry  of  the  dioptric  system  in  his  own 
person,  and  who  is  accepted  as  the  discoverer  of  regular  astigmatism. 
Nearly  fifty  years  passed  before  this  knowledge  influenced  the  prac- 
tice of  prescribing  glasses.  In  1827,  England’s  Koval  Astronomer, 
Airy,  described  the  asymmetry  of  his  own  eye  and  considered  it  as  a 
defect.  He  was  the  first  to  have  used  cylindrical  glasses  for  the  cor- 
rection of  the  error  he  himself  discovered.  The  invention  of 
Helmholtz’s  ophthalmometer  gave  a new  impetus  to  the  study  of 
this  imperfection  of  the  human  eye.  Many  famous  physicists  with 
the  aid  of  this  instrument  studied  the  dioptric  system  of  the  eye. 
Fundamental  points  were  settled,  as,  for  instance,  that  the  curvature 
of  the  cornea  is  not  changed  by  accommodation  ; that  astigmatism 
is  almost  exclusively  due  to  the  form  of  the  outer  surface  of  the 
cornea  ; that  all  eyes,  with  but  few  exceptions,  have  a certain  degree 
of  astigmatism  ; that  the  meridian  of  strongest  refraction  is  the 
vertical  one  in  the  great  majority  of  cases.  Notwithstanding  all 
this,  the  ophthalmometer  did  not  come  into  general  use,  and  practice 
contented  itself  with  subjective  tests. 

To  Javal’s  energy  and  perseverance  we  are  indebted  for  the  special 

* “ The  Determination  of  Astigmatism  with  the  Ophthalmometer.”  Carl  Kel- 
ler, M.D.,  Journal  Am.  Med.  Ass’n,  September  13,  1890. 

“Javal’s  Ophthalmometer  and  Atropine.”  N.  Y.  Med.  Journ.,  September 
10,  1892. 

“The  Main  Defects  of  Javal’s  Ophthalmometer.”  Carl  Weiland,  M. D.,  Medical 
News,  June  4,  1892. 


THE  REFRACTION  OF  THE  EYE. 


383 


form  given  to  the  ophthalmometer  that  bears  his  name.  The  prin- 
ciple of  the  instrument  was,  of  course,  well  known  before  JavaPs 
time.  Taking  his  starting  point  from  the  general  stock  of  knowl- 
edge, Javal  gave  the  bi-refracting  prism  a definite  place  in  the  tele- 
scope, then  made  the  calculation  for  the  refractive  power  of  the 
cornea,  and  added  the  arc  and  two  reflectors.  The  calculation  and 
the  arc,  as  well  as  the  two  reflectors,  are  not  absolutely  correct,  hence 
variations  noted  by  different  observers  and  the  necessity  for  increas- 
ing or  diminishing  the  findings  of  the  ophthalmometer  by  from  one- 
quarter  to  one-half  dioptre. 

In  the  first  place,  Javal  makes  the  relation  of  the  object  to  the 

image  depend  upon  the  formula  ~ = — , which  is  the  formula  used 

I r 

by  Helmholtz  in  his  calculations,  but  he  placed  his  object  at  2000 
mm.  from  the  cornea,  while  Javal  makes  the  distance  equal  only 
270  mm.  This  formula  is  right,  if  the  object  lies  so  far  from  the 
mirror  that  its  image  falls  at  the  focus  of  the  mirror,  which  is  at 

V 

2*  To  prove  the  inaccuracy  we  must  remember  that  JavaPs  instru- 


ment that  the  image,  i,  is  always  a constant  quantity  as  soon  as  the 
two  reflectors  have  been  adjusted  so  that  their  two  inner  images 

touch.  Working  out  the  problem  we  see,  therefore,  ^ = ^becomes 

? = as  r’  ^)e  average  radius  of  curvature  of  the  cornea,  equals 
o 7.0 

7.8  mm.  Then  0 = 215.13  mm.,  whereas  the  instrument  makes 
O = 200  mm.,  to  say  nothing  of  the  result  obtained  by  using  the 

v 

if  we  desire  to  fulfill  the  correct 


more  correct  formula 

1 r 

condition  stated  above. 

Another  source  of  error  in  the  instrument  arises  from  the  fact  that 
the  reflectors  slide  on  an  arc,  consequently  the  distance  of  the  object 
from  the  cornea  undergoes  a change  in  the  adjustment  necessary  to 
get  contact  of  the  images.  While  this  error  is  small  yet  it  helps  to 
show  that  the  instrument  is  not  as  accurate  as  we  are  led  to  suppose 
from  statements  of  some  observers.  The  remedy  for  this  defect  is 
simple  and  no  doubt  will  soon  be  applied  by  the  makers  of  the  in- 
strument. 

In  the  calculations  for  finding  the  refractive  power,  or  the  radius 


384 


world’s  homoeopathic  congress. 


of  curvature  of  the  cornea,  certain  values  not  absolute  in  themselves, 
have  to  be  adopted.  Another  observer  using  exactly  the  same 
formulae  but  adopting  different  values  for  the  index  of  refraction  of 
the  cornea  and  aqueous,  and  for  the  radius  of  curvature  of  the  cor- 
nea, will  of  course  arrive  at  different  results.  But  as  we  are  dis- 
cussing the  mathematical  principles  applied  to  the  special  form  of 
the  ophthalmometer  of  Javal,  we  must  use  the  formula  he  himself 
has  indicated,  together  with  the  values  thereto  attached. 

Javal’s  formula  for  finding  the  refractive  power  of  the  cornea,  in 
the  different  meridians  expressed  in  dioptrics,  is  : 

_ 1000  (n— 1 ) 350 

v v 

Here  n = 1.35,  index  of  refraction  of  cornea  and  aqueous;  and 
r = 7.8  average  radius  of  curvature  of  cornea.  But  as  we  want  to 
find  the  refractive  power  of  the  cornea  for  rays  coming  from  the 
outer  world,  we  must  take  account  of  the  refractive  index  of  the 
cornea  in  addition  to  its  radius  of  curvature,  for  this  alone  tells  us 
how  far  back  from  the  anterior  surface  of  the  lens,  parallel  rays 
from  distant  objects  would  meet.  Hence,  the  correct  formula  ex- 
pressed in  dioptrics  should  read  : 

_ 1000  (n  — 1)  _ 350 
r n rn 

According  to  these  formulae  we  have  the  following  table  illustrat- 
ing the  differences : 


35  j D of  Javal  ought  to  be  26.4  D for  r = 10  mm. 

43  D of  Javal  ought  to  be  32.2  D for  r = 7.8,  etc. 

Although  the  question  is  not  as  to  the  absolute  refractive  power 
of  the  cornea,  but  the  difference  between  those  powers  in  the  differ- 
ent meridians,  in  other  words  the  amount  of  astigmatism.  But  the 
amount  of  astigmatism  is  affected  also,  for  example: 

1 D astigmatism  of  Javal  only  = 0.75  D of  the  cornea. 

2.5  D astigmatism  of  Javal  only  = 2 D of  the  cornea. 

3.5  D astigmatism  of  Javal  only  ==  2.6  D of  the  cornea. 

6 D astigmatism  of  Javal  only  = 4.5  D of  the  cornea. 


THE  REFRACTION  OF  THE  EYE. 


385 


From  the  formulae  given  above  for  finding  the  refractive  power 
of  the  cornea  we  see  that  all  the  values  of  Javal  for  the  amount  of 
refractive  power  of  the  cornea  and  the  amount  of  corneal  astigma- 
tism are  n times  too  large  if  n = index  of  refraction  = 1.35. 
Hence  we  see  a reason  for  Javal’s  instruction  to  subtract  half  a 
dioptre  when  the  astigmatism  was  with  the  rule,  or  give  the  full 
correction  or  add  half  a dioptre  when  the  astigmatism  was  against 
the  rule.  In  giving  this  instruction,  which  is  a recognition  of  the 
variation  of  the  instrument,  Javal  assumed  the  variation  to  be  a 
constant  one.  While  this  is  so,  we  must  not  forget  that  half  a 
dioptre  does  not  always  make  up  for  the  difference,  and  so  not  be 
led  to  expect  more  of  the  instrument  than  it  is  capable  of  giving. 

This  instruction  of  Javal  has  been  followed  in  all  of  the  statistics 
of  refraction  examined  with  the  instrument  that  have  come  under 
my  observation,  and  to  my  mind  is  the  reason  for  the  good  results 
obtained  with  the  instrument  in  clinical  work. 

In  concluding  this  brief  study  of  the  ophthalmometer  I have  to> 
reiterate  among  other  of  our  criticisms  made  at  the  meeting,  one 
year  ago,  of  the  American  Institute  of  Homoeopathy,  viz.,  the  very 
principle  of  the  instrument  is  defective,  because  the  bi-refracting 
prism  is  not  achromatic,  which  makes  it  impossible  to  get  the  accu*- 
rate  contact  of  the  images  so  necessary  for  an  accurate  result,  for  the 
simple  reason  that  a sharp  definition  of  the  images  cannot  be  ob- 
tained. 

It  is  not  uncommon  experience  to  find  the  indications  of  the  oph- 
thalmometer exactly  reversed  by  subsequent  use  of  other  objective 
tests.  For  instance  three  cases  recently  examined  in  which  Javal’s 
instrument  indicated  an  astigmatism  with  the  rule  requiring  for  its 
correction  either  a convex  cylinder  axis  90°  or  a concave  cylinder 
axis  180°.  Retinoscopy,  or  the  “illumination  test”  according  to 
Schweigger,  indicated  the  opposite  conditions,  the  patients  requiring 
for  correction  a convex  cylinder  axis  180°,  which  latter  glass  they 
accepted,  getting  perfect  vision  and  comfort. 

From  the  foregoing  we  may  summarize  the  use  of  the  ophthal- 
mometer as  follows  : 

1.  It  shows  the  meridians  of  greatest  and  least  refraction  with 
certainty. 

2.  By  its  use  mydriatics  may  be  dispensed  with  in  a greater  propor- 
tion than  is  the  case  with  other  methods  of  estimating  astigmatism. 

25 


336 


world’s  homoeopathic  congress. 


3.  From  reasons  stated  at  length  in  the  body  of  the  paper  its  form 
and  principle  do  not  warrant  us  in  relying  upon  it  exclusively. 

The  objective  test  just  referred  to  is  one  to  which  we  wish  to  draw 
especial  attention.  AVith  its  history  and  various  names  you  are  quite 
familiar.  Some  ophthalmologists  attach  but  little  importance  to  it 
as  a test,  others  practice  it  constantly  and  value  it  accordingly.  We 
shall  not  rashly  claim  it  as  an  infallible  test,  nor  recommend  it  to 
the  exclusion  of  others,  but  it  can  be  shown  to  be  the  most  convenient 
and  accurate  objective  test  for  estimating  astigmatism,  particularly 
astigmatism  of  small  as  well  as  of  larger  degree.  In  this  particular 
it  differs  from  the  ophthalmometer,  in  that  the  latter  is  most  useful 
in  the  adjustment  of  astigmatism  below  about  1.5  dioptres. 

Relative  to  the  use  of  mydriatics  in  the  practice  of  retinoscopy,  we 
may  state  that  it  is  our  practice  to  suspend  the  accommodation,  be- 
cause spasm  of  the  accommodation  is  frequently  present  in  cases  of 
astigmatism.  Here,  as  elsewhere,  accurate  correction  of  errors  of 
refraction  requires  skill  and  practice,  and  a knowledge  of  refraction. 

This  allusion  to  retinoscopy  is  not  for  the  purpose  of  describing  it 
in  theory  and  method  of  practice,  but  to  call  your  attention  to  Dr. 
W.  E.  Lambert’s  apparatus  to  obviate  the  tedious  process  of  chang- 
ing glasses  in  front  of  the  patient’s  eye.* 

His  apparatus  “ consists  essentially  of  two  discs,  about  12  inches 
in  diameter ; in  these  discs  concave  and  convex  spherical  lenses  are 
so  arranged  that  by  adjusting  one  of  the  discs  for  a certain  range  of 
glasses,  the  strength  of  the  glass  in  front  of  the  eve-piece  is  increased 
or  diminished  0.25  D.  by  turning  the  other  disc  either  to  the  right 
or  to  the  left.  The  cylinders  are  arranged  in  consecutive  numbers 
from  0.25  D.  up,  in  slides  which  fit  into  a clip  on  the  front  of  the 
eye-piece  that  revolves,  so  that  the  cylinder  can  be  placed  in  any 
axis,  the  same  being  indicated  as  on  trial  frames;  the  strength  of  the 
cylinder  can  then  be  increased  or  diminished  by  pushing  the  slides 
through  the  clips.” 

In  this  connection  reference  should  be  made  to  Dr.  Elmer  Starr’s 
instrument  for  quickly  determining  errors  of  refraction.  In  this  in- 
strument the  important  condition  of  ascertaining  the  visual  acuteness 


* “ Retinoscopy  as  a Means  of  Estimating  Astigmatism,”  by  W.  E.  Lambert, 
L.R  O.P.,  N.  Y.  Med.  Journ.,  August  27,  1892. 


THE  REFRACTION  OF  THE  EYE. 


387 


and  refraction  simultaneously  is  met,  for  the  retinal  images  of  all 
eyes  examined  by  it  have  the  same  size.* 

It  would  not  be  in  keeping  with  our  high  regard  for  the  genius  of 
such  men  as  Helmholtz,  Mauthner  and  Loring,  to  pass  this  portion 
of  our  subject  without  a reference  to  the  ophthalmoscope  as  an  aid 
to  the  determination  of  refraction. 

The  difficult  “direct  method”  of  examination  bids  fair  to  be 
superseded  by  the  use  of  the  ophthalmometer  and  other  objective 
tests,  unless  the  young  men  in  our  department  of  special  study  keep 
ever  in  mind  the  high  quality  of  ophthalmoscopic  work  heretofore. 
Briefly  this  method,  like  that  of  retinoscopy,  recommends  itself  be- 
cause it  offers  a means  to  determine  the  refraction  of  the  eye  inde- 
pendent of  its  visual  power  or  the  statements  of  the  person  exam- 
ined, and  it  gives  us  a means  to  measure  the  amount  of  elevation  or 
depression  of  different  parts  of  the  fundus.  This  classical  method 
requires  long  practice  in  overcoming  one’s  own  accommodation,  and 
skill  in  the  use  of  the  instrument,  the  ophthalmoscope.  The  practi- 
cal men  look  upon  the  direct  method  of  examination  with  the  oph- 
thalmoscope as  of  very  doubtful  value,  but  to  the  lovers  of  the  ideal, 
this  method  cannot  be  neglected. 

We  have  thus  far  concerned  ourselves  more  with  the  methods  of 
estimating  the  refraction  of  the  eye  than  with  the  details  of  correct- 
ing its  errors.  Coincident  with  this  latter  a train  of  interesting  and 
important  questions  present  themselves;  the  whole  subject  of  eye- 
strain  and  its  attendant  symptoms  falls  legitimally  within  its  scope. 
The  province  of  writers  upon  ophthalmic  subjects  is  at  the  present 
time  to  bring  into  order  such  as  has  been  discovered  relative  to  the 
general  subject,  eye-strain.  This  term  has  become  quite  generally 
used  and  its  application  must  now  be  sought  before  any  intelligent 
discussion  can  take  place  regarding  headache  due  to  refractive  errors, 
nervous  phenomena  definitely  related  to  faulty  refraction,  muscular 
insufficiencies  with  errors  of  refraction,  and  kindred  questions. 

In  beginning,  we  shall  of  necessity  have  to  clear  our  ground,  not 
because  the  facts  about  to  be  presented  are  new  or  strange ; the  facts 
are  old  ; the  fault  is  in  the  use  of  the  terms  in  which  they  are  clothed. 
We  read  much  about  eye-strain  as  a cause  of  headache,  and  yet  few 


* “A  New  Instrument  for  Quickly  Determining  Errors  of  Refraction,”  by  Elmer 
Starr,  M.D.,  N.  Y.  Med.  Journal , April  9,  1892. 


388 


world’s  homoeopathic  congress. 

have  sufficiently  examined  the  meaning  and  application  of  the 
term.* 

There  are  many  reasons  for  this;  the  discovery  of  reflex  neuroses 
has  come  about  slowly  and  silently.  No  one  man  has  made  it,  and 
yet,  paradoxical  as  it  may  seem,  there  are  but  few  men  that  proclaim 
the  importance  and  realize  the  value  of  the  discovery.  In  properly 
introducing  this  part  of  our  subject,  we  shall  have  to  dwell  for  a 
moment  upon  the  action  of  the  ciliary  muscle,  which  is  a muscle 
closely  allied  in  its  anatomy  and  physiology  to  the  sphincter  muscles 
elsewhere  placed  in  the  economy.  We  do  this  because  the  intelli- 
gent management  of  such  parts  of  the  body  possessing  muscles  of 
this  class  is  a matter  of  great  importance.  All  Homoeopathists,  we 
use  the  term  advisedly,  at  once  see  in  this  a reference  to  a depart- 
ment of  surgery,  which  owes  its  existence  to  the  skill  of  a surgeon 
of  our  school  well  known  to  you  all.  We  value  the  orificial 
methods  because  they  deserve  it,  believing  them  to  be  therapeutic 
measures,  however,  that  depend  for  their  exercise  upon  an  exact 
knowledge  of  delicate  physiological  functions  that  few  possess,  and 
upon  a discrimination  and  judgment  with  which  few  are  endowed. 

The  promulgation  of  knowledge  of  the  influence  of  over-work 
of  the  ciliary  muscle  depends  upon  the  ophthalmologists,  and  unfor- 
tunately it  is  the  fashion  of  great  numbers  to  sneer  at  specialism,  and 
especially  at  the  specialist  who  puts  forth  a new  truth  he  knows,  and 
at  first  only  he  can  know. 

Refraction  work  is  becoming  of  more  and  more  importance,  and 
the  future  routine  work  of  the  specialist  will  be  largely  in  this  line. 
Do  we  exaggerate  when  we  state  that  the  more  common  complaints 
of  half  of  the  patients  that  apply  to  the  general  physician  are  of 
headache  and  digestive  disorders?  It  is  for  the  general  practitioner 
to  say  how  many  of  these  get  permanent  relief.  Do  we  not  know 
that  a large  proportion  of  women  hopelessly  suffer  from  these  com- 
plaints? Of  this  large  proportion  how  many  have  had  the  eyes  in- 
terrogated as  a possible  cause.  Do  you,  specialists,  not  know  of 
many  such  cases  permanently  relieved  by  the  correction  of  an  astig- 
matism, perhaps  compound  hyperopic,  and  unsymmetrical  at  that. 

Consult  the  current  literature  and  if  these  things  are  true  to  the 
extent  indicated,  may  not  the  general  standard  of  health  be  lowered  ? 

* “ Headache  and  Eye-Strain.”  By  Thomas  M.  Stewart,  M.D.,  Trans.  Homoeo- 
pathic Medical  Society  of  Ohio , 1891. 


THE  REFRACTION  OF  THE  EYE. 


389 


You  may  say  we  attribute  too  much  importance  to  eye-strain  and 
that  these  are  but  the  statements  of  another  enthusiast.  Stop  for 
one  moment  and  consider  the  statements.  Headache — disturbed 

function  of  the  organ  closely  related  to  vital  functions — and  dis- 
ordered digestion — nutrition  the  basic  function,  the  source  of  vital 
power — and  we  are  accused  of  over-valuation  of  the  prime  cause  of 
their  existence. 

For  many,  many  years  specialists  have  been  constantly  speaking 
of  eye-strain  due  to  faulty  refraction,  as  the  chief  causes  of  head- 
ache. Personal  inquiry  of  the  leading  specialists  in  Europe  but 
three  years  since,  showed  this  fact  to  be  almost  unsuspected,  very 
generally  disbelieved,  and  so  far  as  therapeutic  use  of  it,  unheard  of. 
Even  in  the  United  States  sufficient  has  not  yet  been  said. 

After  all  other  means  known  to  the  medical  profession  for  the  relief 
of  headache  have  failed  to  re-establish  functional  activity, refraction 
work  can  in  the  majority  of  cases  produce  such  startling  and  satis- 
factory results  as  to  be  a perpetual  surprise  even  to  those  familiar 
with  them.  As  regards  headache,  that  is  only  one-half  the  truth. 
We  have  seen  that  with  headache  there  is  also  nutritional  disturb- 
ance. The  influence  of  eye-strain  upon  the  general  system  will  not 
be  fully  realized  until  there  is  a general  recognition  that  such  dis- 
turbances of  the  general  health  as  we  have  mentioned  are  frequently 
due  directly  to  eye-strain.  Proof  of  this  is  ready  :*  Let  the  doubter 
put  on  a pair  of  lenses  fitted  to  a trial  frame,  such  as  every  oculist 
uses  every  day.  At  the  very  most,  but  a few  hours  will  elapse 
when  the  artificial  ametropia  in  this  manner  produced  will  bring  on 
headache,  and  not  only  nausea,  but  probably  vomiting.  Another 
test  suggested  in  the  article  above  referred  to  : Paralyze  the  accom- 
modation for  a week  or  ten  days  in  a young  patient  suffering 
from  suspected  ocular  reflex.  The  frequent  relief  will  be  an  objec:- 
lesson  in  differential  diagnosis. 

It  seems  well  nigh  impossible  to  become  sufficiently  familiar  with 
the  brilliant  and  far-reaching  effects  of  refraction  work  in  functional 
nervous  diseases,  to  entirely  escape  the  feeling  of  astonishment  at  the 
immediate  transformations  which  are  the  common  experience  of 
refraction ists.  When  a patient  has  suffered  from  sick-headache  for 
twenty  years  to  a distressing  degree,  to  see  entire  relief  quickly 


* The  Pulte  Quarterly , October,  1891. 


390 


world’s  homoeopathic  congress. 


obtained  from  a pair  of  spectacles,  will  always  astonish  one,  no 
matter  how  many  times  it  may  be  observed.  In  generally  impaired 
nutrition,  in  the  nervousness  of  neurasthenics,  we  may  have  the 
worst  result  of  eye-strain.  Even  in  health,  during  waking  hours 
the  eyes  are  never  at  rest.  The  muscles  of  the  eyeball  and  lens  de- 
mand innervation  at  least  sixteen  hours  daily.  Binocular  vision  is 
a very  complex  performance,  demanding  for  its  performance  on  the 
harmonious  co-operation  of  several  cerebral  centres.  The  second, 
third,  fourth  and  sixth  cranial,  and  the  sympathetic  nerves  are  con- 
stantly called  upon  to  furnish  the  nervous  force  for  this  important 
organ.  Now,  if  one  or  more  parts  of  this  system  be  defective,  an 
extra  strain  is  thrown  upon  the  other  parts.  The  organ  of  vision 
is  the  only  one  in  the  human  body  where  perfect  functional  activity 
depends  upon  exact  form.  This  is  by  reason  of  its  dependence 
upon  the  laws  of  refraction  of  light.  Many  questions  present 
themselves  at  this  point : the  correction  and  treatment  of  hyperopia, 
always  an  important  one;  the  full  correction  of  myopia,  and  its 
effect  on  the  eyes ; the  correction  of  astigmatism,  and  what  is  the 
best  means  to  this  end  ; the  value  of  the  0.25  D.  cylinder  in  head- 
ache and  eye-strain  ; amblyopia,  and  its  systematic  treatment  with 
gradual  increasing  lenses  ; muscular  insufficiencies,  and'their  relation 
to  errors  of  refraction,  and  a host  of  subjects  relative  to  refraction 
work.  But  as  the  central  idea  in  our  essay  thus  far  has  been  the 
discussion  of  principles,  we  may  find,  in  closing  with  some  reference 
to  the  reason  for  so  much  eye-trouble  in  modern  life,  sufficient  to 
cause  us  to  mend  our  methods  of  handling  refraction  cases  in  the  first 
instance,  and  many  questions  now  hotly  discussed  on  both  sides,  may 
lose  entirely  their  identity. 

With  Gould,  we  say:  reflection  upon  what  history  tells  us,  will 
show  that  up  to  the  present  century  the  clearest  possible  distant  vis- 
ion was  alone  demanded  of  the  human  eye.  The  progress  of  civ- 
ilization demanded  close  and  continued  use  of  the  eyes  at  the  near 
point,  due  to  the  wonderful  progress  in  the  art  of  printing,  to  the 
multiplication  of  schools  in  compliance  with  compulsory  educational 
laws,  and  the  close  application  demanded  of  the  commercial  man  of 
to-day. 

All  this  is  of  the  present  century ; in  the  midst  of  all  this,  what 
of  the  human  eye  ? An  organ  habituated  by  centuries  to  perform- 
ing certain  work,  cannot,  without  harm,  be  forced  in  an  hundred 


THE  REFRACTION  OF  THE  EYE. 


391 


years  to  a usage  exactly  opposite.  There  is  no  doubt  in  our  mind 
that  the  labor  to  which  the  eye  is  put  brings  ocular  congestion,  with 
consequent  variation  in  tension.  Furthermore,  this  is  certainly  of  some 
influence  in  producing  astigmatism,  the  factor  in  eye-strain.  Accurate 
vision  is  a necessity  in  this  day;  because  of  the  slavish  continuance 
of  long  ocular  and  physical  labor,  there  is  increased  demand  on  the 
ciliary  muscle  and  nerve  centres  supplying  the  eye,  and  as  a conse- 
quence the  manifold  reflex  and  local  ocular  disturbance. 

Any  physiologist  will  say  that  the  eye  is  an  organ  greatly  over- 
worked, an  organ  intimately  associated  with  every  mental  and  phys- 
ical act — its  adjustment  to  perform  its  various  functions  being  the 
perfection  of  delicacy.  In  the  light  of  all  this,  is  it  too  much  to 
lay  down  the  following:  that  every  child  should  have  his  eyes  ex- 
amined, to  detect  any  existing  abnormality  before  harm  is  done. 
And  at  this  point  comes  the  question,  how  shall  this  examination  be 
conducted  ? It  seems  to  me  that  the  changes  of  the  present  century, 
as  contrasted  with  the  preceding,  indicate  the  lines  along  which  the 
examination  should  be  conducted. 

It  is  needless  to  insist  upon  its  being  done  by  a trained  ophthal- 
mologist, with  the  help  of  mydriatics.  The  refraction  to  be  worked 
out  with  the  trial  lenses  to  within  a quarter  of  a dioptre,  and  that 
care  be  taken  to  examine  the  optician’s  work  in  the  quality  and  the 
centering  of  the  lenses,  and  in  the  adjustment  of  the  frame. 

Discussion. 

Charles  H.  IIelfrich,  M.D. : The  doctor  says  that  ITydro- 
bromate  of  hyoscyamine  is  in  his  opinion  the  best  mydriatic  for 
general  use.  Personally  I think  its  use  ought  to  be  so  restricted 
that  it  should  never  be  used  in  people  over  thirty-five  years  of  age. 

The  alarming  symptoms  it  frequently  produces  in  people  above 
that  age,  such  as  partial  paresis,  vertigo,  heart  failure  and  delirium, 
should  teach  us  to  be  rather  cautious  in  its  use. 

As  it  produces  rapid  and  complete  paralysis  of  the  accommodation 
and  its  effects  pass  off  usually  in  about  three  days,  it  is  a favorite  my- 
driatic, but  I have  been  taught  by  some  very  unpleasant  experi- 
ences to  select  my  cases. 

It  is  my  practice  to  drop  it  in  the  outer  canthus  while  the  patient 
tilts  the  head  toward  the  side  of  the  eye  being  thus  instilled,  and  to 
immediately  dry  it  with  a piece  of  soft  linen. 

In  this  way  I have  had  less  ill  effects  than  when  dropped  on  the 
upper  surface  of  the  cornea  as  the  doctor  directs. 


392 


world’s  homceopathic  congress. 


He  speaks  of  the  beneficial  results  obtained  from  using  mydriatics, 
by  not  only  putting  the  eye  completely  at  rest  but  on  account  of 
their  sedative  action  also. 

My  experience  has  taught  me  that  this  is  of  the  greatest  impor- 
tance, and  is  not  secondary  even  to  the  difference  in  results  obtained 
between  the  tests  with  and  without  their  use.  A large  number  of 
cases  of  simple  and  compound  hyperopic  astigmatism,  tested  under 
the  influence  of  mydriatics,  do  not  differ  sensibly  from  the  test  with- 
out. By  this  I mean  the  axis  and  the  strength  of  the  cylinder  re- 
mains unchanged,  and  we  have  added  only  the  latent  hyperopic  which 
was  expected,  of  course. 

In  simple  and  compound  myopic  astigmatism  also  it  is  not  un- 
common to  get  exactly  the  same  test  under  the  influence  as  before, 
yet  a great  many  of  these  very  cases  cannot  tolerate  the  correction 
at  first.  Then  spasm  is  suspected  and  mydriatics  used.  Finally  we 
arrive  at  practically  the  same  glass  we  found  at  first,  and  the  patient 
is  able  to  wear  it  with  the  greatest  comfort. 

The  ophthalmometer  is  gradually  sinking  to  the  level  of  the  proper 
sphere  of  its  usefulness. 

Giving  corneal  measurements  only,  it  does  not  embrace  the  changes 
produced  by  astigmatism  residing  in  the  lens. 

As  is  well  known,  lenticular  astigmatism  may  just  neutralize  the 
corneal  astigmatism,  or  it  may  augment  it,  or  even  reverse  its  char- 
acter entirely. 

It  can  hardly  be  considered  as  being  more  useful  than  a check 
upon  subjective  methods,  or,  perhaps  better,  an  aid. 

After  all,  how  much  need  has  a competent  man  of  anything  besides 
the  ordinary  subjective  methods  and  the  ophthalmoscope? 

The  use  of  other  appliances  are  invariably  followed  by  the  sub- 
jective tests  also,  and  decision  is  given  to  the  results  of  the  latter. 

In  refractory  children  who  are  determined  not  to  wear  glasses,  and 
in  people  who  are  too  illiterate  to  read  letters  or  figures,  these  auxiliary 
methods  are  sometimes  of  great  assistance. 

From  the  scanty  mention  made  of  muscular  insufficiencies,  I infer 
the  doctor  relies  upon  the  careful  and  minute  correction  of  the  refrac- 
tive error  to  relieve  eye-strain  and  its  chain  of  allied  disorders  rather 
than  exercise  of  the  weakened  muscles  or  correction  by  prisms  or 
tenotomies. 

Those  enthusiasts  who  are  being  called  upon  to  advance  some  of 
the  muscles  they  set  back  several  years  ago,  are  learning  to  place  the 
operation  where  it  properly  belongs.  While  it  has  proven  a boon 
to  a large  number  of  sufferers  it  has  produced  a quota  of  its  own. 
Moderation  is  becoming  the  order  of  the  day. 

D.  A.  MacLachlan,  M.D. : There  is  much  to  commend  in  Dr. 
Stewart’s  admirable  paper,  and  I cannot  do  better,  perhaps,  than  to 
enlarge  somewhat  upon  thoughts  which  he  has  not  discussed  at 


THE  REFRACTION  OF  THE  EYE. 


393 


length.  We  all  differ,  however,  in  our  methods  of  thought  and  ac- 
tion, and  we  often  get  mutual  good  in  comparing  ideas  and  methods. 
Very  frequently  our  differences  are  not  due  solely  to  native  peculi- 
arities, but  to  early  instruction,  surrounding  circumstances  and  op- 
portunities, the  kind  of  patients  we  have  to  treat,  etc. 

I am  not  in  the  habit  of  relying  upon  the  ophthalmoscope  in  de- 
termining refractive  errors.  In  fact,  I seldom  rely  upon  any  one 
method  ; and  even  after  verifying  one  test  by  another,  and  another, 
and  accurately  measuring  the. refraction,  it  has  been  my  experience 
that  a large  amount  of  judgment  must  be  exercised  in  prescribing 
lenses.  We  find,  as  we  do  in  prescribing  remedies,  that  each  person 
is  an  individual  having  native  and  acquired  peculiarities  which  must 
be  taken  into  account  in  our  endeavor  to  relieve  his  complaint. 

We  all  believe  in  the  necessity  of  mydriatics  to  determine  refrac- 
tion accurately,  and  we  are  all  indebted  to  Dr.  Stewart  for  giving  us 
the  results  of  his  careful  and  thorough  investigation  as  to  the  relative 
value  of  the  various  drugs  in  use.  My  own  preference  is  for  hotna- 
tropine,  chiefly  because  accommodation  is  so  soon  recovered  after  its 
use.  For  years  I have  used  a preparation  comprised  of  homatro- 
pine  (the  alkaloid)  and  cocaine,  of  each  10  grains  and  castor  oil  1 
ounce.  It  acts  much  more  profoundly  than  the  aqueous  preparation 
of  the  hydrobromate,  which  is  insoluble  in  castor  oil.  The  oil  is  not 
as  pleasant  to  use  as  water,  but  the  very  sticking  to  the  lids,  which 
is  the  unpleasant  feature,  causes  it  to  be  retained  longer  in  the  con- 
junctival sac,  and  thus  renders  the  drug-effects  more  profound.  I 
have  rarely  found  the  use  of  any  other  mydriatic  necessary.  When 
relaxation  is  desired  for  a length  of  time,  I have  used  atropine  or 
hyoscyamine  from  the  start.  One  drop  of  the  homatropine  prepa- 
ration usually  produces  complete  relaxation  in  from  twenty  to  thirty 
minutes,  which  lasts  about  twelve  hours.  The  eyes  should  be  kept 
closed  until  the  examination  begins,  to  avoid  the  slight  corneal  film 
arising  from  the  cocaine.  A four-grain  solution  of  eserine,  which  I 
use  in  oil  also,  restores  accommodation  in  a few  hours. 

As  my  patients  are  largely  students,  who  must  use  their  eyes  again 
within  a few  hours  at  most,  I am  obliged  to  use  something  very 
transient  in  its  effects.  The  mydriatic  being  so  unobjectionable  I 
use  it  in  almost  every  case,  and  almost  always  associate  examination 
of  the  fundus  at  the  same  time,  so  as  to  learn  the  exact  condition  for 
record  and  possible  future  reference. 

Retinoscopy  is  a favorite  method  with  me  also,  especially  in  ex- 
amining children,  or  unintelligent  patients,  and  in  bad  cases  of  astig- 
matism; I find  it  a great  saving  of  time  in  many  instances,  and  the 
greatest  possible  help  when  other  methods  can  hardly  be  used  at  all. 

The  question  of  eye-strain  is  of  such  peculiar  interest  that  I can- 
not refrain  from  saying  a word  upon  the  subject.  That  it  is  of  the 
highest  importance  no  one  doubts.  So  much  has  been  said  concern- 


394 


world’s  homoeopathic  congress. 


ing  it  that  specialists  are  frequently  accused  of  making  a “fad”  of 
it.  While  I recognize  that  it  is  a very  great  factor  in  producing 
numerous  and  varied  disorders,  I must  be  classed,  I think,  among 
the  conservatives. 

Doubtless,  over-use  of  the  eyes,  more  than  any  one  thing,  makes  it 
necessary  for  patients  to  put  on  glasses.  General  enervating  influ- 
ences, however,  in  most  cases,  make  ordinary  use  of  the  eyes  over- 
use. The  student  who  reads  long  and  late,  at  the  same  time  deprives 
himself  of  necessary  exercise  and  fresh  air,  and  in  the  majority  of 
persons  there  can  be  but  one  result,  viz.,  loss  of  vigor  and  that  physi- 
cal well-being  which  we  call  “ tone.”  Now,  he  becomes  “bilious,” 
and  ordinary  use  of  the  eyes  becomes  over-use,  while  his  study  must 
be  kept  up,  and  so  he  goes  from  bad  to  worse.  Glasses,  like  crutches 
to  the  lame  man,  will  tide  him  over  until  he  can  resume  his  hygienic 
habits  and  thus  regain  lost  strength,  after  which  his  glasses  may  pos- 
sibly be  discarded. 

A somewhat  extended  experience  in  general  practice  making  me 
acquainted  with  the  many  localized  conditions  which  induce  systemic 
derangements  has  made  me  less  hasty  in  ascribing  headache,  dys- 
pepsia, etc.,  to  eye-strain.  A goodly  number  of  nervous  disorders 
are  undoubtedly  due  solely  to  refractive  errors,  but  by  far  the  larger 
proportion  are  due  to  lowering  of  general  tone  and  vigor  in  the  first 
place.  When  this  has  occurred,  an  accommodative  or  muscular  effort 
that  had  formerly  been  made  with  ease  now  becomes  difficult  and 
painful.  How  often  do  we  see  patients  who  have  for  thirty  or  forty 
years  had  the  most  perfect  health  with  never  a suspicion  that  there 
was  anything  abnormal  about  their  eyes,  following  an  illness,  find 
themselves  unable  to  read  or  use  the  eyes  without  serious  trouble, 
which  nothing  but  glasses  would  relieve.  Perfect  recovery  from  the 
spell  of  sickness  may  have  taken  place  in  every  part  but  the  eyes. 
There  the  natural  defect  which  previously  required  no  conscious 
effort  to  compensate  for,  now  must  be  corrected. 

My  own  case  is  a fair  example  of  this.  I require  a lens  of  -f-  .25  D.  S. 
E.  -f-  .25  cy.  ax.  90,  for  each  eye  for  reading  only.  Up  to  30  years  of 
age  I had  subjected  my  eyes  to  the  hardest  kind  of  use  without  ever 
experiencing  the  slightest  difficulty,  although  I had,  more  than  once, 
suffered  from  severe  illness — in  one  instance,  from  malaria  lasting 
two  or  three  years.  During  one  winter,  I became  greatly  reduced  in 
strength  by  overwork,  while  at  the  same  time  my  eyes  were  unduly 
exposed  to  sun  and  snow.  From  that  time  I have  suffered  more  or 
less  constantly  from  eye-strain.  Several  leading  American  and  Euro- 
pean oculists  have  prescribed  for  me  both  simple  and  compound 
lenses,  including  prisms,  but  nothing  gives  me  more  than  partial  re- 
lief. When  I am  in  the  best  possible  physical  condition  I have  the 
least  difficulty,  and  vice  versa. 

It  would  seem  to  me  very  far-fetched,  indeed,  to  attribute  my  ocu- 


THE  REFRACTION  OF  THE  EYE. 


395 


lar  disability  to  refractive  error.  It  was  not  a factor  at  all,  until 
my  general  vigor  was  impaired,  and  is  now  proportionatply  lessened 
or  increased  by  improvement  or  loss  in  my  physical  condition. 

I sometimes  think  that  weakness  of  the  ocular  muscles  has  more 
to  do  in  producing  eye-strain  than  do  errors  of  refraction.  And  yet, 
how  often  we  find  a refractive  error  deranging  the  ocular  muscles. 
I recall  the  case  of  a vigorous  man  of  about  25  years,  a farmer,  who 
had  very  bad  convergent  strabismus.  He  was  perfectly  healthy,  and 
suffered  no  inconvenience  except  constant  and  somewhat  annoying 
diplopia.  He  brought  his  child  to  me  for  operation.  1 noticed  his 
own  crossed  eyes,  and  examination  showed  a manifest  hypermetro- 
pia  of  about  1 H.  in  both  eyes.  Relaxation  revealed  a total  of  about 
4 D.  Thinking  it  would  be  an  interesting  experiment  to  try  the 
effect  of  the  correcting  lenses  upon  the  strabismus,  I fitted  him  with 
glasses,  with  the  result  of  completely  straightening  the  eyes. 

In  this  case,  the  refractive  error  caused  spasm  of  both  the  ciliary 
and  internal  rectus  muscles,  and  was,  moreover,  the  sole  cause  of  the 
trouble.  Such  striking  instances,  however,  are  comparatively  rare. 
In  the  vast  majority  of  cases,  the  cause  of  the  ocular  difficulty  is  a 
mixed  one,  depending,  first,  upon  a predisposing  cause,  such  as  ill 
health  or  reduced  vigor;  and  second,  upon  an  exciting  cause,  such 
as  a refractive  error,  or  a lack  of  balance,  or  co-ordination  of  the 
ocular  muscle.  In  my  own  experience,  eye-strain  is  rarely  the  cause 
of  such  remote  troubles  as  dyspepsia,  etc.;  my  own  observation  would 
lead  me  to  think  that  the  effects  of  eye-strain  are  limited  to  disor- 
ders of  the  head,  with  a few  secondary  reflex  disturbances  of  more 
distant  parts. 

It  is  true,  that  putting  strong  glasses  over  normal  eyes  will  in- 
duce prompt  nervous  disturbances;  but,  it  also  is  true,  that  eyes 
which  have  been  accustomed  to  abnormal  refraction  from  birth  ex- 
perience a surprising  degree  of  comfort  and  good  vision.  So  recon- 
ciled do  they  become  to  the  effort  required  to  compensate  for  their 
ocular  defect,  that,  frequently,  they  will  not  tolerate  correcting- 
glasses — it  has  become  “a  second  nature.” 

I most  heartily  endorse  Hr.  Stewart’s  suggestion  that  all  chil- 
dren’s eyes  should  be  examined.  If  there  is  a sufficient  error  to 
require  correction,  it  can  scarcely  be  done  too  early.  Squint,  am- 
blyopia, exanopsia,  and  other  conditions  dependent  directly  or  indi- 
rectly upon  abnormal  refraction  may  be  averted.  The  ultimate  form, 
mind,  and  disposition  of  such  a child  may  be  greatly  improved  also, 
by  proper  glasses. 

The  paramount  importance  of  this  subject  makes  it  more  desira- 
ble that  we,  as  specialists,  should  be  fully  conversant  with  the  sub- 
ject, and  that  we  should  treat  it  in  a simple,  scientific  way.  I mean 
by  that,  that  we  should  be  careful  not  to  attribute  to  eye-strain  more 
of  the  ills  of  humanity  than  properly  belong  to  it.  We  often  blame 


396 


world’s  HOMCEOPATHTO  CONGRESS. 


the  general  practitioner  because  he  seems  to  attach  little,  if  any, 
importance  to  eye-strain  as  a factor  in  disease,  but  I sometimes 
think  he  is  driven  to  assume  this  indifference  to  it  by  the  extrava- 
gant claims  of  some  specialists,  who  would  have  us  believe  that 
nearly  all  disease  is  due  to  refractive  errors  and  allied  disturbances 
in  the  eyes. 

Myron  H.  Chamberlain,  M.D.,  Council  Bluffs,  la. : I think  I 
understand  the  doctor  to  say  that  refractive  powers  should  be  cor- 
rected in  troublesome  cases,  especially  up  to  one-quarter  dioptre. 
Perhaps  it  was  difficult  for  me  to  hear  him,  but  I know  a great 
many  cases  where  I have  found  that  refractive  troubles  of  only  one- 
quartre  dioptre,  especially  astigmatic,  have  given  a great  deal  of 
trouble,  and  a correction  of  this  has  been  very  satisfactory  to  the 
patient.  I would  like  to  know  the  attitude  of  the  profession  on  that 
point  because  I have  so  many  of  that  kind  of  eases,  and  have  got 
such  relief  from  them  (especially  from  those  who  are  in  the  habit  of 
complaining  of  eye-strain)  by  correcting  one-quarter  dioptre  of 
astigmatism. 

Harold  Wilson,  M.D. : I think  I understand  Dr.  Stewart  to 
imply  that  he  would  prescribe  glasses  for  children  at  as  early  an  age 
as  they  could  wear  them,  and  which  may  be,  perhaps,  anywhere  from 
two  and  a half  years  up. 

Now  I wish  to  enter  my  protest  against  prescribing  glasses  for 
children  when  it  is  not  necessary.  It  is  very  well  known  that  the 
refraction  of  the  eye  undergoes  a modification  from  childhood  to 
adult  life.  The  normal  condition  of  the  child’s  eye  is  hypermetro- 
pic. Now  why  should  we  prescribe  glasses  for  hypermetrophy  in 
children  simply  because  we  have  found  that  such  a state  of  refrac- 
tion exists,  when  we  know  that  hypermetrophy  may  become  obliter- 
ated by  the  natural  process  of  growth  ? If  we  put  our  glasses  on, 
we  destroy  the  natural  growth  of  the  eye.  If  there  are  not  sufficient 
reasons  for  doing  so,  I,  for  one,  enter  my  protest  against  burdening 
children.  This  same  feature  applies  also  to  adults;  for  in  a great 
many  cases  it  is  often  possible  to  avoid  the  use  of  glasses  altogether 
by  proper  treatment  of  the  patient  himself  or  of  the  eyes  themselves. 
There  is  one  method  of  examining  the  eye  to  which  I do  not  think 
Dr.  Stewart  referred  (though  I think  I did  not  correctly  hear  all  of 
his  paper),  and  that  is  the  shadow  test  for  determining  the  refraction. 
In  my  experience,  and  in  my  judgment,  we  have  in  the  shadow  test 
one  of  the  most  accurate,  most  rapid  and  most  satisfactory  methods 
of  making  the  examination.  To  any  members  of  this  section  who 
have  not  enjoyed  this  method  I most  heartily  recommend  it.  It  is 
very  accurate  in  the  determination  of  small  degrees  of  astigmatism 
where  we  are  perhaps  more  anxious  to  obtain  accuracy. 

Dr.  Linnell:  There  were  two  points  in  Dr.  Stewart’s  paper 
which  I do  not  clearly  understand.  I would  like  to  ask  the  doctor 


THE  REFRACTION  OF  THE  EYE. 


397 


the  question,  in  the  first  place,  as  to  the  strength  of  the  Hyoscya- 
mine  solution  ; and  whether  he  uses  the  same  Hyoscyamine  or  a 
solution.  I understand  the  doctor  to  say  that  he  uses  the  Hyos- 
cyamine solution  alone. 

E.  Elmer  Keeler,  M.D.,  of  Syracuse:  It  is  with  more  than 
pleasing  attention  that  I have  listened  to  the  paper  of  Dr,  Stewart 
and  the  discussion  thus  far,  and  I am  sure  that  the  members  will 
agree  with  me  when  I say  it  is  a question  of  vital  importance  to  our 
patients,  and  if  there  be  a drug  that  we  may  use  with  universal  sat- 
isfaction, I,  for  one,  will  be  very  glad  to  use  it  in  place  of  Atropine. 
But  in  the  remarks  that  have  been  so  far  made  they  show  that  gen- 
erally where  the  results  would  be  satisfactory,  it  is  claimed  it  is 
made  from  these  other  mydriatics,  and  if  so,  it  leaves  us  in  a faulty 
position.  I have  given  all  the  various  mydriatics  a thorough  trial 
in  my  practice,  and  must  say  that  I have  discarded  them  for  the  old 
stand-by.  That  point  I would  like  to  have  some  one  emphasize 
emphatically — if  it  can  be  made  a universal  and  successful  drug — 
any  one  of  these  mydriatics. 

Wm.  R.  King,  M.D  : I have  very  few  remarks  to  make.  In 
the  first  place,  the  subject  of  the  correction  of  the  low  degrees,  as 
spoken  of  by  Dr.  Chamberlain,  to  my  mind,  is  the  most  important, 
or,  at  least,  we  get  our  best  results  in  reflex  neurosis,  as  a result  of 
refractive  errors.  That  has  been  my  experience.  In  cases  where 
we  have  a more  or  less  high  degree  of  refractive  error,  whether  it 
be  hyperopia  or  astigmatism,  there  are  describable  symptoms  ascrib- 
able  to  the  eye.  This  neurosis  is  ascribable  to  more  distinct,  and 
often  overlooked,  degrees  of  astigmatism  as  low  as  one-quarter  diop- 
tre. The  correction  of  low  degrees  has  often  relieved  symptoms  that 
have  entirely  baffled  remedies  and  hygienic  treatment  of  other  physi- 
cians and  those  who  are  not  examining  and  looking  to  the  eye  for 
causes;  and  I think,  for  that  reason,  they  give  us,  perhaps,  the  most 
unsatisfactory  results  in  the  correction  of  those  low  degrees. 

With  reference  to  mydriatics,  I may  say  that  I never,  or  almost 
never,  use  them.  I am  satisfied  with  my  results  without  mydri- 
atics, and  my  patients  seem  to  be  satisfied  with  them,  and,  conse- 
quently, I very  rarely  use  them  unless  I have  a case  of  very  severe 
ciliary  spasm  to  deal  with.  I find  the  necessity  for  mydriatics  be- 
coming less  frequent  wherever  I have  been.  The  only  mydriatic 
that  I have  used  to  any  great  extent  has  been*  the  old  reliable  Atro- 
pia.  The  Hydrobromate  of  bromium  I have  used  several  times.  I 
cannot  say  that  it  has  been  of  more  advantage  from  the  fact  that  its 
effect  sooner  passes  away.  We  get,  of  course,  absolute  correction 
with  mydriatics  of  the  absolute  amount  of  error,  but  it  is  not  always 
the  correction  that  is  of  most  practical  value  to  the  patient. 

Dr.  Stewart,  in  closing  the  discussion,  said:  There  are  two 
things  in  the  paper  I did  not  do.  In  the  first  place  I did  not  try  to 


398 


world’s  homoeopathic  congress. 


cover  all  the  ground,  and  for  two  reasons.  In  the  first  place  I was 
not  capable  of  doing  it,  and  if  I could  have  done  it,  it  would  not 
have  left  any  room  for  discussion.  In  regard  to  the  gentleman  that 
speaks  of  one-quarter  dioptre  of  refraction,  let  me  say  that  you 
should  examine  for  errors  of  refraction  and  correct  up  to  one-quarter 
of  a dioptre.  One  question  I put  very  particularly  was  the  value  of 
the  twenty- five  dioptre  cylinder  in  the  refractive  work.  In  regard 
to  children  in  the  prescribing  of  glasses,  to  which  Dr.  Wilson  re- 
ferred, the  statement  was  not  to  put  on  the  glasses,  but  it  was  to  ex- 
amine the  eyes,  and  then,  if  necessary,  use  your  glasses.  The  word 
“ necessary  ” covers  a good  deal  of  ground.  Of  course,  that  should 
be  left  to  the  judgment  of  the  physician,  and  it  depends  upon  a great 
deal.  To  have  gone  into  the  question  in  detail,  that  would  have 
been  to  diverge,  so  I underlined  the  word  “ necessary.”  I avoided 
the  subject  of  muscular  insufficiencies  for  a very  good  reason.  In 
the  first  place,  it  is  in  the  hands  of  a gentleman  that  is  just  as  capa- 
ble of  handling  it  as  anybody  I know  in  the  American  Institute  in 
this  section.  It  has  been  brought  up,  and  I want  to  say  that  I have 
frequently  found  cases  where  there  were  no  errors  of  refraction,  and 
in  which  I did  find  muscular  insufficiences,  and  of  course  I did  not 
ignore  the  use  of  the  prism.  Regarding  retinoscopy,  I regard  it 
very  highly,  and  I drew  some  close  remarks  regarding  that  and  the 
ophthalmometer;  but  in  my  endeavor  to  get  some  other  points  in 
the  paper  I avoided  that  point ; but  it  is  in  the  paper,  and  the 
Transactions  will  perhaps  show  my  standing  upon  that  question. 
Regarding  the  question  of  Hyoscyamine  and  its  strength,  1 to  100 
has  been  the  strength  I have  been  using,  and  it  has  been  the  pure 
white  crystals. 


OPHTHALMIC  SURGERY. 


399 


OPHTHALMIC  SURGERY. 

By  Elmer  J.  Bi^sell,  M.D.,  Kochester,  N.  Y. 


Medical  history  records  no  more  rapid  and  marvellous  advance- 
ment than  has  characterized  ophthalmology  in  the  past  quarter  of 
a century.  During  this  brief  period,  spanned  even  by  the  profes- 
sional career  of  some  who  listen  to  me  to-day,  there  has  gradually 
developed  a science  which  excels  in  its  perfection  and  exactness 
that  of  any  other  department  of  medicine.  From  a dark  and  un- 
explored chamber  the  eye  has  been  transformed  into  a ball  of  light, 
revealing  not  only  what  is  within  its  narrow  bounds,  but,  like  a 
mirror,  much  that  lies  outside  it.  So  vast  and  important  has  become 
the  consideration  of  abnormalities  affecting  the  visual  apparatus, 
and  so  wonderful,  yet  still  imperfect,  our  facilities  for  detecting  and 
overcoming  these,  that  when  I was  asked  to  present  to  this  Congress 
a paper  upon  ophthalmic  surgery  and  to  cover  as  much  of  the  field 
as  possible,  although  less  than  one-tenth  of  the  oculist’s  work  is 
strictly  surgical,  I thought  that  volumes  could  not  do  it  justice.  I 
shall  therefore  endeavor  to  bring  before  you  not  only  that  which  is 
newest,  but  that  which  is  most  practical.  There  are  endless  unique 
operations  for  rare  and  complicated  cases,  but  they  must  of  necessity 
be  passed  by,  and  only  those  surgical  procedures  be  presented  which 
will  most  frequently  tax  our  thought  and  skill.  By  thus  limiting 
the  scope  of  this  paper,  I hope  to  elicit  a more  general  and  definite 
discussion. 

Aside  from  a better  understanding  of  the  anatomy  and  physiology 
of  the  eye  and  an  improved  technique  in  many  operations,  three 
elements — perfected  instruments,  local  anaesthesia  by  cocaine,  and 
absolute  cleanliness  secured  either  by  simple  irrigation  or  antiseptic 
agents — contribute  largely  toward  accomplishing  better  surgical 
results  than  formerly. 

Great  improvement  has  been  made  in  the  character  and  quality 
of  our  instruments.  I think  we  are  under  obligation  to  the  manu- 


400 


world’s  homoeopathic  congress. 


facturers  for  furnishing  us  such  delicate  instruments,  perfect  in  ad- 
justment and  yet  easily  rendered  aseptic. 

A wonderful  boon  came  to  ophthalmic  surgery  in  the  introduc- 
tion of  cocaine.  By  it  we  not  only  are  enabled  to  secure  anaesthesia 
limited  to  the  parts  to  be  operated  upon,  but  other  quite  as  desirable 
and  important  effects.  I refer  particularly  to  its  power  to  contract 
the  bloodvessels,  so  that  less  haemorrhage  obscures  our  work  during 
such  operations  as  tenotomy  or  advancement  for  strabismus  ; and  to 
its  action  in  producing  hypotony,  a certain  degree  of  which  is  a great 
factor  in  the  extraction  of  cataract.  I think  more  attention  should 
be  given  to  this  latter  point,  because  by  a careless  and  unscientific 
use  of  cocaine  an  unnecessary  element  of  danger  is  artificially  in- 
duced in  operations  involving  the  opening  of  the  eyeball.  My  rule 
has  been  to  apply  a 2 per  cent,  solution  three  or  four  times  during 
eight  minutes  in  cases  where  there  was  a strong  probability  that  an 
iridectomy  would  be  unnecessary,  care  being  taken  that  the  lids 
are  kept  closed  during  cocainization  so  as  to  prevent  dryness  of  the 
cornea.  This  strength  I have  found  to  pfoduce  sufficient  ansesthesia 
and  a degree  of  hypotony  which  favors  the  delivery  of  the  lens  in 
cataract  extraction,  and  at  the  same  time  aids  in  preventing  prolapse 
of  the  iris.  In  fact,  it  is  this  action  on  the  part  of  cocaine  which 
has  done  much  to  make  simple  extraction  possible  in  so  many  cases. 
With  a 2 per  cent,  solution  I also  believe  that  a smoother  incision 
can  be  made,  and  the  healing  process  goes  on  more  rapidly  and  per- 
fectly because  the  epithelium  of  the  cornea  is  less  affected  than  when 
stronger  solutions  are  applied.  On  the  other  hand,  if  there  are  in- 
dications that  an  iridectomy  will  be  necessary,  or  if  there  is  a slightly 
increased  tension,  I employ  a 4 per  cent,  solution  and  prolong  its 
action  to  ten  minutes.  In  operation  upon  the  lids  or  external  ocular 
muscles  I use  this  same  strength.  By  thus  individualizing,  we  can 
make  cocaine  serve  a double  purpose. 

The  third  factor  in  the  general  consideration  of  ophthalmic  sur- 
gery is  antisepsis.  The  great  fact  to  keep  before  us  is,  that  the  end 
to  be  attained  is  absolute  cleanliness , and  I have  no  hesitation  in 
saying  that  if  this  can  be  secured  and  maintained  without  the  use 
of  chemical  germicidal  agents,  it  is  much  the  superior  method,  but 
I do  not  believe  this  possible  under  all  circumstances.  If  the  truth 
could  be  known  I doubt  not  that  many  major  operations  are  suc- 
cessfully performed  when  only  ordinary,  I may  say  partial  cleanli- 


OPHTHALMIC  SURGERY. 


401 


ness  has  been  accomplished  and  not  the  theoretical,  scientific,  absolute 
cleanliness  which  we  talk  so  much  about.  Possibly  there  is  a 
practical  surgical  cleanliness  which  is  not  synonymous  with  absolute 
surgical  cleanliness.  However,  as  long  as  we  cannot  tell  what  point 
less  than  perfect  cleanliness  is  safe  and  practical,  we  must  diligently 
strive  after  the  ideal.  The  fact  to  be  emphasizied  is  that  in  our 
enthusiasm  to  secure  a state  of  perfect  antisepsis,  we  avoid  employ- 
ing methods  or  agents  irritating  to  the  eye,  which  indirectly  may  do 
more  harm  than  good.  Very  careful  discrimination  is  necessary. 
The  efficiency  of  an  antiseptic  agent  is  not  simply  its  power  to  destroy 
micro-organisms,  but  to  accomplish  it  quickly.  Many  of  the  drugs 
which  possess  truly  antiseptic  properties  are  irritating  to  the  eye 
when  used  in  sufficient  quantity  to  be  effective,  and  the  question 
resolves  itself  into  this,  whether  the  dangers  are  greater  in  trying  to 
secure  cleanliness  by  simple  irrigation  and  possibly  failure  to  ac- 
complish the  high  ideal,  or  by  using  active  germicidal  agents  which 
probably  prove  thoroughly  effective,  but  in  many  cases  cause  some 
irritation  which  may  mar  the  result  of  the  operation.  This  cannot 
be  satisfactorily  answered  without  going  somewhat  into  detail  and 
bringing  before  us  a few  recent  experiments.  The  list  of  anti- 
septic drugs  which  are  being  used  in  eye  surgery  is  quite  long — Car- 
bolic acid,  Peroxide  of  hydrogen,  Pyoktannin,  Chlorine  water,  Boro- 
glyceride,  Boracic  acid,  the  Biniodide  and  Bichloride  of  mercury.. 
Some  of  these  are  too  irritating,  others  act  too  slowly,  and  Boracic 
acid  has  been  shown  to  possess  no  germicidal  properties,  although  it 
is  employed  as  much  as  any  one  drug  named.  I use  it  very  fre- 
quently myself  as  a means  to  increase  the  specific  gravity  of  liquids 
used  about  the  eye.  If  it  serves  no  other  purpose  than  raising  the 
specific  gravity  and  thus  preventing  osmosis,  it  accomplishes  great 
good.  The  most  effective  and  at  the  same  time  the  safest  germicide 
is  the  Bichloride  of  mercury.  In  strengths  varying  from  one  to  five 
thousand  to  one  to  fifteen  thousand,  it  quickly  destroys  micro- 
organisms, but  when  the  anterior  chamber  is  opened,  there  is  a pos- 
sibility of  its  inducing  striped  keratitis,  resulting  in  permanent 
opacity  of  the  cornea.  The  experiments  of  Carl  Mellinger  go  to 
prove  the  following  facts; 

First. — That  a solution  of  corrosive  sublimate,  1 to  5000,  and 
even  1 to  15,000,  if  present  in  the  anterior  chamber  for  any  con- 
siderable length  of  time,  will  cause  permanent  opacity  of  the  cornea. 

26 


402 


world’s  homceopathic  congress. 


Second. — That  cocaine  alone  produces  no  corneal  opacity,  but 
that  its  presence  within  the  anterior  chamber  increases  the  effect 
of  the  sublimate  solution  by  making  the  endothelium  more  perme- 
able. Its  use,  also,  by  lowering  the  tension,  favors  the  retaining  of 
these  solutions  within  the  eyeball. 

Third. — That  a 3 per  cent,  solution  of  boracic  acid  or  a one-half 
per  cent,  solution  of  sodium  chloride  can  be  injected  into  the  ante- 
rior chamber  without  any  unpleasant  results. 

My  plan  of  preparing  my  instruments  and  patients  for  all  major 
operations  is  as  follows  : All  instruments  are  placed  in  boiling  wa- 
ter, to  which  one-third  alcohol  is  added.  They  are  allowed  to 
remain  a few  minute,  then  dried  and  transferred  to  an  Arnold’s 
sterilizer,  in  which  also  I place  all  solutions  to  be  used  about  the 
eye  either  during  or  after  the  operation.  The  various  solutions  of 
cocaine,  atropine,  eserine,  boracic  acid,  etc.,  are  in  bottles  corked 
with  absorbent  cotton,  and  these,  with  the  instruments,  are  subjected 
to  sterilization  for  one  hour.  The  instruments  are  then  placed  in 
antiseptic  absorbent  cotton,  and  the  bottles  containing  the  liquids 
are  not  uncorked  until  necessity  requires  it.  I could  never  under- 
stand the  reasonableness  of  a surgeon  being  so  very  particular 
about  his  instruments,  and  at  the  same  time  (as  I have  seen  done) 
employ  solutions  of  cocaine  or  atropine  made  up  simply  with  dis- 
tilled water,  and  placed  in  bottles  probably  not  chemically  clean. 
Such -solutions  I do  not  believe  are  sterile,  and  therefore  safe  to  use. 
4n  the  preparation  of  my  patient,  I have  the  parts  about  the  eye 
washed  with  soap  and  water,  and  in  the  cleansing  of  the  lid-margins 
and  conjunctival  folds  I make  the  following  discrimination  : if  there 
are  any  unhealthy  secretions,  such  as  occur  in  blepharitis,  conjunc- 
tivitis, or  dacryocystitis,  I employ  the  bichloride  of  mercury,  1 to 
5000.  Special  attention  should  be  given  to  the  cleansing  of  the 
cilia  and  lachrymal  sac.  I have  never  found  it  necessary  to  adopt 
the  plan  of  closing  the  punata  by  the  cautery,  or  to  employ  Pag- 
enstecher’s  method  of  slitting  the  canaliculus,  and  packing  with 
iodoform  cotton. 

On  the  other  hand,  if  there  are  no  unhealthy  secretions,  I see  no 
necessity  of  using  a germicide,  which  is  irritating  to  some  eyes,  but 
trust  entirely  to  thorough  irrigation  with  a 2 per  cent,  sterile  boracic 
acid  solution,  before,  during,  and  after  the  operation.  I employ  the 
boracic  acid,  not  because  I believe  it  possesses  any  special  germicidal 


OPHTHALMIC  SURGERY. 


403 


properties,  but  (as  I have  stated  before)  to  increase  the  specific  gravity 
of  the  liquid.  I hold  this  to  be  an  important  point,  if  solutions 
are  to  be  injected  into  the  anterior  chamber.  The  above  plan  of 
antiseptic  surgery  has  given  me  highly  satisfactory  results.  Suppu- 
ration has  been  a thing  almost  unknown,  and  has  never  been  of  a 
serious  character. 

Passing  now  in  brief  review  some  of  the  more  recent  operations 
which  indicate  progress  in  ophthalmic  surgery,  I note,  first,  as  one 
of  the  most  important,  the  mangle'  or  crushing  operation  for  trach- 
oma. Dr.  David  Webster  says  it  is  one  of  the  greatest  discoveries 
of  modern  ophthalmology.  It  is  certain,  however,  that  by  the 
judicious  employment  of  this  procedure,  the  poor  victims  of  trachoma 
are  saved  months  and  even  years  of  suffering  and  annoyance.  Dr. 
Holtz  was  the  first,  I believe,  to  attract  the  attention  of  the  profes- 
sion to  this  plan  of  treatment;  but  as  he  advised  the  use  of  the 
thumb-nails  to  express  the  granules,  it  was  not  generally  employed 
until  others  devised  instruments  which  rendered  it  possible  to  do 
more  thorough  and  skilled  work.  The  various  instruments  which 
are  being  used  accomplish  the  same  result  by  slightly  different 
methods.  Dr.  Noyes’s  angular  forceps  are  simply  a squeezing  instru- 
ment, so  constructed  as  to  facilitate  the  operation  well  up  in  the 
retro-tarsal  folds.  Dr.  Knapp’s  roller  forceps  express  the  trachom- 
atous substance  by  a sort  of  mangle  process.  Sometimes,  in  chronic 
inflammatory  cases,  before  using  his  forceps,  he  scarifies  the  infil- 
trated parts  with  the  sillonneur  of  Johnson.  Dr.  George  Lindsay 
Johnson,  the  originator  of  the  sillonneur  just  referred  to,  scarifies 
the  everted  lids,  and  then  destroys  the  granules  with  an  electrolyzer. 
This  plan  is  superior  to  the  old  cautery  treatment.  Other  instru- 
ments have  been  made,  but  they  do  not  differ  essentially  from  those 
mentioned.  In  all  of  the  above  methods,  general  anaesthesia  is 
usually  necessary  in  order  to  thoroughly  do  the  operation.  The 
variety  or  stage  of  the  disease  modifies  the  character  of  the  opera- 
tion, and  affects,  to  a considerable  extent,  the  ultimate  result.  The 
most  highly  satisfactory  cures  are  obtained  in  follicular  trachoma. 
There  is  one  point  still  unsettled  : that  is,  whether  or  no  better  re- 
sults are  secured,  when  these  operations  are  finished,  by  rubbing 
the  lids  with  a corrosive  sublimate  solution.  I have  employed  both 
methods,  and  think  I have  gained  quicker  results  by  cleansing  (but 
not  rubbing)  the  lids  with  the  bichloride.  In  this  connection  let  me 


404 


world’s  homoeopathic  congress. 


state  that  I have  had  very  favorable  results  with  “ grattage  ” alone, 
using  a small,  stiff  brush  and  the  bichloride,  1 to  1000,  as  advised 
by  Darier,  Von  Hippel,  and  others. 

One  of  the  unpleasant  complications  of  trachoma  is  blepharo- 
spasm. I have  relieved  two  cases  of  this  condition  by  stretching 
the  orbicularis  with  lid-retractors.  This  operation  was  first  brought 
to  my  notice  through  an  article  by  Dr.  Allport.  The  lids  are  held 
widely  open  for  five  minutes,  and  the  operation  repeated  on  another 
day  if  necessary. 

If  one  subject  more  than  another  has  occupied  the  thought  of 
ophthalmologists  during  the  past  few  years,  it  has  been  that  regard- 
ing the  normal  and  abnormal  conditions  of  the  external  ocular 
muscles.  Dr.  Harold  Wilson  will  bring  before  you  this  subject,  so 
that  there  is  only  one  point  which  is  pertinent  to  this  paper.  Is 
surgical  interference  necessary  in  heterophoria  ? The  vast  majority 
of  oculists  now  answer  this  in  the  affirmative  for  some  cases  ; still 
there  are  those  yet  who  have  not  got  their  eyes  or  ideas  straight 
regarding  it.  I care  not  for  your  theories ; experience  has  demon- 
strated beyond  the  shadow  of  a doubt  that  tenotomy,  either  complete 
or  partial,  is  the  only  means  which  will  permanently  cure  many 
cases.  Neither  do  I think  it  wise  to  spend  much  time  discussing 
whether  a complete  or  graduated  tenotomy  is  the  better  sur- 
gery. I start  in  with  a partial  tenotomy ; I often  end  the  opera- 
tion by  making  it  complete.  The  fact  is,  when  I accomplish  exactly 
what  I want,  I do  not  quarrel  with  the  method.  I hardly  see  how 
I could  get  along  without  both  operations.  In  some  cases  of  eso- 
phoria  and  exophoria,  a graduated  tenotomy  has  proven  entirely 
inadequate;  while  in  slight  degrees  of  heterophoria,  especially  hy- 
perphoria, it  has  given  just  the-  result  I desired.  In  a few  cases 
where,  twenty-four  hours  after  the  operation,  the  eye  had  returned 
to  the  same  relative  position  as  before  the  tenotomy,  I have  per- 
manently improved  their  condition  from  one-half  to  one  degree  by 
carefully  passing  the  S-tevens  hook  intothe  wound  and  simply  re-open- 
ing it.  No  hemorrhage  occurs,  and  the  healing  process  is  only  tem- 
porarily interfered  with.  Two  years  ago,  Dr.  Winslow  stated 
that  tenotomies  changed  the  corneal  curvature.  Since  that  time  I 
have  tested,  with  Javal’s  ophthalmometer,  a great  many  cornee  after 
the  operation,  and  only  in  one  case  have  I been  able  to  verify  his 
experience.  Dr.  Swan  M.  Burnett  has  also  been  searching  for 


OPHTHALMIC  SURGERY. 


405 


this  complication,  but  writes  that  he  has  been  unable  to  discover  it. 
In  the  January  number  of  the  Archives  of  Ophthalmology , Dr.  Eu- 
gene Smith  presents  a new  method  of  performing  tenotomy.  He 
raises  the  muscle  well  up  from  the  sclerotic  with  peculiar  ring- 
shaped  forceps,  and  then  passes  a De  Wecker  stopkeratome  through 
the  conjunctiva  and  centre  of  tendon,  close  to  its  attachment.  The 
only  advantage  over  Dr.  Stevens’s  operation  is  that  less  haemor- 
rhage occurs.  I have  not  performed  the  operation,  but  should 
fear  that  there  would  be  some  danger  of  passing  the  lance-shaped 
keratome  into  the  sclera. 

A few  rules  have  served  to  guide  me  in  my  surgical  work  for 
heterophoria : 

First . — Carefully,  repeatedly,  and  by  various  methods,  test  the 
muscles  before  deciding  upon  an  operation. 

Second. — Correct  any  existing  ametropia  and  try  other  plans  of 
treatment  first. 

Third. — Be  reasonably  sure  that  the  defect  is  symptom-pro- 
ducing. 

Fourth. — Be  over-careful  to  do  too  little  rather  than  too  much. 

My  experience  has  been  that  tenotomy  for  heterophoria,  if  skill- 
fully performed  upon  carefully  selected  cases,  gives  more  uniformly 
definite  results  than  any  other  operation  in  ophthalmic  surgery. 

Closely  allied  to  the  surgical  work  for  heterophoria  are  the 
operations  for  strabismus.  Nothing  markedly  new  has  been  pre- 
sented in  this  field.  Dr.  Wray  has  suggested  the  introduction  of  a 
central  suture  in  advancement  operations  to  take  the  strain  off  of 
the  supra  and  infra-corneal  sutures.  Briefly,  his  method  is  as  fol- 
lows: One  end  of  the  suture  is  secured  to  the  stump  of  the  tendon 
near  the  cornea;  the  other  is  passed  well  back  so  as  to  transfix  from 
within  out  the  muscle  and  conjunctiva.  Over  this  end  of  the  suture 
is  passed  a perforated  shot,  and  the  amount  of  traction  regulated  by 
means  of  it.  It  seems  as  though  this  would  unnecessarily  compli- 
cate the  operation  and  annoy  the  patient.  I am  securing  uniformly 
good  results  in  advancement  by  using  Dr.  C.  H.  Beard’s  single  pul- 
ley suture.  More  perfectly  than  by  any  other  operation  which  I 
have  employed  has  this  method  advanced  the  muscle  in  the  direct 
line  of  its  axis. 

It  has  been  a reproach  upon  opthalomology  that  so  little  has  been 
accomplished  in  removing  defects,  either  in  the  shape  or  transparency 


406 


WORLD  S HOMOEOPATHIC  CONGRESS. 


of  the  cornea.  Transplantation  of  the  cornea  has  almost  inevitably 
proven  a failure.  Galvanism  for  slight  leticoma  is  far  from  satis- 
factory. Dr.  Knapp  has  lately  introduced  a new  operation  for 
kerato-conus,  which  I think  is  destined  to  be  quite  generally  em- 
ployed in  treating  this  deformity.  By  means  of  an  oval-tipped 
electrode  he  cauterizes  the  apex  of  the  kerato-conus.  Considerable 
reaction  follows,  but  all  of  his  six  cases  reported  were  ultimately 
somewhat  improved.  The  advantage  of  a cautery  in  ulcerations  is 
being  more  and  more  appreciated.  I use  in  my  office  the  Edison 
current  for  this  purpose,  and  find  that  some  of  the  worst  corneal 
ulcers  heal  as  by  magic  after  thorough  cauterization.  In  fact,  it  is 
largely  displacing  Saemisch’s  incision.  I have  several  times  per- 
forated the  cornea,  but  no  bad  results  have  followed. 

There  are  a number  of  operations  which  are  in  an  experimental 
stage  yet  and  of  doubtful  expediency.  Chief  among  them  are  op- 
tico-ciliary  neurotomy,  resection  of  the  optic  nerve  and  injection  of 
the  bichloride  for  deep  structural  changes,  such  as  in  choroiditis. 

The  last,  and  still  the  most  important,  operation  in  ophthalmology 
which  I shall  consider,  is  senile  cataract  extraction.  This  I cannot 
hope  to  present  in  full,  but  only  touch  on  certain  points,  which  I 
trust  will  elicit  discussion.  At  the  present  time  no  question  bear- 
ing upon  this  subject  is  of  greater  importance  than  how  to  deal  with 
immature  cataracts.  Statistics,  such  as  presented  by  Dr.  W.  A. 
Brailey,  show  what  a small  per  cent,  of  cataractous  lenses  are  mature 
when  first  examined.  In  his  practice  he  found  only  one  in  seven, 
excluding  congenital,  zonular  and  secondary.  Of  the  immature 
cataracts,  45  per  cent,  remained  unchanged  ; 13  per  cent,  were 
slightly  better;  19  per  cent,  slightly  worse;  and  23  per  cent,  de- 
cidedly worse,  the  interval  of  re-examination  varying  from  three 
months  to  eight  years.  Dr.  A.  B.  Norton  has  given  us  the  results 
of  one  hundred  cases  of  incipient  cataract  treated  at  his  office  with 
Homoeopathic  remedies.  Forty-two  per  cent,  remained  unchanged  ; 
13  per  cent,  were  improved  ; 26  per  cent,  were  slightly  worse;  and 
19  per  cent,  were  decidedly  worse.  There  is  a striking  similarity 
between  the  results  presented  by  the  two  surgeons.  This  goes  to 
show  how  hard  it  is  to  determine  just  what  is  nature  and  what  is 
drug  effect.  Dr.  liisley  believes  that  vision  can  be  improved  or 
maintained  in  many  cases  by  correcting  errors  in  the  refraction  and 
giving  attention  to  the  general  health.  He  emphatically  states  that 


OPHTHALMIC  SURGERY. 


407 


increased  visual  power  is  not  due  to  “the  absorption  of  any  opacities 
already  formed  in  the  lens,  but  to  improved  conditions  of  the  vitreous, 
choroid  or  retina.” 

Admitting  that  there  are  cases  helped  by  the  Homoeopathic  remedy 
and  correcting  of  the  refraction,  still  there  is  a large  class  of  im- 
mature cataracts  in  which  both  of  these  means  are  out  of  the  ques- 
tion. Sufficient  vision  remains  to  go  about,  but  not  to  engage  in 
the  ordinary  avocations  of  life.  These  are  the  patients  which  en- 
list our  sympathy  and  tax  our  skill.  Waiting  for  maturation  of  the 
cataract  may  mean  broken-down  health,  or  poverty,  or  both. 
What  can  be  done?  Two  active  courses  can  be  pursued  : 

First. — Remove  the  immature  lens  as  it  is. 

Second. — Artificially  mature  it  and  then  remove  it. 

For  myself,  I prefer  the  first  plan  as  involving  less  risk.  This 
can  be  accomplished  by  two  methods,  each  with  a variety  of  modi- 
fications. The  one  feature  which  distinctly  distinguishes  one  from 
the  other  is  whether  or  not  injections  are  made  into  the  anterior 
chamber.  Dr.  Tweedy  does  not  use  injections,  but  performs  an 
iridectomy  and  makes  a peripheral  opening  in  the  capsule  with  the 
Grafe  knife.  He  claims  that  such  a capsulotomy  keeps  the  par- 
ticles of  lens  substance,  which  cannot  be  removed,  from  coming  in 
contact  with  the  iris.  Some  surgeons,  however,  remove  a piece  of 
the  anterior  capsule,  and  others  make  a point  of  doing  a preliminary 
iridectomy.  The  method  of  making  intra-ocular  injections  is 
rapidly  gaining  ground.  McKeown,  De  Wecker,  Panus,  Knapp, 
Lippincott,  and  many  others,  are  employing  it  to  a considerable  ex- 
tent. A variety  of  instruments  has  been  devised  for  this  purpose 
and  a number  of  different  solutions  tried.  McKeown  has  used  sim- 
ply distilled  water  in  70  per  cent,  and  Panus’s  solution  in  30  per 
cent,  of  his  cases.  De  Wecker  injects  a weak  solution  of  Eserine; 
Lippincott  a one-half  per  cent,  boracic  acid  solution,  and  Knapp  a 
one-half  per  cent,  of  sodium  chloride.  The  bichloride  of  mercury 
is  not  now  used  because  of  the  discovered  danger  to  the  cornea.  I 
have  employed  injections  ten  times.  If  the  lens  is  very  immature,  as 
it  was  in  six  cases,  I do  an  iridectomy  ; otherwise  not.  I make  a 
free  laceration  of  the  anterior  capsule  and  inject  a warm  1 per  cent, 
sterile  boracic  acid  solution.  I have  not  had  a single  bad  result. 

20 

In  two  cases  V = ^q.  A sharp  attack  of  iritis  followed  in  one  case, 


408 


world’s  homceopathic  congress. 


but  was  controlled,  and  useful  vision  resulted.  I employ  a one-half 
ounce  hypodermic  syringe  with  a sterling  silver  tip,  and  never  use 
the  same  tip  on  more  than  one  case.  A point  made  by  Knapp  is 
not  to  be  overlooked  ; that  is,  to  introduce  the  nozz'e  within  the 
corneal  section,  so  that  the  liquid  will  run  from  within  out.  This 
is  disregarded  by  some,  but  it  seems  to  me  that  there  is  an  element 
of  danger  in  washing  septic  matter  into  the  wound. 

The  second  plan,  that  of  artificially  ripening  the  lens,  has  many 
followers : Foerster,  McHardy,  Noyes,  and  others.  There  are  six 
different  ways  of  accomplishing  it : 

First. — Simple  division  of  the  anterior  capsule. 

Second. — Division  of  anterior  capsule  and  iridectomy. 

Third. — Division  of  anterior  capsule  and  external  massage. 

Fourth. — Simple  paracentesis  and  external  massage. 

Fifth. — Iridectomy  and  external  massage  (Fderster’s  operation.) 

Sixth. — Iridectomy  and  internal  massage. 

As  the  mere  mention  of  these  methods  so  clearly  indicates  the 
work  to  be  done,  a fuller  description  seems  unnecessary. 

In  operating  upon  mature  or  nearly  mature  cataracts,  the  first 
thing  to  be  decided  upon  is,  shall  an  iridectomy  be  performed  ? The 
profession  are  still  divided  on  this  point.  Simple  extraction,  how- 
ever, now  has  the  lead,  and  certainly  is  the  ideal  operation.  With 
a section  well  in  the  corneal  tissue,  prolapse  of  the  iris — the  chief 
danger — is  not  a common  complication.  In  extractions,  with  an 
iridectomy,  prolapse  of  the  iris  into  the  angles  of  the  wound  is  nearly 
as  frequent.  Preliminary  iridectomy  still  has  its  advocates,  and  it 
would  be  hard  to  furnish  better  visual  results  than  they  are  able  to 
present. 

No  one  method  of  operating  will  be  adapted  to  all  cases.  We 
should  never  sacrifice  the  best  visual  results  for  the  sake  of  cosmetic 
appearances.  Simple  extraction  followed  by  secondary  capsulotomy 
combines  cosmetic  effects  with  good,  visual  acuteness.  There  are, 
however,  many  cases  of  cataracts  associated  with  myopia  or  slightly 
increased  tension,  in  which  iridectomy  gives  the  better  results. 

There  is  one  feature  of  simple  extraction  which  has  been  of  inter- 
est to  me.  Formerly  I always  used  Eserine,  a one-half  or  one  per 
cent,  solution  immediately  after  the  delivery  of  the  lens.  I have  of 
late  largely  discarded  it.  Prolapse  of  the  iris  rarely  occurs,  less 
iritis  follows,  and  fewer  adhesions  between  the  iris  and  capsule  re- 


OPHTHALMIC  SURGERY. 


409 


main.  When  I employ  Eserine  now,  I apply  only  a one-fourth  per 
per  cent,  solution.  This  causes  less  irritation.  I should  be  pleased 
to  know  the  experience  of  the  members  present  regarding  their 
treatment  of  a prolapsed  iris.  Some  claim  to  have  been  able  by 
gentle  manipulation  to  replace  it  within  the  anterior  chamber : 
others  absoise  it  at  once ; and  Dr.  Knapp  allows  it  to  remain  ten 
days  or  longer  before  absoising,  unless  it  occurs  during  the  first 
twenty-four  hours  after  the  extraction. 

Regarding  the  after-treatment  and  dressing  little  need  be  said 
here.  Nearly  every  oculist  seems  to  have  a method  peculiarly  his 
own.  The  tendency  is  markedly  toward  more  freedom  for  the 
patient  and  more  simple  dressings  for  the  eye.  Some  have  gone  to 
the  very  extreme  and  practically  abandoned  the  idea  of  any  after- 
treatment. 

During  the  past  few  years  a number  of  interesting  modifications 
of  cataract  extraction  have  appeared,  and  in  conclusion  I will  briefly 
bring  to  your  attention  some  of  them. 

Dr.  F.  Parke  Lewis  divides  the  posterior  capsule  immediately  after 
the  delivery  of  the  lens.  He  claims  that  by  so  doing,  secondary 
cataracts  are  less  frequent.  Dr.  Carter  adopts  the  same  procedure, 
claiming  that  it  prevents  the  development  of  glaucoma.  Both  Drs* 
Tyner  and  Brockman  prefer  a preliminary  peripheral  capsulotomy 
with  a Bowman’s  stop-needle.  Dr.  Brockman  reports  four  thousand 
cases  thus  operated  upon.  Galezowski  and  others  open  the  capsule 
with  the  knife  after  making  the  first  corneal  puncture.  Suarez  De 
Mendoza  introduces  a suture  into  the  lips  of  the  section;  and  J.  S. 
Prout  keeps  the  lids  closed  by  means  of  a suture.  These  measures, 
however,  have  not  received  any  general  adoption. 

Finally,  careful  attention  must  be  given  to  the  division  of  secon- 
dary cataracts.  A capsulotomy  should  be  performed  as  soon  as 
practicable.  If  delayed  too  long,  the  capsule  becomes  tough  and 
hard  to  cut.  In  the  prescribing  of  glasses,  Javal’s  ophthalmometer 
has  been  of  great  service  to  me.  It,  more  perfectly  than  any  other 
instrument,  shows  the  changes  in  the  corneal  curvature.  This  facili- 
tates the  work  of  finding  the  proper  astigmatic  glass  which  will  give 
the  highest  visual  result. 

Secondary  capsulotomy,  when  necessary,  and  the  prescribing  of 
glasses,  are  the  final  steps  in  the  operation  for  giving  sight  to  a cata- 
ract patient.  They  are  the  finishing  touches  upon  a piece  of  work 


410 


world’s  homoeopathic  congress. 


that  has  been  skillfully  and  delicately  wrought,  and  without  which 
all  that  has  preceded  may  be  of  no  avail. 

Discussion. 

B.  B.  Vietz,  M.D.  : Cocaine. — Of  course  all  appreciate  its  worth. 
The  strength  of  the  solution  to  use,  and  the  dangers  of  the  drug  are 
points  that  interest  us  and  about  which  any  discussion  can  be  raised. 
For  the  first  two  years  after  cocaine  came  into  use,  I used  a four- 
grain  solution  only  in  all  operations  about  the  eye.  Enucleation 
was  painlessly  performed  in  two  cases,  iridectomy  many  times,  etc., 
and  I am  not  yet  entirely  convinced  but  that  the  effect  of  a weak 
solution,  everything  considered,  is  as  satisfactory  as  when  a stronger 
one  is  used.  If  then,  a four-grain  solution  produces  anaesthesia  so 
completely,  surely  a two  per  cent,  solution  is  plenty  strong  enough 
for  the  oculist. 

Dangers  of  Cocaine  were  not  mentioned  by  the  essayist.  But  the 
note  of  alarm  is  frequently  sounded  in  our  journals,  one  surgeon  dis- 
carding it  entirely  in  throat  work.  The  dangers,  I think,  are  over- 
estimated, for  I have  never  seen  any  toxic  effects  whatever,  and  have 
used  a 10  per  cent,  solution  in  operations  about  the  nose  and  throat. 

Antisepsis. — Dr.  Bissell  states  that  “ cleanliness  secured  and  main- 
tained without  the  use  of  germicidal  agents  is  the  superior  method.” 
I am  fully  in  accord  with  this  declaration.  I take  issue  with  the 
Doctor,  however,  upon  the  method  he  suggests  for  preparing  our 
instruments.  I do  not  believe  it  is  necessary  to  take  so  much 
trouble  and  precaution.  He  puts  them,  he  says,  first  into  boiling 
water  and  alcohol ; then  transfers  them  to  a sterilizer,  where  for  an 
hour  they  are  sterilized  together  with  all  solutions  to  be  used.  I 
confess  to  being  very  unscientific  when  it  comes  to  the  matter  of  an- 
tisepsis. 

In  eye  surgery  my  practice  has  been  to  wash  my  hands,  wipe  the 
instruments  with  absorbent  cotton,  have  the  patient’s  face  washed 
and  cheek,  lid  and  brow  wiped  with  cotton.  The  cocaine  solution 
I make  myself  in  small  quantities  using  always  hydrant  water.  In 
eight  years’  private  hospital  and  college  clinic  practice,  I have  yet  to 
see  suppuration  in  a single  case  or  bad  effects  that  could  be  traced, 
remotely  even,  to  germinal  influence.  I do  not  wish  to  be  under- 
stood as  advocating  carelessness.  Reasonable  precautions  should  be 
taken  in  every  case ; but  this  striving  after  perfect  antisepsis  is,  to 
my  mind,  a useless  waste  of  time  and  energy.  Careless  handling, 
bruising  of  parts  during  operations,  has  much  to  do  with  causing 
suppuration. 

Surgical  Interference  in  Ileterophoria. — It  is  the  consensus  of 
opinion,  I think,  that  high  degrees  of  heterophoria,  especially  exo- 
phoria,  can  be  cured  by  complete  tenotomy,  also  that  many  cases  of 


OPHTHALMIC  SURGERY. 


411 


low  degree  get  relief  by  systematic  exercising  of  the  muscles  with 
prism.  What  to  do  with  the  medium  grades  is  as  yet,  with  me,  an 
unsolved  problem.  I have  nothing  satisfactory  to  offer  on  the  sub- 
ject. Unfortunately,  I have  seen  so  many  cases  operated  upon  by 
others  where  the  condition  was  actually  made  worse,  or  at  best  not 
benefited,  that  it  has  deterred  me  from  experimenting  to  any  extertt. 

Strabisnms  Operations. — The  advancement  of  a muscle.  In  my 
library  there  are  works  on  the  eye  by  thirteen  different  authors.  In 
describing  this  operation,  all  say  substantially  the  same  thing,  only 
that  some  recommend  two  sutures,  some  three  or  more.  But  all 
claim  that  a diverging  eye  can  be  brought  into  position  and  held 
there  by  passing  the  sutures  through  the  flap  of  conjunctiva  only,  at 
the  margin  of  the  cornea.  Utter  failure  was  the  record  of  my 
efforts  to  advance  a muScle  in  bad  cases  of  divergence,  until  I learned 
how  to  make  the  operation.  But  not  a hint  is  given  in  these  thir- 
teen books  mentioned  of  the  necessary  proceedings  to  ensure  success. 
And  that  is  the  method  of  Dr.  Wray,  mentioned  in  the  paper.  One 
end  of  the  sutures  must  be  secured  to  the  stump  of  the  tendon  at  its 
insertion  into  the  sclerotic  to  relieve  the  strain  upon  the  conjunctiva 
or  the  sutures  will  tear  out.  Ninety-five  per  cent,  of  the  operations 
for  advancement  are  made  upon  the  internal  rectus,  and  usually  upon 
adults.  The  eye  seems  to  have  become  almost  fixed  in  this  position, 
and  considerable  power  must  be  exerted  to  bring  it  into  place,  much 
more  in  my  experience  than  the  thin  delicate  conjunctiva  is  capable 
of  sustaining. 

Immature  Cataracts — Artificial  ripening  of  the  lens.  My  expe- 
rience leads  me  to  declare  against  the  procedure,  from  the  fact 
that  I have  been  unable  to  accomplish  anything  of  the  kind.  The 
growth  or  formation  of  a senile  cataract  is  a physiological  progres- 
sive sclerosis.  That  of  soft  cataract  is  a regressive  metamorphosis, 
different  processes  entirely.  It  is  true  that  you  may  puncture  the 
anterior  capsule,  perform  iridectomy  or  institute  any  of  the  proceed- 
ures  mentioned  in  the  paper  and  set  up  this  regressive  process,  and 
any  transparent  portions  of  a lens  in  a very  short  time  will  be- 
come opaque.  But  this  portion  artificially  ripened  is  no  harder  than 
before,  no  more  easy  to  operate  upon  for  removal.  It  is  possible 
that  this  cortical,  opaque,  pasty  mass  might  harden  if  left  long 
enough,  though  I have  waited  a year  and  upon  removal  found  no 
evidence  of  any  hardening.  I make  no  further  attempt  to  artificially 
ripen  a senile  cataract. 

Dr.  Vilas  : In  undertaking  to  discuss  the  paper  of  Dr.  Bissell, 
I am  embarrassed  at  the  outset  in  that  direction  by  a hearty  con- 
currence in  nearly  all  contained  therein.  Moreover,  on  so  vast  a 
subject,  so  well  treated  by  the  essayist,  I can  hope  to  shed  no  ad- 
ditional light,  but  perhaps  may  emphasize  some  of  the  points  made. 

It  seems  to  me  that  if  I were  asked  to  name  the  greatest  aid  to 


412 


world’s  homoeopathic  congress. 


the  ophthalmologist  supplied  during  the  time  I have  practiced  oph- 
thalmology, I should  answer  the  present  use  of  cocaine.  It  has 
altered  the  whole  course  of  professional  life  of  an  oculist,  while  to 
those  who  are  constantly  in  the  surgical  arena  it  has  proved  invalu- 
able. I shall  not  dwell  on  the  reasons  for  this  warm  encomium, 
because  its  advantages  have  been  well  set  forth  by  the  essayist,  in 
whose  method  of  use  I concur.  It  requires  a little,  experience  to 
get  its  best  effects,  however,  even  with  the  method  given.  Were  I 
not  confined  to  its  surgical  aspect,  much  more  concerning  its  use 
might  be  said. 

The  attention  which  anti-  and  asepsis  has  attracted  can  only  be 
for  the  best  interests  of  the  profession,  and  yet  I am  of  the  opinion 
that  reputations  have  been  made  by  many  of  the  special  procedures 
connected  therewith,  only  to  quickly  pass  away.  In  my  judgment 
absolute  cleanliness  secured  and  maintained  by  the  simplest  methods, 
is  the  result  to  be  sought  after ; and  I cannot  but  believe  that  too 
much  and  too  careful  irrigating  and  drenching  of  the  eye,  internally 
and  externally,  is  on  the  whole  not  only  unnecessary,  but  often 
harmful.  Too  much  care  to  the  sterilization  of  instruments,  lotions, 
and  all  adjuvants  to  an  operation,  and  to  the  cleanliness  of  the  patient 
and  operator,  can  hardly  be  given,  however;  and  it  is  oftener  that 
the  result  is  affected  by  neglect  of  this  precaution  than  from  appar- 
ently injurious  pathological  surroundings. 

In  my  own  practice  I also  prefer  to  combat  the  dangers  which 
may  arise  from  an  immature  lens  in  a cataract  extraction,  than  to 
attempt  to  artificially  ripen  it;  and  yet,  unless  some  excellent  reason 
(one  almost  imperative)  compels,  I prefer  to  forego  the  operation 
rather  than  to  tempt  disaster  by  too  boldly  attacking  a lens  which 
seems  not  yet  fully  ready  for  successful  delivery. 

With  the  exception  of  the  conclusions  as  to  the  results  of  opera- 
tions for  heterophoria,  which  I consider  too  optimistic,  I agree  in 
the  main  with  the  balance  of  the  paper — all  of  which  is  a valuable 
contribution  to  our  proceedings. 

Dr.  Randall:  I have  seen  a little  in  some  of  the  journals  in 
regard  to  Phenic  Acid  obviating  the  systemic  affection.  I would  like 
to  know  if  any  one  has  had  any  experience  with  that  agent  ? 

# Harold  Wilson,  M.D.,  of  Detroit:  I wish  to  mention  an  op- 
eration for  convergent  strabismus,  which,  although  perhaps  not 
altogether  novel,  has  not  to  my  knowledge  been  brought  particularly 
to  the  knowledge  of  the  profession.  It  is  an  operation  which  I have 
derived  from  my  father,  and  from  what  source  he  obtained  it  I do  not 
know,  but  I have  used  it  for  some  time.  It  consists,  briefly,  in 
making  two  incisions  through  the  conjunctiva,  one  parallel  to  the 
lower  border,  and  one  parallel  to  the  upper  border  of  the  rectus 
muscle.  The  conjunctiva  or  the  sub-conjunctival  tissue  is  then 
dissected  up  with  scissors  back  under  the  caruncle,  and  as  far  later- 


OPHTHALMIC  SURGERY. 


413 


ally  as  may  be  desired.  The  hook  is  then  introduced  under  the 
muscle  through  one  of  these  incisions,  and  the  point  brought  out 
through  the  other.  The  muscle  is  then  severed.  If  further  correc- 
tion is  desired,  lateral  incisions  into  the  capsule  may  be  made.  The 
advantages  of  the  operation  are  the  slight  disfigurement  and  no  (or 
very  little)  retraction  of  the  caruncle. 

F.  Parke  Lewis,  M D.  : Just  a word  about  the  use  of  stronger 
cocaine  in  lowering  the  vision  of  the  eye  in  the  extraction  of  cata- 
ract, in  four-grain  solution,  continued  for  ten  or  fifteen  minutes.  I 
believe  that  a certain  amount  of  elasticity  is  necessary  in  the  lens, 
and  if,  after  using  your  cocaine  ten  minutes  or  more,  you  find  all 
the  elasticity  is  gone,  and  you  have  to  squeeze  the  lens  out,  you 
very  seriously  imperil  the  result  of  the  operation.  I thoroughly 
agree  in  limiting  the  time  for  the  use  of  cocaine  in  extracting  the 
cataract.  I very  often  use  the  cocaine  two  to  four  minutes  ; it  is 
quite  enough.  During  the  last  year  I have  several  times  made  oper- 
ations, in  one  instance  with  very  peculiar  results.  The  patient,  an 
old  man  with  the  lens  so  far  matured  as  to  make  reading  impossible, 
and  locomotion  difficult ; after  having  made  an  operation  the  patient 
was  told  to  come  back  in  three  or  four  weeks  and  have  the  lens 
removed.  Not  doing  so  after  two  months,  inquiry  was  made,  and 
it  was  found  the  operation  had  cured  the  lens  in  such  a degree  as  to 
make  it  possible  for  him  to  read.  No  operation  was,  of  course, 
necessary  ; he  could  easily  get  around,  and  could  read  large  print. 
It  was  rather  a unique  instance,  and  worth  putting  on  record.  In 
regard  to  the  immediate  capsulotoray,  which  Dr.  Bissell  has  re- 
ferred to:  while  I was  not  aware,  at  the  time  I first  made  it,  that 
it  had  been  made  by  others,  I subsequently  learned  by  conversa- 
tion with  Dr.  Knapp,  that  the  same  operation  had  been  made,  and 
had  been  discontinued.  The  completing  of  an  operation  at  one  time 
is  to  me  an  important  matter.  The  patient  may  come  fifty,  one 
hundred,  or  two  hundred  miles  to  have  an  extraction  made.  If  you 
can  finish  the  operation  at  the  time  the  patient  is  convalescing,  it 
is  a very  important  thing,  and  it  does  not  necessitate  any  long  oper- 
ation. Moreover,  the  division  of  the  capsule  is  in  some  instances 
followed  by  a general  inflammatory  condition.  It  is  by  no  means 
a simple  operation,  or  one  devoid  of  danger.  If,  therefore,  you 
can  complete  your  operation  at  the  time  corneal  incision  is  made 
and  the  lens  removed  without  adding  to  the  danger  of  your  oper- 
ation, you  have  added  enormously  to  the  value  of  your  primary 
operation.  Since  the  matter  to  which  Dr.  Bissell  has  referred,  I 
have  many  times  made  this  immediate  capsulotomy,  and  have  had 
no  reason  to  regret  it.  I believe  it  to  be  an  entirely  safe  operation. 
So  long  as  we  have  the  iris  in  proper  position,  we  may  open  the  pos- 
terior capsule  allowing  the  vitreous  to  go  into  the  anterior  chamber 
with  no  serious  results.  When  the  support  is  taken  off,  then  an 


414 


world’s  homoeopathic  congress. 


element  of  danger  is  introduced.  There  has  sometimes  been  a little 
loss  of  vitreous,  a loss  not  sufficient  to  imperil  the  operation,  but  to 
make  me  feel  like  going  no  further. 

A.  B.  Norton,  M.D. : I would  like  to  add  a suggestion  as  to 
w hat  to  do  with  those  medium  cases  of  exophoria.  I want  to  reiterate 
the  benefit,  the  improvement  of  leaving  off  your  convex  glasses  in 
those  cases  of  exophoria.  I find,  over  and  over  again,  cases  where 
they  have  been  wearing  glasses,  and  have  been  treating  for  it. 
Leave  off  convex  glass,  and  the  exophoria  soon  disappears.  In 
other  cases,  where  they  are  not  wearing  those  glasses,  I think  they 
should  put  on  prisms.  Let  them  have  a prism  to  wear.  Treat 
the  muscles,  strengthen  the  internal  recti  up  to  70  degrees  power, 
and  if  that  does  not  correct  the  power,  let  them  wear  prisms,  and 
later,  in  the  higher  degrees.  If  necessary,  I am  willing  to  op- 
erate. The  operation  which  Dr.  Wilson  spoke  of,  for  squint,  seems 
to  me  to  be  like  that  of  sub-conjunctivitis  in  the  text-books.  In 
regard  to  one  of  the  Doctor’s  questions  about  tannin,  I will  say 
that  I do  frequently  use  it,  one  to  two  hundred  or  five  hundred. 
I use  it  very  frequently,  drop  it  into  the  eye  every  hour  or  two 
hours,  and  believe  the  essential  value  of  it  is  found  very  frequently. 

Dr.  Bissell,  in  closing  the  discussion,  said  : The  question  has 
been  asked  me  regarding  the  special  preparation  of  cocaine.  I have 
had  no  special  connection  with  it,  and  have  not  seen  it  used  in  our 
work.  1 do  not  think  it  is  superior  to  any  other  anaesthetic  agents 
that  we  have,  and  it  is  unpleasant  to  use,  in  soiling  the  clothing 
and  staining,  although  it  may  be  used.  I think  in  one  or  two  cases 
it  has  acted  unfavorably,  seemingly  aggravating  the  case,  and  was 
probably  used  too  strong;  but  1 immediately  discarded  it  and  took 
something  else. 

Regarding  the  operation  for  strabismus  spoken  of  by  Dr.  Wilson, 
I should  have  given  him  the  credit  for  it  if  I had  known  that  it 
was  peculiar  to  him.  The  first  operation  that  I ever  saw  of  the 
kind  was  not  done  by  Dr.  Wilson,  and  the  only  modification  I make 
is  a suture  I put  in,  which  has  certainly  given  me  wonderful  results. 
In  that  respect  it  differs  from  Dr.  Wilson’s,  if  he  is  really  the  orig- 
inator of  it. 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORIA.  415 


THE  STUDY  AND  CORRECTION  OF  HETERO- 
PHORIA. 

By  Harold  Wilson,  M.D.,  Detroit,  Mich. 


Heterophoria  may  be  defined  as  that  condition  in  which  bi- 
nocular vision,  being  temporarily  suspended,  the  visual  lines  of  the 
two  eyes  do  not  intersect  at  the  point  of  fixation.  It  is  characterized 
by  a change  in  the  innervation  of  the  ocular  muscles  when  the  bi- 
nocular fusion  of  images  is  prevented.  Under  normal  conditions, 
binocular  vision  for  a given  point  is  maintained  by  the  co-ordinate 
action  of  the  entire  group  of  these  muscles,  and  in  the  ideal  eye,  at 
least  within  certain  limits,  the  innervation  of  these  muscles  is  not  a 
necessary  function  of  the  binocular  act.  That  is  to  say,  the  binocular 
fusion  of  images  being  suspended,  the  innervation  remains  unal- 
tered. It  becomes  a function  of  this  act  only  in  states  of  hetero- 
phoria. 

Heterophoria  is  due  essentially  to  a condition  of  faulty  innerva- 
tion, which  depends  upon  one  or  more  of  the  following  factors: 

1.  The  form  and  position  of  the  eyeballs  (orbits). 

2.  The  place  of  insertion  of  the  ocular  muscles. 

3.  The  essential  and  relative  power  of  the  ocular  muscles  (ampli- 
tude of  convergence). 

4.  The  ratio  of  the  positive  and  negative  portions  of  the  relative 
accommodation,  together  with  the  ratio  of  the  convergence  and  accom- 
modation for  the  point  in  question. 

Under  the  first  head  it  is  clear  that,  assuming  certain  ratios  of  ten- 
sion among  the  muscles  of  the  eye  as  normal  when  fixing  some  point 
at  a given  distance  from  the  eye,  such  as  1 m.  for  example,  these 
ratios  must  vary  with  the  length  of  the  basal  line  of  the  eyes.  For  at 
this  distance,  with  a basal  line  of  50  mm.,  the  angle  of  convergence  is 
1.43°,  while  with  a basal  line  of  75  mm.  it  is  2.15°.  In  high  de- 
grees of  myopia  the  alterations  in  the  form  of  the  eyeballs  limit  their 
mobility,  and,  consequently,  modify  the  convergence  tension  of  the 
muscles. 


416 


world’s  homoeopathic  congress. 


There  is  some  variation  in  the  place  of  insertion  of  the  ocular  mus- 
cles. Stilling  has  observed  a wide  variation  in  that  of  the  superior 
oblique.  We  may  assume  as  normal  the  following  measurements, 
representing  the  distances  of  the  insertion  of  the  recti  muscles  from 
the  cornea  (Fuchs) : 

mm. 


Rectus  internus,  5.5 

“ externus, 6.9 

“ inferior, 6.5 

“ superior, 7.7 


In  an  eye  where  the  muscular  balance  is  ordinarily  good,  one  or 
more  muscles  may  become  weakened  by  fatigue  or  disease,  necessitat- 
ing an  increase  in  the  amount  of  nervous  stimulus  to  these  muscles 
in  order  to  preserve  binocular  vision.  Under  these  circumstances,  if 
binocular  vision  becomes  abrogated,  heterophoria  is  an  easy  and 
necessary  consequence.  Here  we  have  true  “ muscular  insuffi- 
ciency.” 

From  the  essential  connection  of  accommodation  and  convergence, 
it  is  evident  that  the  ratio  of  the  positive  and  negative  portions  of 
the  relative  accommodation  for  any  given  point  has  an  important 
bearing  upon  the  muscular  balance  for  that  point.  Indeed,  if  no 
other  factor  were  operative  to  affect  the  muscular  equilibrium,  itseems 
reasonable  to  assume  that  it  could  be  calculated  from  a knowledge  of 
the  relative  accommodation.  However,  as  a matter  of  fact,  other 
causes  uniformly  do  exert  an  influence  upon  the  position  of  the  eyes, 
and  moreover  may  be  of  such  moment  that  their  effects  entirely  nega- 
tive that  of  the  relative  accommodation. 

We  see,  then,  that  heterophoria  may  originate  in  a number  of 
ways.  From  the  variety  of  causes  we  may  infer  that  there  must  be 
a corresponding  variation  in  the  treatment  of  this  disorder.  We  shall 
revert  to  this  further  on. 

Methods  of  Examination. — In  ascertaining  the  amount  and  char- 
acter of  the  heterophoria  present  in  a given  case,  the  essential  de- 
termination to  be  made  is  the  position  of  the  non-fixing  or  deviating 
eye.  The  common  and  most  exact  methods  of  making  this  determi- 
nation are  subjective.  Of  objective  methods,  the  only  one  that  is 
practical  is  the  old  test  of  alternately  covering  and  uncovering  one 
eye  with  a screen.  This  is  too  crude  to  be  of  much  value.  Subjec- 
tive methods  depend  upon  the  uniformity  and  congruity  of  retinal 


THE  STUDY  AND  CORRECTION  OF  H ETEROPH O RI A . 417 


projection.  The  first  instrument  of  precision  for  making  the  neces- 
sary measurements  was  Stevens’s  phorometer.  With  this  instrument, 
supposing  the  patient  to  be  of  ordinary  intelligence,  it  is  possible  to 
measure  deviations  of  the  eyes  in  any  plane  with  much  accuracy. 
The  substitution  of  a “ stopped”  convex  lens  of  short  focus  for  the 
vertical  and  horizontal  prisms  employed  in  the  phorometer,  added  to 
the  rapidity  with  which  a diagnosis  as  to  the  character  of  the  devia- 
tion could  be  made.  The  “ rod  test  ” of  Maddox  marked  another 
gain  in  the  rapidity  of  the  examination,  and  made  it  possible  to 
measure  the  deviation  of  the  non-fixing  eye  by  means  of  scales  drawn 
upon  the  wall  of  the  examining-room.  Burnett’s  use  of  a strong 
convex  cylinder  was  based  upon  the  same  principle.  Another  gain 
in  convenience  and  precision  was  the  introduction  of  the  rotating 
prisms  of  Stevens,  by  which  the  separate  displacing  prisms  were  done 
away  with.  I have  added  another  instrument  to  this  number,  a rough 
model  of  which  I have  the  pleasure  of  exhibiting  to  this  section. 
It  consists  essentially  of  a frame,  holding  upon  its  right  side  a cell 
containing  two  6°  prisms,  with  their  bases  in  contact;  or  a Maddox, 
rod,  suitably  mounted  ; and  on  the  left  a “ prism  mobile  ” of  two  5>° 
prisms,  which,  by  suitable  mechanism,  may  be  rotated  in  the  same  or 
in  opposite  directions,  and  the  amount  of  rotation  measured  upon  a- 
graduated  circle  so  placed  as  to  be  easily  seen  by  the  observer.  Be- 
hind the  openings  of  this  frame  or  slide  are  clips  for  holding  various 
accessories,  such  as  abducting  or  adducting  prisms,  a red  glass*  etc. 
With  the  double  prism  in  proper  position,  and  the  “ prism  mobile” 
at  0°,  set  to  give  horizontal  displacements,  the  patient  looks  at  the 
point  of  light  through  both  openings  and  sees  three  images-  of  it. 
The  middle  image  is  seen  by  the  left  eye,  and  by  turning  the  milled 
head  of  the  “ prism  mobile”  it  may  be  displaced  horizontally  either 
to  the  right  or  left,  from  0°  to  10°.  If,  therefore,  this  image  is  not 
in  a straight  line  with  the  other  two,  it  may  be  quickly  brought  into 
this  position,  and  the  exophoria  or  esophoria  read  off  at  once  upon 
the  graduated  circle  at  the  patient’s  left.  To  measure  deviations  in 
any  other  plane,  the  double  prism  is  rotated  into  that  plane,  the 
“ prism  mobile”  brought  to  zero,  the  small  milled  head  in  the  face 
of  the  instrument  pushed  well  up,  and,  the  pinion  of  the  recording 
disk  being  pulled  out,  the  two  prisms  are  rotated  by  means  of  this 
milled  head  in  the  same  direction  to  the  desired  angle,  when  these 
adjustments,  being  reversed,  the  measurements  are  made  in  the  same 

27 


418 


world’s  homceopathic  congress. 


manner  as  at  first.  A little  familiarity  with  the  instrument  will 
enable  the  observer  to  make  these  adjustments  very  rapidly.  The 
Maddox  rod  may  be  substituted  for  the  double  prism  if  desired.  To 
measure  heterophoria  greater  than  10°,  a supplementary  prism  may 
be  inserted  in  the  proper  position  in  one  of  the  rear  clips,  and  its 
value  added  to  the  readings  of  the  instrument. 

To  measure  abduction  and  adduction,  or  in  fact,  muscular  power 
in  any  direction,  the  double  prism  or  rod  is  removed  from  the  right- 
hand  cell,  and  the  “prism  mobile”  having  been  set  in  the  desired 
position,  the  muscular  powers  can  be  easily  found  by  rotation  of  the 
milled  head  at  the  left.  In  these  determinations  also,  supplementary 
prisms  may  be  inserted  into  the  clips  if  necessary. 

It  will  be  seen  that  a considerable  variety  of  measurements  may 
be  made  by  this  instrument  with  rapidity  and  accuracy.  Almost 
any  object  of  fixation  may  be  used,  and  at  any  distance  from  the 
eyes.  The  value  of  the  double  prism  is,  that  it  is  easier  to  deter- 
mine whether  three  points  are  in  the  same  straight  line  than  whether 
(as  in  Stevens’s  phorometer)  two  points  are  in  an  exactly  horizontal 
or  vertical  line,  as  the  case  may  be.  I believe  that  the  credit  of 
suggesting  this  use  of  the  double  prism  is  due  to  Savage,  although 
the  first  model  of  this  instrument  was  made  long  before  his  sugges- 
tion came  under  my  observation. 

So  far  as  accuracy  is  concerned,  there  is  a substantial  agreement 
in  the  results  obtained  by  the  use  of  the  Stevens  phorometer,  the 
rod  test,  and  the  little  instrument  above  described.  Bissell  has  made 
a series  of  comparisons  of  the  rod  and  prism  tests.  In  fifty-two 
cases  of  heterophoria,  the  findings  of  the  rod  test  were  greater  than 
those  of  the  prism  test  in  twenty-six,  the  differences  ranging  from 
0.25  to  4 prism  dioptries,  from  which  he  concludes  that  the  rod  test 
is  the  more  accurate.  I do  not  believe  that  this  accords  with  the 
experience  of  observers  generally. 

For  the  determination  of  “ insufficiencies  of  the  oblique  muscles,” 
Savage  employs  the  double  prism  before  one  eye,  and  a horizontal 
stripe  at  a distance  of  eleven  inches,  as  a test  object.  If  there  is  an 
insufficiency  present,  the  middle  line  will  run  obliquely  between  the 
other  two,  the  direction  of  the  obliquity  being  dependent  upon  the 
particular  muscle  at  fault. 

Heterophoria  may  be  measured  in  degrees  of  refracting  angle,  or 
of  minimum  deviation  ; in  prism  dioptries,  in  metre-angles,  or  in 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORIA.  419 


centigrades.  The  most  common  method  is  to  use  the  refracting 
angle  of  the  necessary  prism.  There  is  at  present,  no  agreement 
among  oculists  as  to  the  most  desirable  of  the  various  reforms  that 
have  been  suggested. 

Symptoms. — In  attempting  to  enumerate  the  symptoms  of  hetero- 
phoria, we  enter  at  once  upon  debatable  ground.  A wide  difference 
of  opinion  prevails  among  physicians  as  to  the  symptoms  which 
heterophoria  is  capable  of  setting  up.  On  the  one  hand  is  a class  of 
enthusiasts  who  claim  for  this  disorder  the  power  of  exciting  nu- 
merous, remote  and  profound  alterations  in  the  functions  of  the  ner- 
vous system,  extending  its  effects  to  include  chorea,  epilepsy  and 
insanity.  In  support  of  this  claim,  clinical  experience  in  these 
affections  is  set  forth,  showing  that  they  have  sometimes  been  re- 
lieved by  proper  treatment  directed  to  the  heterophoria  alone.  On 
the  other  hand  there  are  those  who  deny  these  claims  in  toto  and 
presumably  upon  scientific  grounds.  It  is  difficult  to  deny  the  evi- 
dence of  one’s  own  experience,  or  that  of  other  competent  observers, 
but  it  is  not  always  easy  to  interpret  clinical  facts.  So  far  as  con- 
cerns the  cure  of  remote  disturbances  of  the  nervous  system,  such  as 
epilepsy,  for  example,  by  the  performance  of  graduated  tenotomy,  it 
must  be  borne  in  mind  that  in  idiopathic  epilepsy  at  least,  patients 
have  often  recovered  as  an  apparent  result  of  a variety  of  surgical 
operations,  such  as  trepanation  without  discoverable  lesion  of  the 
brain  or  meninges;  circumcision  for  phimosis  ; the  excision  of  scar- 
tissue  ; the  removal  of  bullets,  and  many  other  diverse  procedures. 
It  is  of  the  greatest  importance  to  observe  the  fact  that  there  is  often 
a curative  influence  in  a purely  indifferent  surgical  operation.  Thus 
we  have  recorded  cases  where,  independent  of  the  direct  and  proper 
results  of  the  operation,  abdominal  tumors  of  considerable  size  have 
disappeared  after  a simple  incision  of  the  abdominal  walls,  and  hip- 
disease  has  been  cured,  it  is  said,  by  removal  of  the  fore-skin.  Even 
without  the  hypothetical  effects  of  trauma  upon  the  nutrition,  func- 
tional and  organic  diseases  have  not  infrequently,  I think,  been  cured 
simply  by  some  radical  change  in  the  patient’s  emotional  state.  My 
attention  has  just  been  called  to  a case  of  cataract  reported  as  cured 
by  “ Christian  Science.”  From  the  accumulated  evidence  now  at 
hand,  I believe  that  hardly  more  can  be  affirmed  than  that  these 
remote  neuroses  may  in  rare  instances  be  among  the  symptoms  of 
heterophoria,  but  that  their  claim  to  such  a place  has  not  yet  been 
established  beyond  cavil. 


420 


world’s  homoeopathic  congress. 


Seguin  has  recently  given  a provisional  statement  of  the  symptoms 
of  certain  forms  of  eye-strain.  According  to  this  writer,  paresis 
(insufficiency)  of  the  third  cerebral  nerves  and  attached  muscles  (in 
which  condition  we  may  get  exophoria  or  hyperphoria  or  both)  is 
marked  by  certain  rather  definite  symptoms,  of  which  he  regards 
occipito-cervical  pain  and  distress  as  the  most  characteristic.  ‘‘The 
pain,”  he  says,  “ diurnal,  as  a rule,  and  often  not  appearing  until  the 
patient  has  used  his  eyes  in  dressing,  eating  or  reading,  is  usually 
greatest  between  the  occipital  bone  and  the  second  vertebra,  though 
it  often  extends  from  the  upper  part  of  the  occiput  to  the  fourth  or 
even  sixth  vertebra.  It  is  sometimes  more  a ‘distress’  than  a true 
pain,  and  is  often  accompanied  by  sensations  of  stiffness  and  tight- 
ness (‘  as  if  a hand  grasped  the  neck  ’).  There  is  never,  strictly 
speaking,  neuralgia  of  the  occipital  nerves,  or  objective  rigidity,  as 
in  beginning  caries.  Tenderness  is  rarely  found,  though  in  women 
spinal  hypersesthesia  (so-called  spinal  irritation)  often  coincides.  Fre- 
quently there  is  a sensation  of  weight  or  downward  pressure  on  the 
back  part  of  the  head,  with  (usually)  intermittent  numbness  (a  ‘dead’ 
or  ‘ wooden  ’ feeling)  and  formication.  In  some  cases  the  fulness  or 
tightness  (cincture  or  cap  feeling)  extends  to  the  whole  head.  Appa- 
rent loss  of  power  of  attention  and  concentration  (volition)  is  much 
complained  of,  even  to  a degree  simulating  mental  failure.  Reading, 
writing,  sewing,  piano  practice,  conversation,  even  eating,  are  pain- 
ful or  unbearable;  in  other  words,  the  symptoms  are  increased  by 
any  act  requiring  convergence  and  accommodation.  The  prolonged 
duration  of  these  symptoms,  or,  rather,  of  the  strain,  may  lead  to 
neurasthenia,  insomnia  and  a curious  mixture  of  hysteria  and  hypo- 
chondria, so  that  the  diagnosis  becomes  more  obscure.  Headache  is 
not  rare,  but  in  such  cases  there  are  also  faults  in  refraction  or  other 
factors.  Simple  asthenopia,  sense  of  fatigue,  or  pain  in  the  eyes, 
orbits,  brow  or  temples,  is  only  occasional,  and  seldom  a prominent 
symptom.  Uusually  the  patient  pretends  to  have  strong  eyes.” 

Payne  has  recorded  a somewhat  similar  classification,  referring  the 
occipital  headaches  to  exophoria  and  hyperphoria.  He  adds  the 
additional  symptom  that  these  patients  show  marked  inability  to  use 
their  eyes  at  night,  while  their  ordinary  use  in  the  daytime  is  com- 
paratively easy.  Frontal  pain  or  headache  is  referred  to  excessive 
strain  of  convergence  or  accommodation,  as  in  hyperopia  and  astig- 
matism. 

The  symptoms  of  esophoria  are  less  clearly  marked.  Seguin 


THE  STUDY  AND  CORRECTION  OF  HETEROPIIORIA.  421 


notes,  as  associated  with  paresis  of  the  “ sixth  cerebral  nerves/’  that 
a sense  of  confusion,  or  dizziness,  not  a true  vertigo,  is  one  of  the 
most  prominent  symptoms.  The  use  of  the  eyes  for  distant  objects, 
walking  in  the  streets,  contact  and  business  with  other  persons,  at- 
tendance at  church  or  in  the  theatre,  sight-seeing,  shopping  and  sim- 
ilar occupations  may  be  productive  of  great  distress  to  the  patient, 
who  feels  better  when  quiet  and  alone.  “ Various  and  peculiar  sen- 
sations are  felt  in  the  head,  such  as  a sense  of  fulness,  ‘ as  if  the 
head  would  burst ;’  a downward  pressure  on  the  head,  diffused  or 
localized,  ‘ as  if  a stone  or  sharp  stick  ’ pressed  on  it;  a sense  of 
constriction,  general  or  cincture-like;  pain  in  various  areas  of  the 
scalp;  occasional  feelings  of  numbness  (a  ‘dead  ’ or  ‘wooden’  feel- 
ing), or  of  formication  or  worm-like  crawling,  also  variously  dis- 
tributed; a quasi-tinnitus,  or  noise  in  the  head  (not  in  the  ears)  is 
not  rare.”  (Seguin.) 

The  symptoms  of  esophoria  are  not  so  characteristic  as  those  of 
exophoria  and  hyperphoria,  and  will  be  seen  to  overlap  them. 

Insomnia  and  general  nervous  debility  are  said  to  be  not  uncom- 
mon results  of  continued  eye-strain.  In  the  eyeball  itself  there  are 
reasons  to  believe  that  various  forms  of  local  inflammatory  affections, 
such  as  conjunctival  hypersemia,  blepharitis,  ulcers,  etc.  (Stevens), 
may  sometimes  be  indirectly  dependent  upon  eye-strain.  Stevens 
has  called  attention  to  certain  facial  expressions  characteristic  of  the 
various  forms  of  heterophoria.  In  esophoria,  for  example,  the  brows 
are  compressed,  with  the  inner  end  curving  down  toward  the  nose; 
lines  upon  the  forehead  low.  In  exophoria  the  brows  are  raised  or 
arched;  lines  upon  the  forehead  high.  In  hyperphoria  the  features 
are  more  irregular,  and  one  eyebrow  is  compressed  or  drawn  down, 
to  correspond  with  the  hyperphoria. 

Treatment. — Here,  again,  we  enter  upon  a subject  where  widely 
different  opinions  are  held.  In  approaching  the  question  of  treat- 
ment we  must  not  fail  to  bear  in  mind  the  various  causes  which  may 
lie  back  of  the  heterophoria.  I am  convinced  that  an  intelligent 
appreciation  of  the  causation  in  a given  case,  where  possible,  will 
often  lead  to  a more  just  treatment  than  could  be  given  by  any  man- 
ner of  routine.  It  is  true  that  it  is  often  impossible  to  ascertain  the 
cause  in  a given  case  of  heterophoria  with  any  exactness,  but  even  a 
reasonable  inference  is  highly  desirable.  Thus,  in  a case  of  exopho- 
ria due  to  paresis  of  the  internal  recti  from  general  debility  or  over- 


422 


world’s  homoeopathic  congress. 

work,  it  would  be  manifestly  improper  to  resort  to  tenotomy  for  its 
correction,  while  if  it  were  due  to  the  anatomical  changes  in  the  eye- 
ball incident  to  a high-grade  myopia,  the  surgical  procedure  might 
be  eminently  proper. 

The  treatment  of  heterophoria  should  begin  with  the  determination 
of  the  following  points: 

1.  The  amount  and  character  of  the  heterophoria:  a,  for  infinity; 

b , for  reading  distance:  i.e .,  metre. 

2.  The  mobility  of  the  eyeballs  in  various  directions. 

3.  The  refraction. 

4.  The  muscular  power;  a,  adduction;  b,  abduction;  c,  sursum- 
duction  ; d,  amplitude  of  convergence. 

5.  The  relative  accommodation;  a,  for  infinity;  b,  for  reading 
distance. 

The  practical  value  of  these  determinations  is  evident.  That  of 
the  relative  accommodation  will  be  necessary  or  at  least  useful,  in 
certain  cases  only.  The  amplitude  of  convergence  may  be  deter- 
mined by  means  of  Landolt’s  ophthal mo-dynamometer,  for  its  posi- 
tive, and  abducting  prisms  for  its  negative  portion.  The  informa- 
tion which  it  supplies  is  largely  contained  in  the  determinations  of 
the  adduction  and  abduction.  Thus  if  the  negative  convergence — 
abduction — in  a given  case  is  markedly  defective,  tenotomy  of  the 
internal  recti  muscles  for  exophoria  would  be  inadmissible. 

Hyperphoria. — Stevens  states  that  the  treatment  for  hyperphoria 
is  tenotomy.  This  statement  is  in  accord  with  my  own  experience. 
In  some  cases,  where  there  is  an  error  of  refraction  requiring  the 
constant  use  of  glasses,  a correcting  prism  may  be  incorporated  with 
them,  and  give  satisfactory  relief.  Or  with  emmetropic  eyes,  the 
prism  may  be  mounted  in  spectacle  frames  and  worn  constantly. 

It  is  questionable  what  internal  remedies  can  do  for  the  relief  of 
hyperphoria.  The  late  Geo.  S.  Norton,  M.D.,  in  1889,  called  attention 
to  the  provings  of  Senega  and  Onosmodium,  and  their  usefulness  in 
affections  of  the  ocular  muscles,  and  reported  a number  of  cases  in 
which  these  drugs  had  been  used  with  apparent  benefit.  The  value 
of  Senega  in  hyperphoria  has  been  made  the  subject  of  a recent  com- 
munication by  Linnell,  but  as  I have  elsewhere  endeavored  to  show,* 
the  usefulness  of  the  remedy  in  this  disorder  is  by  no  means  proven 


* Jour.  0.,  0.  and  L.,  April,  1893. 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORIA. 


423 


by  the  cases  related.  Indeed,  the  provings  of  Senega  do  not  show 
any  special  adaptability  of  the  drug  to  hyperphoria,  so  far  as  we 
understand  the  symptoms  of  this  affection.  Nevertheless,  it  might 
have  an  empirical  or  clinical  value,  but  the  evidence  even  here  is 
defective.  Norton  says  that  the  symptoms  calling  for  Senega,  are 
“dull,  tired,  aching,  pressing  pains  in  the  eyes,  or  throughout  the 
whole  head,  with  smarting  and  burning  in  the  eyes,  always  worse 
after  using  them  and  often  accompanied  by  catarrhal  symptoms  of 
the  conjunctiva.” 

Onosmodium  has  many  symptoms  of  heterophoria  in  its  proving, 
e.g.,  occipital  headache;  a dull  aching  pain  extending  down  the 
back  of  the  neck,  or  over  one  side  of  the  head,  generally  the  left ; 
vertigo,  with  strained  or  stiff  sensation  in  the  eyes,  aggravated  by 
use  of  the  eyes  for  near  work.  Gelsemium  has  a transient  vertical 
diplopia,  and  may  be  of  value  in  those  cases  of  hyperphoria  accom- 
panied with  the  paretic  or  other  characteristic  symptoms  of  the 
remedy.  Stramonium  shows  a marked  vertical  diplopia  in  its  prov- 
ings. The  importance  of  this  symptom  in  the  proving  of  a drug,  is 
simply  that  it  indicates  that  the  drug  has  a direct  influence  upon 
these  muscles  which  are  concerned  in  the  production  of  hyperphoria. 
We  do  not  find  diplopia  (unless  it  be  transitory)  in  heterophoria. 
But  as  a drug-symptom,  diplopia  is  an  indication  that  the  remedy 
has  an  action  along  the  line  in  which  we  seek  for  curative  effects, 
and  suggests  that  it  may  possess  valuable  therapeutic  properties  in 
the  treatment  of  affections  of  the  upward  and  downward-turning 
muscles  of  the  eyes.  So  far  as  the  applicability  of  these  or  other 
drugs  to  the  cure  of  hyperphoria,  is  concerned,  the  evidence  in  their 
favor,  is  at  the  best,  obscured  by  the  fact  that  in  almost  all  of  the 
cases  reported,  other  treatment  than  the  medicinal  was  given  the 
patient,  so  that  the  action  of  the  remedy  is  not  clearly  shown. 
Norton,  himself,  limits  all  attempts  at  a cure  by  remedies  to  hyper- 
phoria of  less  than  2°.  In  higher  degrees,  an  immediate  tenotomy 
was  advised. 

Systematic  exercise  of  the  affected  muscles  by  means  of  prisms, 
has  been  used  and  recommended  as  a cure  for  hyperphoria,  and  the 
clinical  evidence  in  our  hands  is  favorable  to  its  usefulness.  In  hy- 
perphoria of  1°  and  perhaps  2°,  if  persisted  in,  it  may  effect  a cure, 
but  in  higher  degrees  it  does  not  seem  to  be  of  much  value. 

In  a case  where  there  is  a manifest  hyperphoria  of  say  1°,  circum- 


424 


world’s  homoeopathic  congress. 


stances  often  suggest  that  there  is  an  additional  amount  that  is 
latent,  and  a correcting  prism  is  prescribed,  to  be  worn  constantly, 
for  the  purpose  of  revealing  this  latent  defect.  Under  these  circum- 
stances, in  many  instances,  the  daily  examination  will  show  an 
apparent  increase  in  the  hyperphoria,  until  we  may  have  developed 
in  the  course  of  a week,  beginning  with  1°,  as  much  as  5°  or  more. 
This  final  amount  is  then  accepted  as  the  total  of  the  real  hyperpho- 
ria present,  and  made  the  basis  of  an  operative  correction.  Now 
while  it  may  happen  that  latent  hyperphoria  can  be  made  manifest 
in  this  way  in  some  instances,  we  must  not  lose  sight  of  the  fact  that 
under  the  constant  influence  of  a prism,  the  normal  equilibrium  of 
the  eyes  will  often  be  temporarily  changed  so  as  to  generate  a species 
of  false  heterophoria.  Thus  it  is  possible  to  produce  at  will  exo- 
phoria  or  esophoria  in  the  same  eyes,  by  wearing  prisms  with  the 
base  in  or  out,  as  the  case  may  be,  and  either  right  or  left  hyper- 
phoria, as  we  please,  in  a similar  manner.  The  heterophoria  thus 
produced  is  of  variable  duration,  but  always  temporary.  It  may 
not  be  possible  always  to  distinguish  between  the  factitious  and  the 
real  defect.  The  increased  relief  of  concomitant  symptoms,  by  the 
corrected  increase  in  the  manifest  heterophoria,  if  it  occurs,  or  the 
greater  permanency  of  the  disordered  equilibrium,  might  serve  as 
distinguishing  marks,  but  if  we  accept  as  the  true  state  of  muscular 
equilibrium,  that  shown  while  the  eyes  are  under  the  influence  of 
prisms  constantly  worn,  we  are  treading  upon  dangerous  ground, 
and  if  it  is  taken  as  the  guide  to  the  extent  of  the  operation,  we  are 
apt  to  afflict  our  patients  with  an  over-correction. 

With  regard  to  the  details  of  the  operation  itself,  I have  little  to 
say,  except  that  in  tenotomy  of  the  rectus  superior,  care  must  be 
taken  to  make  the  incision  high  enough,  so  that  the  tendon  of  the 
muscle  will  lie  in  the  wound.  Rather  than  to  fail  in  this  respect, 
the  operator  should  measure  the  necessary  eight  mm.  from  the  cor- 
neal margin  with  exactness.  In  my  experience,  complete  section  of 
the  tendon  is  often  required  for  the  correction  of  even  low  degrees  of 
hyperphoria.  The  lid  retractor,  held  by  an  assistant  is  much  more 
comfortable  for  the  patient  than  the  spring  speculum.  At  the  end 
of  the  operation,  the  correction  should  be  as  nearly  perfect  as  pos- 
sible. If  an  over-correction  is  made,  an  appropriate  advancement 
is  easily  done. 

Exophoria  and  Esophoria. — As  in  the  treatment  of  hyperphoria, 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORIA.  425 


we  have  here  a variety  of  methods  to  choose  from  ; surgical,  gym- 
nastic, hygienic  and  medicinal.  As  indicated  above,  we  are  to  be 
guided  by  the  causes  lying  back  of  the  particular  troubles  in  ques- 
tion, so  far  as  we  are  able  to  discover  them.  There  is  associated  with 
most  cases  of  disturbed  muscular  equilibrium  a defective  ratio  ,of 
abduction  and  adduction,  as  well  as  positive  deficiencies  in  muscular 
power.  Thus  in  a typical  case  of  exophoria,  we  may  find  that  the 
adduction  is  abnormally  low,  or  the  abduction  excessively  high.  In 
the  exceptional  and  irregular  cases  this  does  not  obtain.  We  may 
have  exophoria  with  an  adduction  of  40°  or  50.°  Or  there  may  be 
exophoria  in  remote  vision  and  esophoria  for  the  near  point ; or  the 
reverse  may  be  true.  Out  of  two  hundred  and  twenty-nine  cases 
of  exophoria,  Norton  found  ten  with  esophoria  in  accommodation; 
in  one  hundred  and  fifty-eight  cases  of  esophoria  there  were  sixty- 
eight  with  exophoria  in  accommodation.  These  atypical  cases  are 
credited  to  the  disturbing  influence  of  hyperphoria,  and  the  recom- 
mendation is  made  to  correct  this  before  undertaking  the  correction 
of  the  lateral  disturbances.  In  some  cases  clinical  experience  seems 
to  justify  this  assumption.  Upon  theoretical  grounds  however, 
there  would  not  seem  to  be  any  satisfactory  explanation  of  what  we 
may  call  “crossed  heterophoria,”  in  a faulty  innervation  of  the  supe- 
rior or  inferior  recti  muscles.  It  is  true  that  there  is  a slightly  in- 
creased tension  of  these  muscles  in  the  act  of  convergence,  but  this 
seems  hardly  enough  to  account  for  the  abnormal  conditions  so  fre- 
quently met  with.  As  I have  elsewhere  suggested,  a more  rational 
and  satisfactory  explanation  of  “ crossed  heterophoria  ” may  be 
found  in  the  relations  between  accommodation  and  convergence.  If 
we  have  a case  of  slight  esophoria  in  remote  vision,  for  example,  it 
is  easy  to  conceive  that  in  convergence  for  the  near  point,  exophoria 
might  result  from  an  enfeebled  power  of  accommodation,  by  which 
the  added  stimulus  of  the  accommodative  act  was  not  adequate  to 
maintain  the  necessary  convergence.  This  is  easily  shown  in  an 
experimental  way,  by  observing  the  effect  of  convex  and  concave 
glasses  upon  the  position  of  equilibrium  of  the  eyes  in  fixation  for 
the  near  point.  If  we  have  orthophoria,  or  a low  degree  of  eso- 
phoria for  distance,  we  can  obtain  exophoria  at  the  near  point,  by 
decreasing  the  amount  of  accommodation  in  use  for  that  point  by 
means  of  convex  glasses.  Exophoria  may  be  transformed  into 
esophoria  or  into  orthophoria  in  a like  manner,  by  means  of  concave 


426 


world’s  homoeopathic  congress. 


glasses.  These  experiments  show  very  clearly  the  ease  with  which 
<f  crossed  heterophoria  ” may  be  explained  independently  of  a real  or 
hypothetical  hyperphoria.  They  also  suggest  a possible  method  of 
treatment  in  some  cases  by  such  exercise  of  the  accommodation  as 
will  increase  its  positive  range.  Clinical  experience  to  justify  this 
suggestion  is  wanting,  as  cases  entirely  appropriate  to  it  have  not 
come  under  my  observation  since  the  idea  occurred  to  me.  I am 
satisfied  however,  that  the  key  to  the  explanation  and  treatment  of  a 
good  many  puzzling  cases  of  heterophoria  will  be  found  in  a study 
of  the  relations  between  the  accommodation  and  convergence,  and  in 
the  relative  amplitude  of  accommodation. 

Tenotomy  of  the  stronger  muscle  after  the  method  of  Stevens  is  a 
familiar  method  of  treatment.  The  extent  of  the  operation  is  de- 
termined by  the  amplitude  of  convergence.  If  we  have  exophoria 
with  subnormal  abduction  for  the  far  point,  it  will  be  improper  to 
tenotomize  the  already  weak  muscles.  In  fact,  it  may  be  laid  down 
as  a general  rule,  that  a tenotomy  is  indicated  in  exophoria  only 
when  there  is  an  absolute  or  relatively  excessive  abduction.  In  the 
contradictory  cases,  the  treatment  must  first  be  directed  to  increasing 
the  power  of  the  weak  muscles,  and  of  the  accommodation,  if  nec- 
essary. If  there  is  hyperphoria  present,  it  may  be  relieved.  The 
immediate  effects  of  a tenotomy  upon  the  lateral  muscles  may  exceed 
the  final  effect  desired  by  1°  or  2.°  It  is  highly  important  that  the 
operation  be  made  with  the  least  possible  disturbance  of  the  tissues 
surrounding  the  muscle,  so  that  there  may  be  as  little  restriction  of 
motion  following  it  as  is  consistent  with  the  correction  of  the  hetero- 
phoria. The  patient  will  commonly  complain  of  diplopia  in  looking 
to  the  extreme  limit  of  the  field  in  the  direction  of  the  tenotomized 
muscle,  and  it  may  be  many  months,  or  even  a year  or  two  before 
this  will  disappear.  If  the  operation  has  not  been  too  extensive, 
normal  mobility  will  be  eventually  recovered. 

In  many  cases  of  lateral  heterophoria,  a tenotomy  is  unnecessary. 
The  muscular  balance,  when  but  slightly  deranged,  will  often  be  re- 
stored by  the  gymnastic  use  of  prisms.  This  method  of  treatment 
will  require  numerous  and  frequent  sittings.  I prefer  to  add  to  the 
office  treatments  the  gymnastic  use  of  prisms  by  the  patient  several 
minutes  daily,  increasing  the  strength  of  the  prism  as  the  adduction 
or  abduction  becomes  greater.  This  exercise  with  prisms  is  to  be 
recommended  in  all  cases  where  the  convergence  is  abnormal,  even 


THE  STUDY  AND  CORRECTION  OF  HETEROFHORTA.  427 


though  an  operation  be  in  view,  and  should  be  continued  until  as 
nearly  a normal  balance  of  power  as  possible  is  secured. 

Therapeutics — The  sphere  of  action  of  remedies  in  the  treatment 
of  heterophoria  is  not  well  defined.  The  reason  for  this,  lies  in  the 
fact  already  alluded  to,  that  specialists  are  usually  unwilling  tore- 
strict  themselves  to  internal  medication,  but  must  correct  by  mechan- 
ical or  surgical,  or  by  other  accessory  means,  obvious  defects  in  the 
eyes.  Thus  errors  of  refraction  and  accommodation  must  be  cor- 
rected, and  the  use  of  systematic  exercise  and  electricity  are  at  least 
very  common  accompaniments  of  the  indicated  remedy.  This  com- 
pounding of  remedial  measures,  together  with  the  somewhat  uncer- 
tain knowledge  in  our  possession  as  to  the  natural  history  of  eye 
strain,  combine  to  increase  the  skepticism  in  the  value  of  drugs, 
which  the  specialist  seems  naturally  to  possess.  Speaking  simply 
from  my  own  experience,  candor  compels  me  to  say  that  evidences 
of  beneficial  effects  from  medicine  in  heterophoria  are  very  obscure. 
Still  there  are  many  men  in  our  school  who  think  otherwise, 
and  this  failure  on  my  part  may  be  a personal  fault.  Even  among 
those  who  are  the  most  sanguine  in  the  use  of  remedies,  however,  it 
is  fair  to  say  that  their  employment  is  made  to  play  a secondary  part 
to  the  other  methods  we  have  considered.  They  are  held  to  be  use- 
ful adjuvants,  rather  that  the  principal  factors  in  the  cure,  and  are 
often  resorted  to,  chiefly  when  other  means  have  failed.  It  is  far 
from  my  intention  to  disparage  the  use  of  internal  remedies  in  the 
treatment  of  ocular  disorders,  and  certainly  when  we  are  called  upon 
to  avail  ourselves  of  their  help,  our  law  of  therapeutics  gives  us  the 
most  satisfactory  guide;  yet  it  cannot  be  denied  that  surgical,  me- 
chanical and  empirical  local  and  constitutional  methods  are  the 
stock-in-trade  of  the  great  majority  of  even  those  oculists  who  call 
themselves  “ homoeopaths”  If  it  were  less  so,  perhaps  it  would  be 
better,  but  we  are  called  upon  to  face  the  facts  as  they  are,  not  as  we 
think  they  ought  to  be.  If  we  have  any  better  success  in  the  prac- 
tice of  any  branch  of  medicine  than  our  Old-School  colleagues,  it  is 
due  directly  or  indirectly  to  our  law  of  therapeutics.  We  cannot 
afford  then,  to  indulge  in  too  much  skepticism  as  to  the  value  of 
drugs. 

Of  the  remedies  likely  to  be  of  benefit  in  heterophoria,  the  follow- 
ing may  be  mentioned  as  among  the  most  important : Onosmodium, 
Gels.,  Senega,  Stram.,  Bry.,  Phos.,  Natr.  mur.,  Ruta.,  Calc,  phos., 
Argent,  nit. 


428 


world’s  homoeopathic  congress. 


Discussion. 

John  E.  Payne,  M.D.  : This  admirable  paper  has  so  covered 
the  ground  of  our  present  knowledge  of  this  subject  as  to  leave  but 
little  opportunity  for  other  than  a statement  of  our  individual  expe- 
rience in  such  cases.  That  heterophoria  does  exist  there  can  be  no 
doubt,  but  tests  of  positive  demonstration  have  been  so  inadequate 
as  to  deter  the  cautious  observer  from  the  application  of  any  remedy 
that  can  not  be  readily  annulled  should  occasion  demand.  We  will 
look  forward  with  much  expectancy  to  the  workings  of  Dr.  Wilson’s 
improved  instrument,  a description  of  which  he  has  been  so  kind  as 
to  give  us.  All  prism  tests  heretofore  devised  have  had  the  disad- 
vantage of  being  inaccurate  when  used  over  strong  convex  or  con- 
cave lenses  improperly  centered.  Rapid  work  is  manifestly  impos- 
sible under  these  conditions,  especially  when  testing  for  small 
degrees  of  heterophoria.  A strong  cylinder  lens  decentered  in  the 
meridian  of  its  greatest  curvature  may  upset  all  our  elaborate  meas- 
urements, and  lead  us  into  errors  of  treatment. 

We  know  that  the  persistent  use  of  prisms  has  power  to  induce 
simulated  heterophoria;  why  not  therefore  the  same  of  strong  convex 
or  concave  spherical  or  cylinder  lenses  improperly  centered.  As  a 
preliminary  therefore  to  all  tests  for  heterophoria  we  must  make 
accurate  adjustments  of  all  lenses  correcting  errors  of  refraction. 
Then  as  to  times  for  making  measurements;  I have  found  that  inner- 
vation of  the  recti  is  greater  in  early  morning  and  in  evening  hours, 
the  maximum  of  control  being  during  the  middle  of  the  day.  This 
I have  been  accustomed  to  ascribe  to  the  temporary  muscular  inac- 
tivity that  is  an  integral  part  of  our  existence  after  prolonged  repose 
in  sleep,  in  case  of  the  morning  hours,  and  to  the  fatigue  that  follows 
a day’s  exertion,  in  the  evening  hours.  I have  found  a difference  of 
as  much  as  four  degrees  in  exophoria.  Surely  this  must  have  an  im- 
portant bearing  on  our  final  diagnosis.  Again,  who  can  say  from 
our  present  methods  of  examination  that  a case  of  heterophoria  that 
presents  itself  to  us  is  not  quite  as  much  due  to  a spasm  of  one  of  the 
recti  muscles  as  to  an  insufficiency,  or  innervation,  of  its  opponent  ? 
My  experience  would  lead  me  to  suppose  that  such  is  the  fact  in 
some  cases  at  least,  if  not  in  a majority.  During  my  early  study 
of  heterophoria  I had  occasion  to  operate  on  several  cases  of  exo- 
phoria, and  to  my  surprise  I found  that  a very  careful  tenotomy  per- 
formed on  one  of  these  by  the  Stevens’  method  (without  the  use  of 
strabismus  hook,  and  making  the  conjunctival  opening  very  small 
and  exactly  over  the  tendinous  insertion)  was  followed  by  a swing- 
ing in  of  the  eye  to  an  over -convergence  of  16  degrees  from  an  over- 
divergence  of  10  degrees,  and  by  a decided  diplopia.  The  eye  seemed 
literally  to  “ snap  ” inwards,  such  force  was  used  by  the  internus. 
This  case  presented,  previous  to  the  operation,  a very  limited 
adduction  with  an  exaggerated  abduction.  I have  since  had  the 
experience  repeated.  If  the  trouble  had  been  due  to  an  innervation 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORIA.  429 


of  the  interims,  as,  previous  to  the  operation,  I had  supposed  it  to  be, 
whence  came  its  sudden  accession  of  strength  when  freed  from  the 
restraint  of  its  opponent  ? It  seems  more  reasonable  to  ascribe  the 
whole  trouble  to  a tonic  spasm  of  the  externus,  causing  limited 
adduction  and  decided  exophoria,  than  to  place  it  in  the  usual  cate- 
gory of  weakened  interni.  These  cases  also  suggest  that  our  present 
methods  of  testing  the  actual  strength  of  the  muscles  are  misleading, 
and  that  a limited  adduction  or  a limited  a&duetion  are  merely  such 
relatively,  and  not  sufficiently  positive  in  demonstration  of  individ- 
ual strength  as  to  allow  us  to  apply  such  radical  treatment  as 
tenotomy. 

Dr.  Wilson  has  mentioned  Dr.  Seguin’s  observation  of  a “ quasi- 
tinnitus, or  noise  in  the  head,”  accompanying  esophoria  due  to 
“ paresis  of  the  6th  cerebral  nerves.”  I can  bear  testimony  to  a like 
experience,  in  two  cases  of  exophoria.  In  these,  the  noise  was  de- 
scribed as  a singing,  like  crickets  or  grasshoppers  in  a field,  appar- 
ently located  in  the  ears  themselves,  and  coming  on  after  prolonged 
use  of  the  eyes.  One  patient  said  that  he  considered  the  advent  of 
this  symptom  a warning  to  desist  from  the  use  of  his  eyes,  which, 
if  neglected,  would  result  in  a severe  occipital  headache  the  follow- 
ing day.  An  examination  of  his  tympanic  membranes  disclosed  a 
progressive  subacute  catarrh  of  the  tympanic  cavity  and  membrane, 
with  some  thickening  of  the  latter,  and  a perceptible  diminution  of 
the  acuteness  of  hearing.  The  other  case  was  not  examined  with 
reference  to  this. 

Regarding  treatment,  my  experience  has  not  as  yet  led  me  to 
place  much  reliance  in  the  efficacy  of  internal  medication,  but  rather 
to  prefer  mechanical  methods,  such  as  prisms  and  gymnastic  exer- 
cises, combined  with  general  hygienic  measures.  The  use  of  low 
degrees  of  prisms  (the  1°  or  the  2°  before  each  eye)  in  exophoria  and 
in  esophoria,  even  in  high  degrees  of  aberration,  combined  with  gym- 
nastic exercise  at  intervals  of  two  to  three  days,  under  personal  ob- 
servation and  manipulation,  has  done  more  than  anything  else  to 
secure  a restoration  of  painless  vision  to  the  patient.  Prisms  of  high 
degree  do  not  accomplish  more  in  such  cases,  and  they  eventually 
become  an  element  of  dependence  that  will,  in  the  end,  cause  an  ex- 
aggeration of  the  symptoms. 

Permit  me  to  call  your  attention  to  a Homoeopathic  remedy  that 
I do  not  find  mentioned  in  Dr.  Wilson’s  list,  but  which  I have  found 
useful  in  cases  of  hyperopic  astigmatism  combined  with  various 
forms  of  heterophoria;  I refer  to  Santonme.  The  special  symptoms 
calling  for  its  exhibition  seem  to  be:  A flickering  before  the  eyes; 
objects  seem  to  waver  and  dance;  photophobia  and  lachrymation  ; 
all  of  which  are  induced  by  use  of  the  eyes  at  close  range.  It  seems 
to  serve  in  those  cases  where  Ruta  is  indicated,  but  with  the  addi- 
tional symptom  of  “ unsteadiness  of  objects.” 


430 


WORLD  S HOMOEOPATHIC  CONGRESS. 


Dr.  Linnell:  I have  listened  to  Dr.  Wilson’s  paper  with  very 
great  interest.  This  matter  of  muscular  errors  is  one  which  attracts 
a great  deal  of  attention  in  the  last  few  years,  and  is  certainly  of 
much  importance.  I have  given  the  matter  careful  attention,  and 
much  has  been  written  of  the  experience  of  others.  I have  had  the 
satisfaction  of  curing  several  cases  of  Dr.  Stevens’s,  and  he  has  ope- 
rated a number  of  times  and  left  the  patient  in  a worse  condition 
than  he  was  at  first.  It  seems  to  me  that  the  tendency  to  operate  in 
these  cases  is  sometimes  too  great.  Surgery  is  more  brilliant  than 
the  treatment  by  internal  medication,  and  I think  the  tendency  is 
to  operate  in  many  cases  where  a cure  could  be  effected  as  well  by 
other  means.  Moreover,  it  seems  more  scientific,  if,  by  any  means 
of  treatment,  or  combination  of  treatment,  we  can  produce  two  strong 
muscles,  rather  than  by  crippling  one  muscle  to  relieve  two  weaker 
ones.  For  that  reason  it  has  always  been  my  endeavor  to  treat  these 
cases  by  remedies,  by  suitable  exercise,  leaving  tenotomy  as  a last 
resort.  Dr.  Wilson,  in  his  paper,  makes  the  statement  that  we  are 
too  apt  to  trust  our  own  experience,  even  if  it  is  not  supported  by 
the  experience  of  other  people;  and  I wish  here  to  simply  reiterate 
and  emphasize  what  I have  said  elsewhere  in  regard  to  the  cure  of 
heterophoria  by  means  of  internal  medication  in  connection  with  ex- 
ercise and  electricity.  I have  treated  a great  many  patients  of  this 
kind,  and  where  patients  have  been  willing  to  persevere  for  a length 
of  time,  I have  been  able  to  cure  a majority  of  them.  I have  seen 
only  a few  cases  where  I considered  tenotomy  advisable,  and  the  re- 
sults obtained,  even  with  such  operators  as  Dr.  Wilson  and  Dr.  Ste- 
vens, makes  me  still  more  conservative  in  this  respect.  In  regard 
to  trusting  one’s  own  experience,  it  is  a matter  of  positive  convic- 
tion in  my  mind  that  certain  remedies  are  helpful  in  these  muscular 
troubles  ; and  I especially  think  it  true  of  Senega.  I regard  Senega 
as  probably  the  most  important  remedy  in  the  treatment  of  hyper- 
phoria. I am  in  the  habit  of  making  careful  examination,  with 
various  instruments  of  precision,  and  keeping  an  accurate,  detailed 
account  every  day,  watching  the  progress  of  results  intelligently ; and 
I know,  from  my  own  experience — from  the  records  of  my  books — 
that  hyperphoria  can  be  cured  by  Senega  alone,  or  by  Senega  in  con- 
nection with  other  treatment;  and  it  does  seem  to  me  that  this  very 
scientific  practice  is  what  we  should  aim  to  attain,  and  that  surgical 
methods  should  be  left  to  a secondary  importance.  Of  course,  I 
don’t  mean  to  say  that  tenotomy  is  not  the  best  treatment  in  some 
cases,  but  I don’t  think  it  is  the  treatment  for  the  large  majority  of 
cases. 

Dr.  King  : It  is  not  my  desire  to  get  between  these  two  gentle- 
men in  this  pleasing  argument.  I agree  with  both  of  them  in  some 
points,  and  disagree  with  them  in  other  points.  With  reference  to 
the  cure  of  hyperphoria  in  its  various  phases  by  remedies  alone  or 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORfA.  431 


in  connection  with  systematic  exercise  and  other  remedies,  such  as 
electricity,  etc.,  I must  throw  my  experience  in  the  balance  with  Dr. 
Linnell ; that  is,  I feel  satisfied  that  a number  of  cases  of  more  or 
less  hyperphoria — not  high  degrees  though,  however  annoying — are 
decidedly  relievable  and  curable  by  means  of  treatment  outside  of 
operation.  I don’t  believe  that  I can  stand  up  and  say  that  thera- 
peutic treatment  alone  will  cure  those  cases,  because  I haven’t  given 
it  enough  attention.  I have  not  had  confidence  enough,  perhaps,  to 
allow  my  patients  to  get  along  with  the  remedy  alone,  with  anything 
like  a degree  of  hyperphoria  that  was  practically  admissible;  but  I 
do  use  the  remedies  in  connection  with  exercise  and  the  prism  and 
the  currents  of  electricity  also.  I have  used  those  methods  of  treat- 
ment alone  without  electricity,  and  I have  used  the  treatment  with 
the  remedy  in  similar  cases,  and  I have  decided  that  the  remedy 
assists  most  positively.  I believe  that  in  low  degrees  the  remedy 
alone  will  perhaps  in  many  cases  relieve;  but  if  the  exercise  and 
electricity  and  what  notwill  hasten  the  cure,  why  not  apply  it? 
Dr.  Wilson  says  it  interferes  with  scientific  decision.  If  we  have 
certain  cases  in  hospital  practice  outside  of  private  practice,  it  may 
be  well  to  make  that  experiment. 

With  reference  to  the  application  of  remedies,  I simply  want  to 
make  a suggestion — something  that  I cannot  say  much  as  to  its  actual 
usefulness;  that  is,  I cannot  absolutely  tell  you  that  it  is  helping  me 
much,  but  I believe  it  is  and  I think  it  is  perhaps  worth  a trial. 
That  is,  the  application  of  our  remedies  for  muscular  insufficiencies 
locally,  directly  to  the  eye,  in  the  conjunctival  sac.  Gelsemium  two 
or  three  times  a day,  applied  externally,  helps  the  patient  decidedly. 
I have  used  the  tincture  of  Nux  vomica  in  exophoria,  and  tincture 
of  Senega  in  the  same  manner.  I have  read,  and  have  been  told, 
that  it  is  given  in  hyperphoria.  I am  speaking  now  of  the  empiri- 
cal use  of  these  drugs,  for  in  many  cases  you  must  prescribe  them 
empirically.  It  has  been  suggested  to  me,  in  a general  way,  to  use 
some  of  our  other  remedies,  and  I have  taken  these  means,  and  I 
know  that  I have  had  some  good  results  by  the  application  locally 
of  Gelsemium.  Now,  we  know,  if  we  instil  a solution  of  Atropia 
into  the  eye,  and  prevent  its  passage  through  the  caruncula,  that  we 
may  give  a great  deal  before  we  obtain  constitutional  symptoms. 
We  can  go  further  than  that.  We  know  that  if  we  inject  Atropine 
into  the  foot,  ankle,  knee,  etc.,  we  will  soon  have  dilation  of  the 
pupil,  and  it  seems  to  me  that  in  the  application  of  remedies  to  the 
eye,  if  we  restrict  the  action  of  the  remedy  to  the  organ  in  which  it 
is  placed,  we  can  push  the  remedy  much  further  without  obtaining 
physiological  symptoms. 

Dr.  Stewart  : I would  like  to  ask  Dr.  Wilson  how  the  instru- 
ment here  compares  with  the  test  made  by  the  Stevens’  instrument. 
I believe  that  may  be  recognized  or  called  the  standard  or  point  of 


432 


world’s  HOMCEOPATH1C  CONGRESS. 


departure  at  the  present  time.  There  is  an  instrument  of  this  kind 
made  by  Hardy  & Co.,  of  Chicago.  Those  of  you  who  may  be 
interested  in  this  kind  of  instrument  may  be  glad  to  know  of  this 
other  one. 

The  question  of  internal  remedies  calls  to  my  mind  two  cases, 
one  of  exophoria — a symptom  of  a ball  running  around  in  the  base 
of  the  brain,  and  it  gave  the  patient  so  much  distress  that  he  did  not 
want  any  examination  and  would  not  put  up  with  it.  I,  however, 
got  an  examination,  and  found  a certain  degree  of  deviation  there, 
and  then  gave  him  Kali  carb.  Later,  he  came  back,  and  the  exo- 
phoria wasn’t  so  great.  We  can  get  these  changes  by  the  use  of 
remedies,  but  what  the  drug  has  to  do  with  it  I don’t  know.  An- 
other case : the  patient  came  for  an  examination  for  refraction  or 
muscular  troubles,  and  I had  given  her  Crocus,  and  got  relief  from 
that;  that  is,  a diminution  in  the  amount  of  her  trouble,  which  was 
also  an  exophoria. 

This  brings  to  my  mind  Dr.  Savage’s  prisms,  placed  base  to  base. 
A year  ago  he  left  that  subject  in  an  unsatisfactory  condition.  He 
had  demonstrated  that  he  could  tell  with  reasonable  certainty  which 
oblique  muscle  of  either  eye,  the  inferior  or  superior,  was  the  weak 
one,  but  at  that  time  he  did  not  know  any  relief  for  it.  However, 
that  was  in  1891.  A year  ago  he  read  a paper  before  the  American 
Medical  Association,  in  which  he  says  he  can  with  prisms  exercise 
these  muscles  by  putting  this  prism  before  one  eye  with  the  axis  ver- 
tical and  looking  at  it  in  a horizontal  line.  We  see  the  lines,  and, 
on  opening  the  other  eye,  we  see  a third  line,  and  if  that  third  line 
is  situated  obliquely  to  the  other  two,  it  shows  a deviation  of  one  of 
the  oblique  muscles.  Of,  course,  it  depends  upon  which  eye  is  cov- 
ered or  which  eye  has  the  prism.  Then,  by  putting  that  eye  on  the 
two-dioptre  cylinder  (which  is  quite  strong)  and  revolving  it  to  make 
that  eye  open  a little  more,  we  are  working  that  muscle  which  is  at 
fault,  and  by  then  turning  it  up  in  the  other  line  we  can  exercise  the 
oblique  muscles. 

Dr.  Chamberlain:  I am  very  much  interested  in  this  part  of 
the  subject,  as  I suppose  I have  had  my  share  of  experience  in  this 
kind  of  work,  and  I know  that  we  do  not  yet  fully  understand  all 
the  causes  that  may  be  at  work  upon  these  muscles.  We  find  so 
many  reflex  symptoms  from  other  organs  which  may  come  under  the 
same  influence,  especially  in  the  oblique  muscles.  I have  been  much 
interested  in  this  movement.  We  have  a field  yet  that  is  somewhat 
unexplored.  I have  been  using  for  the  last  year,  nearly,  Savage’s 
prism,  and  following  somewhat  his  methods  of  relieving  eye-strain; 
that  is,  I correct  by  correction  of  the  hyperphoria  or  the  exophoria. 
In  my  practice  for  the  last  three  years  I find  so  many  cases  that  I 
have  not  been  able  to  get  relief  after  correcting  the  astigmatism  and 
other  refractive  trouble,  and  looking  up  carefully  the  record  of  the 


THE  STUDY  AND  CORRECTION  OF  HETEROPHORIA.  433 


oblique  and  recti  muscles  the  patient  would  still  complain  of  diffi- 
culty, and  I have  been  at  a loss  to  account  for  it,  but  I believe  the 
trouble  is  with  the  oblique  muscles.  I think  we  will  find,  if  we 
study  their  action  carefully,  that  they  are  the  muscles  that  govern 
the  eyes,  and  when  we  come  fully  to  understand  their  functions  in 
every  way  and  how  to  correct  them  when  they  are  at  fault,  even  as 
much  as  the  other  muscles,  we  shall  make  still  more  progress.  I find 
that  a certain  class  of  cases,  where  there  is  oblique  astigmatism,  give 
me  a great  deal  of  trouble.  I have  very  little  trouble  with  the 
astigmatism  if  it  is  an  angle  of  180°  or  190°;  but  when  I get 
cases  of  oblique  astigmatism,  if  I am  not  careful  my  patient  will 
come  back  to  me,  and  in  that  kind  of  cases  we  usually  study  the 
oblique  muscles. 

I have  been  looking  up  Savage’s  ideas,  and  I find  some  of  them 
pretty  good,  and  think  they  would  bear  study.  The  oblique  mus- 
cles will  bear  study,  and  we  will  reap  reward  and  very  great  help 
in  these  difficult  cases,  especially  along  the  line  of  oblique  astigma- 
tism. 

Dr.  Wilson:  I have  not  very  much  to  say,  Mr.  Chairman,  ex- 
cept this:  we  must  be  very  careful,  in  my  judgment,  to  distinguish 
between  empirical  and  scientific  therapeutics.  If  we  do  not,  we  are 
going  to  land  in  a very  uncomfortable  position  from  a physiological 
standpoint  at  least.  Because  we  have  found  that  certain  remedies 
have  been  of  service  to  us  in  the  treatment  of  hyperphoria,  we  can- 
not claim  that  the  application  of  that  remedy  to  that  condition  is  a 
scientific  procedure. 

In  regard  to  the  question  that  Dr.  Stewart  has  asked  as  to  the 
comparison  for  the  results  of  this  apparatus  and  Dr.  Stevens’s,  it  is 
to  be  observed  that  it  is  precisely  the  same  thing.  The  mobile 
principle  is  a mechanical  principle  for  saving  time  and  to  insure 
accuracy.  You  can  mark  the  prism  at  zero  up  to  10°  of  infinites- 
simal  gradings.  You  don’t  need  to  go  from  1°  to  2°,  but  you  can 
go  anything  between  those  degrees  with  your  instrument,  as  1 J or  1 J 
can  be  recorded,  and  it  can  be  made  fine  enough  to  measure  of  a 
degree.  I don’t  know  that  there  is  any  other  point  that  has  been 
raised  that  I have  not  touched. 


28 


434 


world’s  homceopathic  congress. 


THE  EFFICACY  OF  THE  VIBROMETER  IN  APPLY- 
ING VIBRATORY  MASSAGE  IN  AURAL 
DISEASES. 

By  Henry  F.  Garey,  M.D.,  Baltimore,  Md. 


Since  presenting  my  paper  before  the  American  Institute,  in  June 
of  last  year  on  “ Vibratory  Motion  as  a Method  of  Massage  in  Aural 
Diseases/’  I have  been  using  an  instrument  specially  devised  for  that 
purpose  called  the  “ vibrometer.”  This  instrument  is  in  shape  like  a 
banjo,  and  has  four  strings  stretched  across  its  length  resting  on  a 
bridge,  which  sets  upon  a diaphragm.  On  each  side,  elevated  above 
the  diaphragm  and  supported  by  posts,  are  two  horizontal  bars, 
which  support  the  mechanical  appliances  used  for  producing  the 
various  vibratory  motions.  This  consists  in  what  is  called  a yoke, 
in  which  revolves  a shaft  connected  with  the  electro-motor  by  pulley- 
wheels  and  a belt.  Behind  the  diaphragm  is  a shallow  air-tight 
compartment,  leading  from  which  are  rubber  tubes  that  are  inserted 
in  the  external  auditory  canal  during  treatment,  consequently  any 
vibratory  motion  of  the  diaphragm,  which  must  necessarily  be  an 
inward  and  a corresponding  outward  movement,  would  be  exactly 
reproduced  upon  the  membrana  tympani,  as  the  confined  air,  not 
being  able  to  escape,  will  undergo  an  alternate  condensation  and 
rarefication  in  the  external  auditory  canal. 

Every  vibratory  movement  of  the  strings  of  the  instrument  is 
communicated  to  the  diaphragm  by  means  of  the  bridge  upon  which 
it  rests.  These  strings  by  varying  their  tension  and  length  can  be 
regulated  to  give  a high  or  low  rate  of  vibration  as  desired,  for  in- 
stance, the  heaviest  string  left  at  its  original  length  adjusted  to  a 
slight  tension  may  make  about  fifty  vibratory  motions  to  the  second, 
while  the  lightest  string  on  the  instrument  adjusted  to  a high  ten- 
sion and  clamped  down  to  one-fourth  its  original  length  would  pro- 
bably make  three  thousand  vibratory  motions  to  the  second. 

In  the  centre  of  the  diaphragm  is  an  attachment  which  works  on 


EFFICACY  OF  THE  VIBROMETER  IN  AURAL  DISEASES.  435 


a lever,  and  when  hit  by  the  cam  on  the  revolving  shaft  lifts  the 
diaphragm  to  a considerable  extent,  causing  a powerful  effect  on  the 
membrana  tympani.  This  attachment  can  be  adjusted  at  four  dif- 
ferent leverages,  which  causes  a modification  or  increase  of  its  inten- 
sity and  can  be  regulated  at  from  one  to  twenty-five  vibratory 
movements  to  the  second.  This  is  only  used  in  very  bad  cases  and 
for  not  more  than  five  minutes  continuously. 

The  instrument  which  I have  been  describing  in  an  improvement 
on  the  first  manufactured,  and  as  far  as  I know,  is  the  only  one  which 
offers  the  same  facilities  for  applying  this  method  of  massage.  The 
class  of  patients  in  my  experience  who  are  generally  benefited  from 
the  first,  are  those  in  which  the  mucous  membrane  lining  the  tym- 
panic cavity  and  Eustachian  tubes  is  in  a hypertrophic  condition. 
The  membrana  tympani  are  depressed,  opaque,  and  thickened.  They 
usually  complain  of  a stuffed  sensation  in  the  ears,  with  a great  deal 
of  tinnitus  aurium,  and  'that  their  hearing  is  worse  during  a cold. 
In  cases  where  the  mucous  membranes  are  atrophied  with  a large 
external  auditory  canal  perfectly  dry  and  Eustachian  tubes  patulous, 
and  generally  very  little  tinnitus,  this  or  no  other  treatment  has  done 
very  much  good  in  the  majority  of  cases,  and  in  looking  over  my 
records  I find  that  only  about  five  per  cent,  have  been  relieved,  while 
in  the  before-mentioned  cases  the  good  results  reach  at  least  seventy- 
five  per  cent.  In  treating  persons,  I always  select  the  rate  of  vibra- 
tion which  corresponds  in  pitch,  if  possible,  to  that  caused  by  the  dis- 
eased condition  of  the  ears.  If  there  is  no  tinnitus  to  guide  me,  I 
find  whether  the  patient  can  hear  a high  or  low  sound  better ; if  it  is  a 
low  sound,  a high  rate  of  vibration  is  used  in  treatment,  and  vice  versa , 
A point  which  I would  like  to  explain  here  is  this  : It  is  not  neces- 

sary that  the  sound  from  the  instrument  should  be  of  the  same  quality 
of  the  tinnitus  experienced  by  the  patient,  but  merely  the  same  pitch, 
for  instance,  if  a banjo,  where  one  of  the  strings  was  adjusted  when 
sounded  to  produce  a certain  note,  and  a musical  instrument  of  any 
other  kind,  whose  quality  of  tone  was  entirely  different,  was  made 
to  sound  the  same  note  in  a room,  the  string  on  the  banjo  would 
vibrate  in  sympathy,  which  has  been  proven  by  experiment,  any 
other  note,  no  matter  how  loud,  would  have  no  effect.  Another 
point  is  in  the  way  the  strings  of  the  vibrometer  are  set  in  motion. 
On  the  revolving  shaft  is  a wheel  projecting  from  which  are  metallic 
picks  which  hit  the  string  it  is  adjusted  over.  It  does  not  make  any 


436 


world’s  homoeopathic  congress. 


difference  in  the  number  of  vibratory  motions  per  second,  whether 
the  string  is  hit  fast  or  slow,  but  at  the  time  the  string  is  first  hit 
the  intensity  is  greater  than  it  is  just  before  being  hit  again,  and  as 
the  motion  of  the  wheel  is  perfectly  rhythmic,  revolving  so  many 
times  to  the  second,  it  has  just  as  good  an  effect  as  if  the  intensity 
during  the  fraction  of  a second  did  not  vary  at  all.  The  idea  of 
using  vibratory  motion,  as  I have  said  before,  originated  within  my 
mind  some  years  ago,  and  later  put  into  practical  operation,  and  as 
far  as  I know,  was  the  first  to  lay  before  the  profession  in  a scientific 
manner,  this  method  of  massage. 

I have  found  that  when  two  of  the  strings  upon  the  vibroraeter 
were  regulated  in  such  a way  that  when  both  were  set  in  vibration 
at  the  same  time,  producing  the  sensation  of  a harmonious  sound, 
the  effect  in  some  cases  on  the  tinnitus  was  especially  beneficial,  re- 
lieving, where  the  various  kinds  of  vibrations  produced  by  a single 
string  failed.  Sub-acute  cases  of  deafness,  accompanied  by  tinnitus 
aurium,  are  quickly  relieved,  as  the  following  case  will  illustrate  : 

Mrs.  M.  Young,  married  lady,  set.  26,  called  at  my  office,  April 
1,  1893,  complaining  of  partial  deafness  and  tinnitui  aurium.  She 
had  a stuffed  sensation,  or  as  if  cotton  had  been  packed  in  the  ex- 
ternal auditory  canal.  She  says  the  tinnitus  was  so  annoying  as  to 
prevent  sleep.  On  examination,  found  considerable  retraction  of 
the  membrana  tympani,  and  hearing  for  the  watch,  on  the  right  side 
five  inches,  on  the  left,  seven  inches.  The  Eustachian  tubes  were 
partially  closed,  which  made  inflation  somewhat  difficult,  giving 
slight  relief.  I used  several  of  the  vibrations  on  the  different  strings 
without  immediate  benefit. 

April  4th. — She  came  again,  and  reported  that  no  improvement 
had  taken  place.  I again  inflated  her  ears,  after  which  she  sat  down 
to  the  vibrometer.  The  central  attachment  was  used  with  consider- 
able force  continuously  for  four  minutes,  after  which  she  declared 
that  the  tinnitus  had  entirely  ceased  in  the  right  ear,  and  greatly 
modified  in  the  left ; the  hearing  for  the  watch  had  increased  for 
both  ears  to  fourteen  inches,  and  the  stuffed  sensation  had  almost 
entirely  disappeared.  On  inspection  of  the  membrana  tympani, 
found  them  comparatively  very  slightly  retracted.  On  April  8th, 
found  improvement  had  continued,  when  the  same  treatment  was 
used  for  three  minutes  ; after  which  she  declared  herself  completely 
relieved  of  the  tinnitus  and  stuffed  sensation,  with  hearing  power 


EFFICACY  OF  THE  VIBROMETER  IN  AURAL  DISEASES.  437 


fully  restored.  Saw  her  again  on  April  13th,  when  she  declared  the 
good  results  from  last  treatment  to  have  still  continued. 

I find  that  in  the  majority  of  cases,  when  the  strings  of  the 
instrument  are  used  it  is  only  necessary  to  strike  them  lightly  with 
the  friction  wheel.  In  vibrating  the  heavy  string,  I generally  set 
the  bridge  back  behind  the  central  attachment,  and  adjusting  the 
motor  in  such  way  that  the  belt  is  at  a considerable  tension,  so  that 
the  pulley-wheel  revolves  slowly.  I also  generally  use  this  adjust- 
ment when  setting  in  motion  two  strings  at  one  time.  The  principle 
of  this  method  of  treatment  embraces  two  essential  features  which 
to  my  mind  makes  this  system  of  massage  the  only  scientific  one 
applicable  to  the  membrana  tympani  and  its  associate  sound-con- 
ducting parts.  Massage  is  the  application  of  motion  to  disease,  and 
its  scientific  administration  consists  of  its  application  in  a systematic 
manner.  In  applying  massage  in  aural  diseases,  it  is  necessary  to 
produce  a to-and-fro  movement  of  the  membrana  tympani,  and, 
if  possible,  by  a force  which  is  harmless  and  at  the  same  time 
effective.  The  vibrometer  fulfills  these  conditions.  Any  of  the 
strings  on  the  instrument  that  may  be  set  in  motion  by  the  friction- 
wheel,  will  produce  a certain  number  of  vibratory  movements  to 
the  second  of  time,  and  the  movements  of  the  central  attachment 
are  also  measured.  What  could  be  more  systematic  than  this  ? 
The  motions  of  the  membrana  tympani  were  intended  by  nature 
to  be  vibratory,  and  as  the  vibrometer  generates  measured  mo- 
tion, and  these  motions  are  vibratory,  theoretically  we  have  a sci- 
entific and  effective  method  of  massage  in  aural  diseases ; and,  as 
demonstrated  practically  by  the  use  of  the  vibrometer,  we  have  in 
fact  a great  scientific  advance  over  all  previous  methods.  Since  the 
introduction  of  this  treatment  in  aural  diseases,  it  makes  possible  a 
more  or  less  benefit  in  cases  of  deafness  heretofore  considered  hope- 
less, and  has  opened  up  the  field  for  the  treatment  of  aural  diseases 
to  such  an  extent  that  the  number  of  deaf  patients  seeking  relief  at 
the  aurist’s  hands  will  at  least  double  itself. 

Discussion. 

H.  C.  Houghton,  M.D. : Dr.  Garey’s  admirable  paper  gives  us 
the  description  of  the  vibrometer,  an  instrument  devised  under  his 
personal  direction  and  inspection,  for  the  purpose  of  applying  massage 
to  the  ear.  It  is  the  only  instrument  of  the  kind  on  the  market,  so  far 


438 


world’s  homceopathic  congress. 


as  I am  aware,  and  after  a somewhat  prolonged  use  of  it,  I am  prepared 
to  recommend  the  latest  production  of  the  vibrometer  company. 

This  instrument  is  a decided  improvement  over  the  instrument  first 
sent  out,  and  is  capable  of  producing  a most  profound  effect  upon  the 
drum-head  and  ossicula  ; indeed,  upon  the  entire  auditory  apparatus. 
I am  able  to  confirm  Dr.  Garey’s  statement  of  the  effect  of  high  and 
low  vibrations  as  regards  treatment. 

I have  also  been  very  much  interested  in  the  use  of  stringed  or  reed 
instruments  for  diagnosis,  and  find  that  we  can  detect  any  abnormal 
sensitiveness  of  the  auditory  nerve  to  high  or  low  tones.  Some  pa- 
tients are  extremely  sensitive  to  all  tones,  high  or  low ; others  to 
high  tones  and  not  to  low  tones  ; others,  conversely.  Again,  in 
some  instances,  there  is  a peculiar  sensitiveness  to  single  tones  or 
to  discords  produced  by  sounding  the  note  and  half-note  at  the  same 
time.  Under  the  action  of  the  central  attachment  of  the  vibrometer 
this  sensitiveness  is  modified,  the  sensitiveness  to  high  tones  disap- 
pearing and  being  replaced  by  a low  tone  or,  conversely,  under 
treatment,  a low  tone  disappears  and  a high  tone  is  established,  tem- 
porarily, at  least.  Again,  in  cases  of  recent  origin,  treatment  will 
substitute  an  undefined  rushing  sound  for  a definite  musical  tone, 
either  high  or  low,  and  later,  the  treatment  will  abolish  this,  the 
patient  being  relieved  of  this  intensely  annoying  symptom.  In 
some  cases,  with  this  relief,  there  is  an  improvement  in  the  audition  ; 
in  other  cases,  no  improvement  follows. 

I confess  to  the  domination  of  the  material  over  my  mind  in  my 
earlier  experiences  with  massage,  and  I think  the  inclination  of  ope- 
rators will  be  to  use  a far  greater  degree  of  power  than  is  necessary. 
I therefore  notice  with  great  satisfaction  Professor  Garey’s  remark, 
that  the  object  should  be  to  produce  a to-and-fro  motion  of  the 
membrana  tympani,  and,  if  possible,  by  a force  which  is  harmless 
and  at  the  same  time  effective.”  I would  hardly  say  “ to-and-fro 
motion  of  the  drum-head,”  because  I think  that  that  expression  is 
liable  to  perpetuate  the  notion  which  is  fixed  in  the  minds  of  most 
physiologists,  that  the  drum-head  moves  as  a whole,  with  a to-and- 
fro  motion.”  That  is  true  under  the  influence  of  the  Politzer,  Siegle’s 
otoscope  and  similar  instruments;  but  it  certainly  does  not  so  move 
in  the  ordinary  function  of  audition,  but  stands  as  the  iris  does  in  the 
eye,  as  an  adjustor,  a regulator  of  sound-force;  in  some  sense  as  the 
iris  does  in  its  relation  with  the  lens,  to  adjust,  regulate  and  direct 
the  essential  force,  and  the  vibration  of  the  drum-head  is  at  every 
node;  every  portion  receives  impressions  that  are  converted  into 
molecular  disturbances  of  varying  lengths,  according  as  they  are 
produced  upon  the  stiff  and  unyielding  portions  of  the  drum-head 
at  the  periphery,  along  the  manubrium,  or  in  the  more  attenuated 
and  easily-yielding  portions  which  lie  between  these  two  areas.  Not 
only  so,  but  these  impulses  are  communicated  to  the  contained  air  of 


EFFICACY  OF  THE  VIBROMETER  IN  AURAL  DISEASES.  439 


the  tympanum,  and  make  their  impression  upon  the  acoustic  nerve 
through  the  round  window  synchronously  with  the  impression  made 
through  the  ossicula. 

This  whole  subject  widens  before  my  mind  in  such  a way  that  one 
might  wish  himself  twenty  years  younger  and  at  liberty  to  devote 
himself  to  a term  of  research  in  acoustics,  such  as  is  offered  only  in 
the  technical  schools  of  the  continent  of  Europe. 

Wm.  R.  KrNG,  M.D. : In  discussing  Dr.  Garey’s  paper  I shall 
begin  by  saying  that  his  methods  have  been  closely  followed  by  me 
since  the  beginning  of  his  experiments,  owing  to  the  fact  that  I have 
been  greatly  interested  in  the  treatment  of  deafness  and  tinnitus  by 
means  of  sound  waves  or  by  aural  massage  since  1887,  and  have 
experimented  and  treated  many  cases  by  this  method  since  then, 
though  with  crude  and  unsatisfactory  instruments.  Since  using  the 
vibrometer — which,  after  much  study  and  experimentation,  is  now 
presented  to  the  profession  in  practical  shape — I have  undoubtedly 
increased  my  percentage  of  good  results. 

I don’t  believe  I am  over-sanguine  or  carried  away  by  my  interest 
in  this  method,  and  believe  I can  rightly  appreciate  that  this  does 
not  offer  us  a panacea  or  cure-all  for  auditory  ailments,  and  hope  I 
may  always  be  ready  to  see  the  failures  and  to  strive  to  find  methods 
or  remedies  to  reach  some  of  them. 

In  speaking  of  the  application  of  the  instrument,  I wish  to  call 
attention  to  the  central  attachment  or  post  for  coarse  vibrations.  Dr. 
Garey  has  not  given  it  as  much  attention  in  the  paper  as  it  deserves. 
It  is  very  useful  as  a general  means  of  aural  massage,  rougher  in 
nature  and  more  general  in  application  than  the  strings  which  help 
to  make  up  the  instrument.  I often  use  it  before  applying  the  “ sim- 
ilar  sound  ” to  a given  case,  as  a species  of  gymnastics,  to  stimulate 
secretion  and  motion  in  the  conducting  apparatus  of  the  ear,  viz., 
membrana  tympani  and  ossicles.  In  most  cases — in  fact,  in  all — where 
tinnitus  is  present,  I follow  this  up  immediately  by  the  nearest  ap- 
proach to  the  similar  pitch  obtainable. 

I agree  thoroughly  with  Dr.  Garey,  that  the  best  results  are 
achieved  in  cases  accompanying  hypertrophic  catarrh,  and  that  the 
least  benefit  is  apparent  in  cases  of  atrophic  nature. 

Regarding  the  method  of  treatment  in  the  absence  of  tinnitus, 
my  experience  does  not  coincide  with  that  of  the  author  of  the  paper 
entirely;  I do  not  feel  that  as  yet  we  have  any  safe  rule  to  guide  us. 
My  method  has  been  to  try  the  numerous  sounds  and  variations 
thereof  until  I find  the  one  that  seems  to  give  the  best  immediate 
results,  or  that  the  patient  himself  will  speak  of  as  very  penetrating 
and  powerful  (though  not  necessarily  loud  and  heavy). 

It  seems  almost  impossible  at  present  to  simulate  all  the  qualities 
of  tone  as  they  occur  in  the  ears  of  those  suffering  with  tinnitus;  in 
fact,  it  would  appear  to  be  unnecessary.  However,  it  seems  advan- 


440 


world’s  homoeopathic  congress. 


tageous  and  quite  necessary  to  secure  the  closest  simulation  of  pitch, 
thus  in  many  cases  soon  obliterating  annoying  tinnitus  and  improv- 
ing hearing  powers. 

The  arrangement  permitting  of  the  picking  of  two  strings  simul- 
taneously adds  decidedly  to  the  usefulness  of  the  instrument,  as  it 
increases  the  range  of  pitch  as  well  as  varying  the  quality  of  tones 
procurable,  thereby  decidedly  enlarging  our  field  of  application. 

The  force  used  for  creating  the  massage  or  gymnastics  of  the  mem- 
brana  tympani  and  the  ossicles — viz.,  vibratory  force  or  sound — 
carefully  and  scientifically  applied,  is  nature’s  remedy,  because  it  is 
adapted  by  nature,  and  is  the  only  force  which  can  rightly  or  safely 
be  applied  to  these  delicate  portions  of  this  complex  organ  of 
hearing. 

A startling  commentary  on  this  subject  is  the  array  of  cases  benefited 
who  have  been  relegated  to  the  shelf  by  ancient  and  modern  otol- 
ogy ; cases  declared  unhelpable  have  been  vastly  improved.  Pray, 
make  no  mistake;  I did  not  say  all  cases. 

It  may  be  interesting  to  hear  the  latest  regarding  the  instrument 
which  was  first  invented  for  the  application  of  this  method  of  aural 
massage.  Mr.  E.  J.  Godman,  the  inventor  and  patentee,  is  constantly 
on  the  lookout,  and  always  striving  for  improvements  to  his  machine. 
He  has  made  many  that  you  all  know  of.  Permit  me  to  report  a 
few  so  recent  they  have  not  yet  left  the  factory. 

j First. — The  machine  has  been  taken  from  its  case,  and  is  now 
mounted  on  a solid  stand  or  table  of  oak,  being  set  below  the  level, 
or  so  that  the  face  of  the  instrument  is  just  level  with  the  face  of  the 
table.  This  is  all  supported  by  rigid,  solid  metal  legs,  which  abso- 
lutely prevent  foreign  vibrations. 

Second. — The  motor  has  been  removed  from  its  little  shelf  and 
relegated  below  the  table.  It  can  be  placed  upon  a box  on  the  floor, 
a shelf  against  the  wall,  or,  better  yet,  a shelf  solidly  attached  to 
the  metal  supports  of  the  table.  A belt  goes  up  through  an  aper- 
ture to  a wheel  on  a shaft,  the  other  extremity  of  which  carries  a 
wheel  with  a rubber  tire  (a  friction  wheel),  which  in  its  revolution, 
being  in  contact  with  a larger  flat-surfaced  wheel  on  the  main  shaft 
of  the  instrument,  turns  this  in  harmony  with  itself.  This  arrange- 
ment does  away  with  the  necessity  of  shifting  the  motor  each  time 
you  wish  to  shift  the  carriage  from  one  string  to  another — a consum- 
mation to  be  devoutly  thankful  for.  The  rejnoval  of  the  motor  from 
the  instrument  as  at  present  attached  will  recommend  itself  to  all 
who  have  used  the  vibrometer,  a great  amount  of  undesirable  jar 
being  thus  avoided. 

Third. — Ratchet  keys  capable  of  very  fine  adjustment  of  tension 
of  strings  are  now  provided  for  the  instrument. 

Fourth. — A rheostadt  or  resistance-coil  is  now  to  be  placed  beneath 
the  table  between  the  storage- battery  and  the  switch,  by  this  means 


EFFICACY  OF  THE  VIBROMETER  IN  AURAL  DISEASES.  441 


enabling  us  to  control  the  speed  and  number  of  revolutions  to  a 
nicety. 

Other,  though  comparatively  minor,  improvements  are  being 
made,  and  others  are  contemplated,  as,  for  instance,  the  substitu- 
tion of  a roughly  corrugated  rubber  band  for  the  picker  on  the 
wheel,  thereby  getting  rid  of  the  metallic  sound  of  the  picker  on  the 
wire  strings. 

I have  experimented  with  a number  of  appliances  for  the  produc- 
tion of  the  sounds  and  pitches  that  I have  required,  but  I always  fall 
back  on  the  vibrometer,  especially  as  at  present  constructed,  for  satis- 
factory work  and  results. 

This  instrument  may  be,  and  probably  is,  as  yet,  in  its  infancy. 
It,  and  the  method  it  applies,  can  only  be  perfected  by  constant  work 
and  experimentation  both  on  the  part  of  the  profession  and  of  the 
manufacturers.  Each  improvement  we  can  suggest,  if  it  only  should 
serve  as  a means  of  helping  one  solitary  case,  would  be  well  worth 
our  while. 

The  experiments  being  made  by  different  methods  for  treating 
deafness  by  sound  waves  is  indicative  of  the  interest  the  profes- 
sion has  taken  in  the  matter.  It  is  indicative  of  a lack  of  some- 
thing in  our  usual  armamentarium  which  is  greatly  longed  for  by 
patient  and  doctor;  that  is,  the  means  for  making  the  deaf  hear 
and  for  relieving  distressing  tinnitus.  There  has  been  a dearth  in 
this  direction,  and  perhaps  there  still  is,  but  I believe  fully  that  we 
have  in  aural  massage  by  vibratory  force  a decided  acquisition  at  our 
hands. 

E.  H.  Linnell,  M.D. : I would  simply  like  to  ask  Dr.  King 
how  long  he  uses  the  instrument,  and  whether  he  uses  it  according  to 
the  deafness. 

Dr.  King:  Yes,  decidedly.  In  an  intense  case  of  deafness  I 
would  have  to  use  it  a great  deal  longer.  The  central  attach- 
ment I never  carry  over  three  or  five  minutes,  and  the  whole 
treatment  I don’t  think  is  ever  carried  over  twenty  or  twenty-five 
minutes  in  one  case,  and  usually  averages  from  ten  to  fifteen. 

Harold  Wilson,  M.D. : I have  only  to  suggest,  what  I have 
elsewhere  called  attention  to,  the  possibility  of  another  mechanical 
device  for  securing  vibratory  motion.  It  is  well  known  that  in  the 
make  and  break  of  a current  of  electricity,  in  the  circuit  of  which 
there  is  a telephone,  we  get  an  influence  upon  the  make  and  break  of 
the  current  in  the  telephone.  Now,  it  is  a simple  matter  with  which 
these  makes  and  breaks  are  made  as  to  obtaining  any  number  of  vi- 
brations that  you  wish.  You  may,  by  a mechanical  device  of  some 
rotary  motion,  if  you  choose,  make  and  break  the  current  as  rapidly 
as  you  please  until  you  have  reached  several  thousand  vibrations  a 
second,  or  you  may  even  make  the  vibrations  so  slow  as  to  be  easily 
counted.  The  application  of  this  suggestion  has  been  put  in  force  in 


442 


world’s  homoeopathic  congress. 


my  own  practice,  more  or  less,  in  the  use  of  the  telephone  as  con- 
nected with  the  induction-coil  of  an  ordinary  battery.  The  more  in- 
tense the  current,  the  more  intense  the  sound.  You  can  easily  see 
that  it  is  a mere  question  of  mechanics  to  secure  these  two  sounds — 
intensity  of  vibration  and  rapidity  of  vibration.  I will  say,  fur- 
thermore, that  it  has  this  advantage.  There  is  no  noise  in  the  office, 
which  I think  is  not  altogether  true  of  the  vibrometer.  I would 
suggest  that  so  far  as  the  vibrometer  is  concerned,  if  it  could  be  made 
to  be  noiseless  to  anybody  but  the  patient,  it  would  be  a decided  im- 
provement. In  that  respect  the  telephone  is  a decided  improvement, 
because  there  is  no  noise  except  to  the  patient,  because  the  noise  is 
right  at  the  ear  of  the  patient.  If  I were  seeking  for  a perfected  in- 
strument in  this  line,  I would  go  outside  of  the  banjo  idea.  As  we 
have  the  most  perfect  writing  machines,  which  have  no  connection 
with  the  ordinary  method  of  writing,  and  sewing  machines,  which 
have  no  connection  with  sewing  by  hand,  so  it  occurs  to  me  that  pos- 
sibly the  securing  of  the  vibratory  motion  upon  the  ears  might  be 
obtained  in  a totally  different  way  from  that  which  you  get  when 
you  listen  to  the  drum  of  the  guitar  or  an  ordinary  musical  instru- 
ment, and  I would  suggest  that  the  make  and  break  of  a telephone 
opens  a very  fruitful  field  for  mechanical  experimentation. 

H.  C.  Houghton,  M.D. : In  my  study  of  this  subject  I made  the 
acquaintance  of  Mr.  Bernhard,  of  New  York  City,  who  is  a personal 
friend  of  Mr.  Emil  Berliner,  the  inventor  of  the  Emil  Berliner  Tele- 
phone, which  is  the  instrument  by  which  the  Bell  Telephone  Com- 
pany maintain  their  monopoly  at  present.  Mr.  Berliner  is  the  in- 
ventor of  the  graphophone,  and  has,  I think,  covered  this  whole 
matter  which  Dr.  Wilson  has  mentioned.  An  ordinary  Bell  tele- 
phone receiver  is  put  into  the  circuit  of  an  ordinary  induction  ma- 
chine, and  you  can  use  it  just  as  the  English  people  use  the  audiom- 
eter, and  as  you  remove  the  coil  you  modify  the  vibrations,  which  is 
covered  with  another  disk  and  a tube,  and  that  tube  covered  with  a 
stethoscope  tube,  which  is  the  same  as  we  use  for  the  phonograph  or 
vibrometer,  and,  as  Dr.  Wilson  has  suggested,  you  can  modify  the 
intensity,  and  of  course  the  whole  matter  is  adjusted  by  the  fine  at- 
tachment of  the  cord,  so  that  you  can  have  fine  vibrations.  The  in- 
tensity of  the  vibrations  is  regulated  by  the  distance  to  which  you 
uncover  the  cord.  The  only  difficulty  in  the  adjustment  is  that  it 
has  been  so  severe  that  it  is  really  uncomfortable,  and  the  noise  of 
the  instrument  is  reduced  to  the  minimum  for  office  use. 

A.  B.  Norton,  M.D. : I will  also  add  that  in  regard  to  the  objec- 
tion Dr.  Wilson  makes  to  the  noise,  there  is  no  doubt  it  is  an  annoy- 
ing thing  in  the  office,  and  in  that  line  I have  some  men  at  work  on 
my  suggestion.  We  are  devising  another  machine,  or  instrument, 
which  is  to  be  entirely  enclosed  in  a cabinet,  so  there  will  be  no 
noise  whatever  in  the  room  if  it  is  made  a success.  The  idea  is  a 


EFFICACY  OF  THE  VIBROMETER  IN  AURAL  DISEASES.  443 


little  crude,  and  I am  quite  uncertain  whether  it  will  amount  to 
anything  or  not.  Then,  in  the  line  of  what  Dr.  King  was  speaking 
in  regard  to  Mr.  Goodwin — he  called,  at  New  York,  to  see  me  last 
week.  I made  two  little  suggestions  to  him,  which  I think  would 
be  in  line  with  his  advancement.  One  is  the  number  of  the  picks. 
The  present  vibrometer  has  four  picks.  I suggest  the  experiment  of 
trying  twelve  or  sixteen  picks,  which  will  make  a more  continuous 
sound ; it  may  be  of  some  value.  Then,  in  regard  to  regulating  the 
speed  of  the  machine  : you  regulate  that  now  by  a series  of  buttons,  so 
as  to  get  three  different  speeds.  We  will  have  a very  slight,  interme- 
diate speed,  and  a very  rapid  speed.  My  experience  with  the 
vibrometer  is  especially  favorable.  I think  the  idea  is  in  the  right 
direction,  and  it  is  simply  a matter  of  instrumentation. 


444 


world’s  homoeopathic  congress. 


THE  HOMCEOPATHY  OF  AURAL  THERAPEUTICT8. 

By  C.  F.  Sterling,  M.D.,  Detroit,  Mich. 


It  is  a cause  for  extreme  regret  and  deep  diappointment  that 
the  one  man  in  our  school  peculiarly  fitted,  by  his  long  training, 
his  patient  study  and  observation,  and  his  extensive  clinical  expe- 
rience, Professor  Henry  C.  Houghton,  should  have  been  prevented 
by  illness  from  the  preparation  of  the  paper  on  this  subject  which 
had  been  originally  assigned  to  him. 

As  his  assistant,  working  at  his  side  and  under  his  supervision  for 
years  at  the  New  York  Ophthalmic  Hospital,  the  writer  knows, 
better  than  most  men,  his  eminent  qualifications  for  the  task,  and 
of  what  the  profession  are  deprived  by  his  inability  to  undertake  it. 

The  brief  notice  of  a few  days  in  which  to  prepare  and  complete 
an  article  on  so  important  a subject,  for  so  profound  an  occasion,  is 
but  simple  justice  to  the  writer  to  plead  in  part  extenuation  for 
the  crude  and  incomplete  remarks  he  presents  for  your  considera- 
tion. 

It  is  nearly  nineteen  centuries  since  the  divine  lips  uttered  the 
words,  “ He  that  hath  ears  to  hear,  let  him  hear.”  8poken  to  the 
scornful  and  unbelieving  Jews  as  a warning,  the  words  have  an  ap- 
plication directly  physical,  and  in  these  days  may  be  construed  as  a 
direct  command ; for  the  neglect  to  guard  and  care  for  the  most 
valuable  of  all  the  special  senses,  with  the  modern  facilities  avail- 
able, is  reprehensible  in  the  highest  degree  where  one  is  responsible 
to  one’s  self  alone;  but  the  responsibility  becomes  criminal  when 
the  neglect  entails  upon  a child  all  the  disastrous  consequences  and 
mental  suffering  that  follow  impairment  of  hearing. 

Considering  the  limitations  necessitated  by  the  brief  time  for  prep- 
aration, no  opportunity  for  research  was  available,  and  it  is  evident 
nothing  new  or  startling  can  be  presented.  Therefore  it  seemed 
that  the  most  practical,  and  in  fact  the  only  possible  way  to  meet  the 
occasion,  was  by  a short  statement  of  the  means  at  our  command 


THE  HOMOEOPATHY  OF  AURAL  THERAPEUTICS. 


445 


for  the  treatment  of  morbid  conditions  of  the  aural  apparatus,  and 
the  relations  they  should  bear  to  each  other. 

The  specialist,  as  a specialist,  will  find  little  of  interest,  because  to 
him  it  is  well-known  ground. 

The  main  point  to  which  I wish  to  call  attention  is  this : that 
there  are  no  therapeutics  (taken  in  the  strict  medical  sense)  which  as 
yet  are  sufficient  in  themselves  to  meet  the  conditions  daily  pre- 
senting. 

I do  not  say  that  drugs  internally  administered  have  no  place,  for 
they  are  of  exceeding  value;  but  this  I do  say,  that  he  who,  in  his 
ardent  faith  in  the  all-powerful  for-good  nature  of  medicine,  and  his 
confidence  in  his  own  ability  to  always  administer  them  accurately,  neg- 
lects the  necessary  means  of  local  treatment,  will  find,  in  dealing  with 
the  ear,  that  there  are  many  conditions  in  which  the  most  scientifi- 
cally prescribed  drug  will  fail  to  meet  the  expectation  of  himself 
and  his  patient ; while  some  judicious  locnl  measure  will  give  both 
satisfaction  and  relief. 

Illustratively,  our  Materia  Medica  is  full  of  symptoms  pertaining 
to  the  head  and  eyes,  and  a case  presents  itself  of  which  the  perfect 
similimum  is  found. 

The  drug  is  given,  with  no  relief.  Again  and  again  is  medicine 
administered,  with  the  most  careful  study  of  the  totality  of  symp- 
toms, and  from  the  tincture  to  the  highest  attenuation.  Ultimately 
an  oculist  is  consulted,  who  finds  a refractive  error,  prescribes  the 
proper  glasses — when,  lo!  all  discomfort  disappears;  all  pain  is 
appeased. 

Such  instances  are  of  too  common  occurrence  to  admit  of  argu- 
ment. 

As  the  result  of  the  prolonged  strain,  certain  morbid  conditions 
may  have  arisen,  characterized  by  certain  symptoms,  which  persist 
after  the  adjustment  of  the  glasses.  For  these  the  proper  remedy 
may  be  applied  with  brilliant  results.  Here  the  Homoeopathic 
remedy  finds  its  true  field. 

Analagous  to  this  is  the  proper  sphere  of  Homoeopathic  aural 
therapeutics. 

Time  and  again  have  patients  presented  themselves,  complaining 
of  deafness  and  tinnitus,  having  been  drugged  for  weeks  with  the 
“ suitable  Homoeopathic  remedy/’  that  have  gone  from  the  office  in 
ten  minutes  with  completely  restored  function,  simply  by  the  removal 


446 


world’s  homoeopathic  congress. 


of  a mass  of  cerumen  from  the  meatus.  It  is  true  that  the  cerum- 
inous accumulation  may  be  due  to  a morbid  condition  of  the  glands, 
arising  from  some  perverted  state  of  the  system.  For  this,  medicinal 
treatment  is  applicable  ; but  the  patient  applied  for  relief  from  his 
discomfort,  and  he  obtained  it  by  a simple  local  measure — while  all 
the  medicine  in  the  pharmacies  would  not  have  helped  him.  Af- 
terwards is  the  time  for  administering  such  suitable  remedies  as 
may  reach  the  underlying  cause  that  resulted  in  filling  his  ears  with 
the  impacted  mass. 

In  the  one  case,  remedies  are  suitable  to  relieve  the  consequences, 
the  cause  being  removed  by  local  means  ; in  the  other,  the  conse- 
quences are  relieved  by  local  measures,  the  cause  being  treated  con- 
stitutionally. 

I have  cited  these  two  conditions  purely  as  illustrations,  and  my 
remarks  may  seem  trivial  to  you,  but  I am  led  to  make  them  for 
these  reasons : 

Upon  the  issuance  of  a small  work  relating  to  the  ear  (in  1885), 
I used  the  following  words  in  the  preface:  u In  regard  to  treatment, 
I am  firmly  convinced  that  we  are  not  yet  in  a position  to  dispense 
with  local  measures;  our  therapeutics  are  yet  too  meagre  in  this 
department.” 

Certain  critics  assailed  the  statement  as  evidencing  a lack  of  faith 
in  the  curative  powers  of  Homoeopathy. 

Another  reason  is,  the  fact  that  Homoeopathy  suffers  from  the  in- 
discreet fanaticism  and  ignorance  of  a class,  of  whom  the  aforesaid 
critics  are  a portion.  This  class,  claiming  that  the  Homoeopathic 
law  of  cure  is  sufficient  for  every  morbid  condition  of  the  system, 
pursue  with  malignity  and  invective  all  who  do  not  subscribe  to  the 
same  view's,  calling  them  mongrels,  hypocrites,  false  to  the  master’s 
teachings,  etc.  These  are  they  who  are  responsible  for  much  of  the 
ridicule  which  Homoeopathy  has  been  compelled  to  endure  in  spite 
of  its  onward  march. 

In  1876,  at  Philadelphia,  Professor  T.  P.  Wilson,  on  a similar 
subject  said:  “This  point  needs  emphasis,  because,  we  as  a school 
have  unfortunately  been  always  handicapped  by  a class  of  professed 
leaders  wffio  have  boastfully  discarded  these  things,  and  taught  us 
to  rely  upon  symptomatology.” 

This  ignorance  and  boastful  assertion  exists  to-day,  and  it  is  in 
an  effort  to  clear  the  ground,  that  the  true  place  and  value  of  our 


THE  HOMCEOPATHY  OF  AURAL  THERAPEUTICS. 


447 


remedies  in  aural  work  may  be  seen  that  the  foregoing  remarks 
have  been  indulged  in. 

Coming,  then,  strictly  to  the  matter  in  hand,  we  find  ourselves  in 
possession  of  two  classes  of  resources  for  reaching  and  relieving  the 
conditions  that  present  themselves,  general  and  specific.  The  gen- 
eral means  includes  all  local  measures,  nutrition,  hygiene,  sanitation, 
etc. ; the  specific,  our  remedies. 

Taking  first,  one  of  the  most  common  affections,  an  earache,  an 
acute  aural  catarrh,  the  otitis  media  catarrhalis  acuta  of  the  speci- 
alist, what  can  be  done  for  it? 

Certainly,  few  conditions  give  rise  to  more  intense  pain,  and  in  a 
certain  class,  with  marked  predispositions,  repeated  attacks  lay  the 
foundation  for  obstinate  and  intractable  consequences.  The  local 
measures  at  command  are  protection,  heat  instillations,  inflation, 
blood-letting,  and  paracentesis. 

These  are  common  property,  and  in  any  given  case  we  resort  to 
more  or  less  of  them. 

Now,  in  the  matter  of  medicine,  have  we  any  advantage  over  our 
confreres  of  the  Old  School  ? Dr.  Roosa  says  : “ The  proper  treat- 
ment of  acute  aural  catarrh  is,  predominantly,  an  antiphlogistic  one. 
The  disease  is  an  inflammation  of  the  severest  form,  and  can  only 
be  successfully  combated  by  such  means  as  blood-letting  and  Opium.” 
Dr.  Burnett  says:  “ Anodynes  should  be  given  in  doses  sufficient  to 
allay  pain  and  produce  sleep.  Aconite  ....  is  of  great  value  in  acute 
otitis ” 

Many  quotations  from  different  authorities  could  be  adduced  to 
the  same  purport,  but  the  consensus  of  most  of  them  is  the  same, 
viz.,  reduce  the  inflammation  by  local  measures,  and  allay  the  pain 
by  anodynes. 

To  this  uniform  paucity  of  medicinal  resources  of  the  Old-School 
specialists,  there  is  one  notable  exception.  Dr.  Sexton,  in  speaking 
of  the  treatment  of  acute  otitis  media,  recommends  quite  an  array  of 
Homoeopathic  remedies — Aeon.,  Hepar.,  Merc.,  Puls.,  etc., — but 
then,  he  is  half  a Homoeopath  anyhow. 

Let  us  look,  now,  at  our  side  of  the  case.  We  find  an  acute  local 
inflammation,  with  constitutional  disturbances,  fever,  frequently  sore 
throat,  etc.  Can  you  not  readily  picture  to  yourselves  the  Aconite 
type,  with  its  flushed  face,  high  temperature,  bounding  pulse,  rest- 
less impatience,  anxious  tossing,  paius  sharp  and  tearing,  extreme 


448 


world’s  homoeopathic  congress. 


sensitiveness  to  noise,  and  all  the  concomitants  that  make  up  an 
Aconite  case.  So  take  your  list  of  remedies,  and  in  your  imagina- 
tion you  can  see  the  Belladonna  case,  the  Ferrum  phos.,  the  Mercur- 
ius,  the  Hepar.  sulph.,  the  Pulsatilla,  and  so  on  down  the  line. 

I am  not  going  into  the  details  of  symptomatology,  but  merely 
direct  your  attention  to  the  contrast  between  the  poverty  of  their 
resources,  and  the  richness  of  our  own  if  but  used  wisely  and  intel- 
ligently. 

Supposing  the  morbid  condition  has  passed  beyond  the  line  of  the 
so-called  catarrhal  form  and  has  eventuated  in  suppuration. 

In  many  cases,  as  you  well  know,  this  point  seems  to  mark  the 
climax  of  the  inflammatory  action,  and  resolution  follows. 

But  this  by  no  means  ends  the  difficulty  in  some  instances,  even 
where  the  membrane  becomes  repaired.  Products  of  inflammation 
remain  in  the  tympanum  to  organize  and  interfere  with  the  delicate 
machinery  therein. 

You  as  specialists  know  the  importance  of  the  pneumatic  speculum 
and  the  air-bag,  in  preventing  the  development  of  adhesions  and 
closure  of  the  tube.  But  you  have  important  aids  in  your  remedies 
to  assist  in  carrying  on  the  process  of  resolution  by  absorption  of  the 
remains,  and  reduction  of  the  swelling  and  infiltration.  Our  friends 
again  here  show  their  poverty,  unless  they  trespass  upon  our  bounty. 
Kali  mur.,  Merc.,  Puls.,  the  Calcareas,  Hepar,  Silicia,  all  stand 
ready  with  a helping  hand. 

But  in  case  resolution  does  not  follow  after  the  suppurative  stage 
is  reached  and  a chronic  pyogenic  condition  is  established  you  are 
confronted  with  a serious  problem. 

Now  as  a rule  it  is  useless  in  aural  suppuration  to  depend  on  in- 
ternal medication  alone,  although  there  are  perhaps  few  conditions 
more  indicative  of  a perverted  systemic  state,  and  showing  more 
need  for  constitutional  treatment.  The  local  conditions  must  be 
complied  with,  and  unless  this  is  done,  your  remedies  are  of  little 
value. 

But  after  cleaning  and  dressing  the  suppurative  tract,  such  reme- 
dies as  Aurum,  Hepar,  Mercurius,  Silicia,  Calcarea,  Sulphur,  Arseni- 
cum, Lycopodium,  come  in  as  powerful  levers  to  so  modify  the  con- 
stitutional state  that  the  local  measures  employed  have  far  greater 
efficacy,  and  vice  versa  the  local  treatment  being  judiciously  used,  the 
medicinal  treatment  finds  fewer  obstacles  in  its  way. 


THE  HOMOEOPATHY  OF  AURAL  THERAPEUTICS. 


449 


A block  between  two  pieces  of  gearing,  disarranges  the  machinery 
and  limitless  fuel  and  steam  does  not  produce  smooth  running,  but 
put  the  local  conditions  of  the  machinery  in  proper  order  and  the 
motive  power  does  its  work. 

It  is  this  mutual  dependence  between  local  and  systemic  treatment 
that  I wish  to  especially  emphasize,  and  thus  assign  to  our  specific 
therapeutics  their  proper  field  of  action.  This  argument  holds 
good  through  all  the  varied  forms  of  aural  pathology  that  we  meet. 

Perhaps  the  most  intractable  of  all  is  the  chronic  catarrhal  condi- 
tion. Taking  the  most  advanced  form  of  treatment  of  the  present 
day,  the  air-bag,  pneumatic  speculum,  vibrometer,  telephonic  attach- 
ment, surgery  of  the  ossicles,  naso-pharyngeal  treatment,  etc.,  one  is 
simply  removing  the  blocks  in  the  machinery,  and  the  more  perfectly 
that  is  done,  the  clearer  is  the  way  for  the  more  satisfactory  action 
of  constitutional  remedies. 

These  ideas  are  not  applicable  to  aural  therapeutics  only.  Through- 
out the  whole  range  of  human  pathology  the  same  principle  applies,, 
and  intelligent  practitioners  everywhere  are  recognizing  the  fact  that 
there  is  more  in  treating  human  ailments,  than  the  suitably  selected 
Homoeopathic  remedy. 

Nutrition,  climatic  conditions,  sanitation,  hygiene,  general  and 
local,  the  elimination  of  mechanical  obstacles  by  mechanical  means,, 
are  indispensable  to  the  best  action  of  the  remedy,  and  the  more 
quickly  this  general  fact  is  appreciated  by  us  as  a school,  and  the 
internecine  warfare — as  to  the  size  of  the  dose,  the  degree  of  attenua- 
tion, who  are  tiue  and  who  are  false  Homoeopaths — eeases,  the  sooner 
will  be  ushered  in  that  wished  for  day,  when  the  law  of  similia 
assigned  to  its  proper  relations  and  limitations , will  be  recognized  by 
the  world  at  large,  as  offering  to  suffering  humanity  its  best  medi- 
cinal aid. 

Discussion. 

Hayes  C.  French,  M.D. : In  the  discussion  of  Dr.  Sterling’s 
admirable  paper  we  are  not  unmindful  of  the  paucity  of  remedies 
that  have  been  found,  even  by  our  Homoeopathic  brethren  to  have 
any  definite  or  constant  affinity  for  the  tissues  involved  in  painful 
and  destructive  aural  troubles. 

Under  the  classification  of  general  and  specific  agencies  for  meet- 
ing ear  diseases  Dr.  Sterling  says  : “ The  general  means  include  all 

local  measures,  nutrition,  hygiene,  sanitation,  etc. ; the  specificsy  our 
remedies.”  To  my  mind  this  classification  seems  indefinite  and 

29 


450 


world’s  homceopathic  congress. 


unphilosophical.  I doubt  if  many  disciples  of  Hahnemann  will  be 
found  willing  to  admit  that  our  remedies  are  specific  in  the  sense 
herein  implied,  from  the  fact,  that  the  symptomatology  that  leads 
to  the  selection  of  an  efficient  remedy  for  the  ear,  may  be  found  to 
have  no  definite  relation  to  the  condition  of  that  organ  at  the  time, 
but  to  quite  remote  ones.  In  selecting  an  ear  remedy  upon  its 
clinical  reputation  the  results  seldom  justify  the  appellation  of 
“ specific,”  and  if  we  chose  it  in  response  to  the  totality  of  the  symp- 
toms, whatever  may  be  the  result,  it  could  not  in  harmony  with  the 
philosophy  of  our  law  of  cure  be  said  to  be  specific  to  the  ear  trouble. 
Again,  in  acute  suppurative  otitis,  with  incarcerated  pus  in  the  mid- 
dle ear,  what  could  be  more  specific  than  the  relief  obtained  by  the 
incisive  offices  of  a lancet?  And  this  certainly  does  not  belong  to  the 
classification — “ our  remedies.”  In  all  curative  ear  troubles,  due  to 
mechanical  causes,  experience  has  taught  most  of  us  that  the  more 
specific  results  have  usually  been  obtained  by  means  of  mechanical 
or  surgical  agencies,  and  in  the  domain  of  prophylaxis  the  same  has 
been  true,  as  in  the  example  of  impacted  cerumem  cited  by  the  author 
in  his  paper.  Even  in  the  few  remedies  for  which  our  Old-School 
colleagues  claim  the  virtue  of  specifics,  our  use  of  the  same  agents 
in  accordance  with  the  law  of  similars  has  always  shown  the  falsity 
of  the  claim  and  the  narrow  limitations  of  the  specific  action,  as 
for  example  the  demonstration  that  the  action  of  quinine  is  after 
all  limited  in  its  antiperiodic  efficacy  to  definite  forms  of  tertian  in- 
ter mitten  ts. 

Would  that  there  might  be  some  solid  ground  on  which  to  found 
our  claims  to  specific  remedies  for  the  painful  and  often  intractable 
diseases,  especially  of  the  middle  ear  and  the  labyrinth.  It  is  as- 
tonishing what  specific  results  sometimes  attend  the  exercise  of  a 
little  good  “ horse  sense,”  even  against  the  general  teachings  of  the 
books  and  the  professors.  In  one  of  our  first  cases  of  suppurative 
otitis  media,  after  cleansing  the  meatus  thoroughly  twice  a day  for 
two  weeks,  following  the  dressing  with  pledgets  of  absorbent  cotton 
in  the  outlet,  with  no  appreciable  diminution  of  the  discharge,  the 
mother  of  the  patient  blandly  suggested  that  the  ear  might  do  better 
if  stopping  the  canal  with  cotton  were  discontinued  ; and  as  soon  as 
it  could  be  done  without  sacrificing  the  dignity  of  the  doctor,  the 
advice  was  acted  upon  to  the  great  benefit  of  the  patient  and  sub- 
sequent advantage  to  the  doctor — loose  bandages,  allowing  free  vent 
to. the  pus,  being  substituted. 


AURAL  THERAPEUTICS. 


451 


AURAL  THERAPEUTICS. 

By  Henry  C.  Houghton,  M.D.,  New  York,  N.  Y. 


What  Dr.  Sterling  has  written  in  his  admirable  paper  is  correct. 
The  lesson  cannot  be  enforced  too  strongly.  It  will  be  needed  as 
long  as  our  colleagues  prescribe  potencies,  low  or  high,  to  meet 
simple,  mechanical  conditions.  As  the  devout  Moslem,  who  said  he 
would  turn  his  camel  loose  and  trust  God,  was  rebuked  by  his 
Master’s  reply,  “tie  the  camel  and  trust  God,”  so  we  must  use  every 
means  that  modern  science  has  brought  to  our  hands,  and  then  add 
that  greatest  vito-chemical  factor,  the  Homoeopathic  remedy.  Still 
the  question  in  my  mind  is  whether  the  greater  danger  lies  in  the 
direction  of  Dr.  Sterling’s  lesson.  I am  inclined  to  believe  that  it 
lies  in  the  direction  of  neglect  of  the  vito-chemical  for  the  mechani- 
cal. I question,  if  to-day,  we  make  as  many  constitutional  cures  as 
we  did  twenty-five  years  ago.  Just  at  that  time  my  effort  and  that 
of  my  colleagues  was  to  test  thoroughly  the  existing  Homoeopathic 
claims  made  in  our  literature  for  the  cure  of  special  diseases — the 
eye  and  the  ear — the  clinic  of  the  New  York  Ophthalmic  Hospital 
having  just  then  been  put  in  our  hands,  and  while  I would  not,  for 
a moment,  disparage  the  work  of  our  specialists  since  then  or  our 
work  of  to-day,  I believe  there  has  been  a retrograde  movement  dur- 
ing, perhaps,  the  last  ten  years. 

The  question  may  be  asked  by  my  hearers,  “ what  do  you  mean 
by  constitutional  cures;  are  not  ‘ Old-School’  cures  constitutional?” 
Yes,  certainly.  “Are  they  not  good,  satisfactory?”  Yes,  certainly. 
“Are  ours  better?”  No,  not  if  they  lack  the  vito-chemical  element 
— the  similar.  The  danger  is  that  we  are  tempted  to  abandon  the 
constitutional  for  the  more  tangible,  because  material,  surgical,  just 
at  the  time  when  Koch  is  giving  us  the  reason  for  our  faith.  Many 
times,  weary  along  right  lines,  from  ignorance,  discouraged,  we  have 
deviated,  tinkered,  until  with  the  use  of  some  individual  remedy  the 
difficulties  have  dissolved  as  by  a charm. 


452 


world’s  homoeopathic  congress. 


Easy  to  practice  Homoeopathy  ? Absurd  ! One  needs  all  the 
wisdom  of  Plumphrey,  Dunham  and  Allen,  joined  with  the  intuition 
of  a Grey  and  the  stolidity  of  a Liebold.  The  charm  that  won  me 
to  the  practice  of  our  art  in  similars,  was  the  physiological  indica- 
tions. Every  salt,  every  metal  that  lies  in  the  mould  of  the  earth, 
every  plant  that  has  appropriated  the  salts  of  earth  and  made  them 
living  vegetable  tissue;  every  virus  that  healthy  action  of  fower 
animals  has  made  a means  of  defence;  every  virus  that  abnormal 
action  of  higher  animals  has  made  a besom  of  destruction,  has  an 
action  that  is  unique,  at  once  so  wonderful  for  simple  study,  that  it 
absorbs  one,  if  only  on  that  line,  but  so  much  more  wonderful  if  we 
study  those  possibilities  which  lie  open  before  us  as  we  turn  to  the 
higher  plane  of  helpfulness  for  cure  of  human  ills. 

Enthusiastic?  Of  course,  we  are.  Sectarian?  Certainly,  in  the 
same  sense  than  an  enthusiastic  geologist,  botanist,  chemist,  may  be 
considered  an  enthusiastic  sectarian  ; only  such  are  we.  What  have 
we  to  offer  to  the  world  that  is  superior  to  the  mechanical  or  the 
constitutional  on  the  old  plan  ? Much  every  way.  Among  these 
metals,  salts,  plants,  etc.,  that  we  use  largely,  some  which  act  not 
only  generally,  constitutionally,  but  by  the  grace  of  an  all-wise  Je- 
hovah, there  are  some  which  act  as  by  fiat  upon  the  ears.  Not  only 
so,  but  upon  special  parts  of  the  ears,  special  function  being  thereby 
conserved ; hence,  I find  ground  not  only  for  faith  as  a medical  man, 
but  faith  as  a Christian  when  I learned  that  this  world  is  not  a 
thing  of  chance. 

Let  me,  then,  to  enforce  my  claim,  cite  a few  instances  of  this 
special,  and  if  I may  be  allowed  to  coin  the  expression,  elective 
chemico-vital  action. 

Take  the  remedy  Plantago  : what  is  there  about  this  simple,  un- 
obtrusive remedy  that  would  lead  one  to  expect  such  special  action 
as  was  demonstrated  in  the  proving  made  by  Francis  Humphrey, 
M.D.  This  action  is  unique  on  the  trifacial  nerve  and  related 
ganglia.  The  pains  are  lightning-like  twinges,  and  patients  who 
have  had  suppurative  inflammation  of  the  middle  ear,  become  alarmed 
at  the  prospect  of  a similar  experience.  The  inspection  of  the  drum- 
head, however,  shows  it  to  be  absolutely  free  from  hypersemia.  The 
relation  to  the  dental  branches  of  the  trifacial  is  very  interesting,  the 
proving  involving  not  only  the  ear,  but  the  teeth,  both  upper  and 
lower  maxillary.  From  the  clinical  note  by  the  prover,  I quote : 


AURAL  THERAPEUTICS. 


453 


“I  have  for  many  years  used  the  Plantago  sufficiently  in  various 
forms  of  odontalgia,  and  doubt  not  this  use  of  the  Plantago  has  been 
confirmed  by  all  who  took  part  in  the  proving  during  these  inter- 
vening years”  (Humphreys). 

A unique  case  may  be  briefly  quoted  : Miss  S.  came  to  me  after 
suffering  for  a number  of  days  with  most  intense  earache.  Her 
brother,  a physician,  feared  that  she  was  on  the  verge  of  suppura- 
tive inflammation.  Inspection  of  the  drum-head  showed  that  it  was 
free  from  any  evidences  of  congestion,  and  the  hearing  was  normal. 
I asked  as  to  her  care  of  the  teeth,  saying  that,  in  all  probability,  the 
trouble  was  due  to  defective  teeth.  I was  laughed  at  for  my  opinion, 
because  the  lady  had  only  a few  days  before  had  the  teeth  put  in 
perfect  order.  I then  thought  that  possibly  the  dentist  might  have 
packed  the  crown  of  the  teeth  too  closely  and  produced  pressure. 
On  inspecting  the  recent  work,  I noticed  two  fillings  in  the  lower 
molar  teeth  on  the  left  side  showed  evidence  of  contact,  and  asked 
her  to  bite  on  the  handle  of  a cotton-carrier  placed  between  those 
two  fillings.  The  result  was  an  increase  of  the  neuralgia  in  the 
ear,  and  the  laugh  was  then  transferred  to  the  other  side  of  the  house. 
The  whole  difficulty  was  obviated  by  burring  down  the  fillings. 

The  Plantago  is  an  admirable  local  application,  either  to  the  ear 
or  to  the  crowns  of  carious  teeth  that  cause  reflex  neuralgia.  Dr. 
M.,  one  of  my  friends  of  the  opposite  school,  was  nearly  converted 
to  the  study  and  practice  of  our  faith  by  the  application  of  the  fluid 
extract  to  his  own  ear  while  suffering  from  an  otitis  that  involved 
the  canal  as  well  as  middle  ear.  The  relief  was  magical,  after  vari- 
ous mitigating  agents,  such  as  the  Magendie  solution,  had  been  used. 

An  interesting  comparison  may  be  made  between  Plantago,  Cliam- 
omilla  and  Pulsatilla.  The  cases  of  intense  neuralgia  under  the  two 
former  remedies  are  associated  with  slight  hyperaemia,  even  if  they 
do  not  pass  on  to  acute  inflammation  ; and  the  peculiarities  of  the 
Chamomilla  symptoms,  the  intense  intolerance  of  pain,  and  the  irri- 
tability of  the  patient,  are  in  decided  contrast  to  the  lachrymose  and 
despairing  depression  of  the  Pulsatilla  patient. 

Capsicum. — Although  I have  frequently  referred  to  this  remedy 
in  other  similar  papers,  it  is  too  good  a sample  of  our  work  to  be 
omitted  from  this.  How  shall  we  account  for  the  action  of  Capsi- 
cum in  mastoid  disease?  Sinapisms  are  as  old  as  the  art  of  healing. 
Possibly  one  of  Hippocrates’s  numerous  students  had  the  earache. 


451 


world’s  homoeopathic  congress. 


Mustard  being  scarce  and  red  pepper  plenty,  a diversion  was  created 
in  the  race,  so  that  future  generations  had  an  impression  on  the  Cap- 
sicum line,  and  the  proving  evolved  this  tendency.  But,  seriously, 
one  would  never  expect  this  symptom,  “ on  the  petrous  bone  behind 
the  auricle  a swelling,  hard,  red,  and  painful  to  the  touch.”  Yet, 
this  was  the  guiding-star,  under  clinical  study,  to  a most  valuable 
remedy.  We  are  under  obligation  to  Professor  Allen  for  a study 
that  leads  to  the  question  : “ Is  Capsicum  of  value  in  the  treatment 
of  ear  diseases?”  In  comparing  it  with  Hepar  and  Mercury,  it  be- 
longs to  the  earlier  stages  of  acute  catarrhal  or  suppurative  inflam- 
mation, and  undoubtedly  saves  patients  from  the  deep-seated  suppu- 
ration in  which  Hepar  and  Mercury  are  needed,  and  operative 
interference  a possible  outcome.  Still,  it  is  very  difficult  to  draw 
that  line,  and  it  is  effective  even  after  profuse  suppuration  is  well 
established,  and  has  made  the  knife  unnecessary.  Compared  with 
Hepar,  the  area  of  sensitiveness  is  very  much  greater,  and  there  is 
less  of  the  variations  due  to  exposure,  time  of  day,  etc.  Compared 
with  Mercury,  the  area  of  sensitiveness  is  as  great,  perhaps,  but  we 
do  not  notice  the  peculiar  nightly  aggravations  of  the  latter  remedy, 
nor  the  sticky,  uncomfortable  perspiration. 

Tellurium. — Why  should  a metal  like  this  select  the  tympanum 
as  its  point  of  offensive  warfare  ? Why  should  it  produce  an  offence 
that  smells  to  heaven? — an  odor  of  fish-brine  so  offensive  that  one 
finds  a parallel  in  the  proverbial  profanity  of  the  fish  woman ; pos- 
sibly the  drug  was  proved  on  one  of  them. 

The  proving,  as  made  by  Dr.  Dunham,  shows  that  there  were 
most  profound  changes  in  the  mucous  membrane  of  the  tympanum, 
as  well  as  of  the  drum-head.  One  of  the  most  remarkable  cases  that 
I have  ever  seen  was  the  action  of  this  remedy  in  the  person  of  a 
young  married  woman,  Mrs.  M.,  21  years  of  age.  She  had  had 
suppuration  of  the  ear  from  childhood,  and  now  that  the  responsi- 
bility devolved  upon  herself  since  her  married  life,  she  was  very 
anxious  to  be  relieved  of  this  annoying  condition.  The  canal  was 
large,  tissues  wasted,  the  drum-head  undefined  and  oozing  a thin, 
watery,  most  offensive  discharge.  Under  Psorinum  this  was  modi- 
fied, and  developed  the  characteristic  odor  of  fish-brine.  Under 
Tellurium,  the  appearance  of  the  ear  gradually  changed,  the  dis- 
charge grew  less,  scales  formed,  were  exfoliated,  the  outlines  of  the 
perforated  drum-head  came  into  view,  the  perforation  healed,  and, 


AURAL  THERAPEUTICS. 


455 


to  ray  great  surprise,  a fair  degree  of  hearing  was  secured.  The  cure 
was  permanent,  at  least,  so  far  as  I know  up  to  date.  I have  seen 
the  lady  frequently  since,  and  the  result  is  very  gratifying. 

The  comparison  between  this  metal  and  the  virus,  Psorinum  is 
unique.  I admit  that  ] had  an  intense  prejudice  against  the  latter 
remedy,  but  experience  among  the  poor  children  at  the  Five- Points 
House  of  Industry,  and  later  on  at  the  Ophthalmic  Hospital,  over- 
came it  entirely,  and  one  need  only  study  the  wretched,  puny,  pre- 
maturely aged,  with  discharges  of  a cadaverous  odor  from  the  ears, 
stinking  diarrhoea,  stench  of  the  very  person,  which  is  indescribable, 
but  well  recognized  by  those  who  have  had  experience  with  these 
cases  who  present  themselves  at  our  institutions,  to  be  profoundly 
thankful  for  any  remedy  that  will  correct  such  conditions. 

Chenopodium  Anthelminticum. — Why  should  this  vegetable  select 
not  only  the  auditory  nerve  but  particular  portions  of  it?  Notice 
these  symptoms  taken  from  Allen’s  Encyclopaedia : 

“ Deafness  to  the  sound  of  the  voice,  but  exquisite  sensitiveness  to 
the  sounds  of  passing  vehicles.  He  remarked  as  each  vehicle  rolled 
by  that  it  sounded  like  the  roaring  of  immense  cannons  right  into  his 

ear;  also  annoying  buzzing  in  the  ears During  all  this  time 

his  deafness,  as  described,  was  progressive,  and  became  so  pronounced 
as  to  make  it  impossible  to  talk  to  him.  Still,  there  was  the  same 
kind  of  sensitiveness  to  other  sounds.  For  example,  when  the  tea- 
bell  rang,  though  he  was  on  the  third  story,  three  flights  from  where 
the  sound  came,  he,  without  notice  from  members  of  his  family,  to 
their  utter  astonishment,  got  up  and  walked  as  deliberately  as  ever 
into  the  dining-room.” 

Here  we  have  a picture  of  profound  effect  upon  the  auditory  nerve, 
and,  more  than  that,  not  an  abolition  of  function,  but  a modification 
which  shows  deafness  to  voice,  but  sensitiveness  to  both  high  tones 
and  low  tones.  Clinically,  it  has  proved  curative  for  the  low  tones 
of  the  organ,  16-  and  32-foot  pipe,  and  should  be  thought  of  when 
there  is  in  the  patient  the  perception  of  high  tones,  like  those  of 
small  bells, ‘whistles,  etc.,  and  also  a shrinking  from  low  tones,  the 
intermediate  tones  being  either  good  or  absolutely  lost. 

I have  given  thus  rapidly  pictures  of  remedies  acting  upon  the 
sensory  nerves  of  the  tympanum,  not  involving  the  mucous  mem- 
brane to  a degree  of  inflammation  or  suppuration ; also,  remedies 
affecting  the  tympanum  in  such  a condition  of  acute  inflammation, 


456 


world’s  homoeopathic  congress. 


and  one  remedy  affecting  the  auditory  nerve  entirely  independent  of 
conditions  of  the  middle  ear. 

These  statements  do  not  need  any  argument.  They  are  too  well 
known  to  those  who  are  interested  in  this  subject.  If  this  be  so,  the 
question  then  arises,  why  is  it  that  the  profession  does  not  use  these 
remedies  and  similar  remedies?  Dr.  Sterling  has  referred  to  one 
gentleman  who  does  use  them,  and  who  has  used  them  for  years,  to 
my  personal  knowledge,  but  when  he  offers  them  to  his  colleagues 
in  a paper  read  in  their  hearing,  they  simply  state  that  these  are  the 
remedies  and  the  methods  of  Homoeopathy.  Let  the  gentleman  take 
them  and  go  with  them  to  those  who  practice  sectarian  medicine. 

The  simple  fact  is  that  we  are  none  of  us  free  from  prejudice,  and 
we  are  not  likely  to  be  freed  from  our  prejudices.  Here  and  there 
peculiar  circumstances  of  association  or  accidental  conviction  lead 
one  to  the  investigation  of  physiological  medicine,  which  is  Homoe- 
opathy, and  such  persons  modify  their  methods,  if  not  their  relations. 

Perhaps  it  is  not  well  to  ask  more  in  medical  lines  than  we  do  in 
other  lines  of  experience  and  conviction. 


SOME  RECENT  ADVANCEMENTS  IN  OTOLOGY. 


457 


SOME  RECENT  ADVANCEMENTS  IN  OTOLOGY. 

By  Howard  P.  Bellows,  M.D.,  Boston,  Mass. 

The  aim  of  this  paper  is  to  pass  in  review  the  more  notable  ad- 
vancements in  otology,  in  the  departments  of  anatomy,  physiology 
and  bacteriology  during  a period  of  about  five  years  past.  In  the 
time  allotted  little  can  be  done  but  to  summarize,  and  this  mode  of 
treatment  leaves  little  room  for  criticism  and  none  for  originality. 
It  is  hoped,  however,  that  it  will  serve  its  purpose  in  stimulating 
discussion,  and  perhaps,  in  some  instances,  encouraging  or  guiding 
subsequent  reading  in  some  particular  direction.  To  serve  this  end 
there  will  be  found  appended  a very  copious  reference  list  of  authors 
and  articles. 

Anatomy. — In  this  department  of  otology  the  growth  of  knowl- 
edge is  of  necessity  slow,  even  where  the  work  of  several  years  is 
scanned.  Considerable  interest  has  lately  attached  to  the  relative 
situation  and  course  of  the  lateral  sinus , this  being  a point  of  vital 
importance  in  the  surgery  of  the  mastoid  region  and  in  brain  sur- 
gery, which  is  just  now  so  enthusiastically  studied  with  relation  to 
diseases  of  the  ear.  This  sinus  is  now  believed  to  follow  a higher 
and  more  arching  course  after  leaving  the  occipital  protuberance  and 
before  beginning  its  downward  dip  behind  the  meatus,  than  was  pre- 
viously taught,  and  also  to  approach  nearer  to  the  meatus  in  its  de- 
scent.1 This  changes  somewhat  the  point  and  method  chosen  for 
surgical  entrance.  To  drain  the  mastoid  antrum,  for  instance,  it  is 
recently  recommended  to  use  a drill,  which  must  not  exceed  J inch 
in  diameter,  and  enter  straight  in  at  a point  immediately  below  the 
level  of  the  upper  border  of  the  bony  meatus  and  as  close  to  its 
interior  wall  as  possible.  Another  point  which  has  apparently  been 
established  recently  is  in  regard  to  the  location  of  the  auditory  centre. 
This  is  claimed  to  be  seated  in  “ the  posterior  third  of  the  first  and 
second  temporal  convolutions.”2  The  fibres  of  the  auditory  nerve 
from  their  origin  “ in  the  bi-polar  ganglionic  cells  of  the  cochlea 


458 


world’s  homceopathic  congress. 


and  vestibular  ganglia,”3  proceed  upward  to  these  convolutions,  and 
on  their  way  undergo  decussation,  so  that  each  cerebral  hemisphere 
is  supposed  to  receive  impressions  from  both  ears.  The  only  nerve 
fibres  which  find  their  way  into  the  cerebellum  are  said  to  be  those 
which  arise  from  the  membranous  semi-circular  canals.4  This  view 
of  the  location  of  the  auditory  centre — for  speech,  at  least — is  cor- 
roborated by  the  finding  of  two  autopsies,  since  published,  in  one 
of  which  5 a pre-existing  deafness  on  the  left  side,  without  apparent 
disease  of  the  left  ear,  is  thought  to  have  been  accounted  for  by  the 
location  of  a cerebral  tumor  upon  the  right  or  opposite  side  of  the 
brain,  by  which  the  first  temporal  convolution  had  been  destroyed 
and  the  second  somewhat  injured;  while  the  second  autopsy,2  in  con- 
nection with  the  previous  history  of  the  case,  seems  to  demonstrate, 
in  addition,  that  total  deafness  only  results  when  the  hearing  centre 
is  destroyed  on  both  sides  of  the  brain.6 

Physiology. — Perhaps  the  most  interesting  of  the  physiological 
questions  which  have  received  recent  discussion,  relates  to  the  func- 
tion of  the  tympanic  membrane , which  has  acquired  a new  import- 
ance within  the  past  year  or  two.  One  view  advanced7  is  that  its 
chief  function  is  that  of  protection  of  the  inner-tympanic  structures, 
its  presence  especially  guarding  the  membranes  of  the  round  and 
oval  windows,  and  preventing  their  becoming  dry  and  rigid.  The 
transmission  of  sound  by  the  drum-head  is  held  to  be  a function  of 
secondary  importance,  and  the  improvement  of  hearing  which  often 
follows  an  artificial  perforation,  it  is  believed  can  be  only  temporary 
because  of  the  absence  of  the  protection  which  the  membrana  tym- 
pani  is  designed  to  afford.  Viewed  from  another,  and  purely  ex- 
perimental, standpoint,  the  function  of  the  tympanic  membrane  as  a 
transmitter  of  vibrations  certainly  seems  to  be  a most  important  one. 
By  means  of  some  exceedingly  ingenious  and  skillful  experiments 
upon  the  cadaver,  it  has  recently  been  demonstrated  that  if  a lateral 
motion  be  given  to  the  head  of  the  malleus,  a corresponding  tilting 
motion  is  communicated  to  the  foot-plate  of  the  stapes,  causing  it 
to  move  from  side  to  side  in  the  direction  of  its  long  axis  ; and  also, 
if  an  outward  and  inward  motion  is  given  to  the  tympanic  mem- 
brane and  malleus  by  means  of  the  pneumatic  speculum,  a similar 
motion  is  perceived  in  the  stapedial  plate,  which  is  seen  to  be  drawn 
outwards  as  well  as  pushed  inwards — a point  of  departure  from  all 
previous  views.  This  the  experimenter8  speaks  of  as  a “ piston 


SOME  RECENT  ADVANCEMENTS  IN  OTOLOGY. 


459 


movement,”  and  he  thinks  it  probable,  from  his  experiments,  that 
in  some  conditions  partial  or  entire  mobility  may  be  restored  to  the 
stapes.  This  ready  response  of  the  stapedial  plate  to  all  movements 
of  the  tympanic  membrane  furnishes  the  latest  explanation9  of  the 
perception  of  the  direction  of  sound,  since  different  vibrations  are 
communicated  in  accordance  with  the  different  angle  at  which  sound- 
waves impinge  upon  the  surface  of  the  membrane. 

In  regard  to  the  mode  of  regeneration  of  the  tympanic  membrane, 
a new  fact  has  been  ascertained.  There  seems  to  be  a difference 
whether  the  membrane  is  newly  formed  in  its  entirety,  begin- 
ning at  the  tympanic  ring,  or  whether  it  is  merely  the  repair  of  a 
perforation.  In  the  former  case,  it  is  demonstrated  by  a recent  mi- 
croscopical examination10  that  the  lamina  propria  is  reproduced  by 
fibres,  somewhat  more  dense  than  normal,  which  radiate  inward  from 
the  tympanic  ring.11 

One  of  the  most  original  of  recent  investigations  in  the  physiol- 
ogy  of  the  ear  relates  to  the  function  of  otoliths.™  It  being  generally 
conceded  that  the  perception  of  turning  is  acquired  through  the 
agency  of  the  semi-circular  canals,  it  is  now  shown  that  perceptions 
of  progressive  movement  and  of  position  in  space  may  well  be  fur- 
nished by  the  otolithic  apparatus.  The  vestibule  is  therefore  found 
to  be  the  organ  of  what  is  very  aptly  called  the  “ static  sense.”  In 
one  series  of  experiments13  the  otolith  was  removed  from  senophores 
and  subsequent  movements  watched.  These  became  irregular,  and 
without  equilibrium.  The  name  “ statoliths”  is  proposed  for 
these  substances  instead  of  otoliths,  because  of  their  newly  demon- 
strated function. 

Finally,  the  cochlea  has  come  in  for  recent  investigation,  with  re- 
sults which  are  of  no  little  importance.  The  destruction  of  this 
organ,  in  whole  or  in  part,  in  forty  guinea-pigs,  has  demonstrated14 
that  total  deafness  invariably  follows  complete  destruction  of  the 
cochlea,  and  sometimes  follows  its  partial  destruction.  It  is  sur- 
mised that  perception  of  the  higher  notes  of  the  musical  scale  may 
occur  at  the  base  of  the  cochlea,  and  the  lower  tones  be  perceived 
at  the  apex.  This  view  is  supported  by  the  result  of  a recent  hu- 
man autopsy.15  The  patient  had  exhibited  total  deafness  upon 
both  sides,  for  all  sounds  except  musical  notes  of  low  pitch.  In 
the  right  cochlea  was  found,  at  the  apex,  a few  nerves  which  were 
fairly  well  preserved,  and  Corti’s  organ  in  perfect  condition. 


460 


world’s  homoeopathic  congress. 

Bacteriology. — This  new  field  of  investigation  has  already 
been  well  cultivated,  and  has  been  prolific  of  both  facts  and  theories, 
the  practical  importance  of  which  the  future  alone  can  determine. 
All  portions  of  the  auditory  tract,  including  the  Eustachian  tube, 
the  mastoid  antrum,  and  even  the  interior  of  the  labyrinth  and  the 
adjacent  meninges  of  the  brain,  have  been  patiently  and  repeatedly 
searched  for  bacteria,  and  cultures  obtained  for  study  and  verifica- 
tion. Also  all  secretions  of  the  ear,  and  especially  those  which  are 
purulent,  have  been  subjected  to  the  same  process.  Cerumen,  for  in- 
stance, has  been  searched  for  the  presence  of  micro-organisms,  and 
one  set  of  experiments16  covers  a series  of  cultures  made  from 
fifty  impacted  cases.  Large  numbers  of  bacilli  and  cocci  of  dif- 
ferent species  were  found,  and  their  subsequent  injection  into  ani- 
mals produced  disorders  of  the  liver,  lungs,  and  abdominal  glands. 
But,  in  this  particular  instance,  no  practical  deduction  seems  pos- 
sible. 

Among  the  curiosities  of  bacteriology  may  be  mentioned  a species 
of  mould  removed  from  the  human  meatus,17  the  spores  of  which  were 
used  for  the  inoculation  of  rabbits.  These  died  in  consequence,  pre- 
senting characteristic  symptoms  of  nephritis.  The  mould  was  there- 
fore named  eurotium  malignum. 

As  might  be  expected,  furuncles  have  received  a special  share  of 
attention,  and  have  been  thoroughly  studied  with  reference  to  the  in- 
fluence of  bacteria.  Cultures  made  from  their  contents  exhibit  con- 
stantly the  staphylococcus  albus,  aureus  or  citreus,18  either  singly  or 
combined.  Experiments  with  these  cultures19  show  that  the  presence 
alone  of  these  cocci  upon  the  surface  of  the  skin  is  not  sufficient  to 
cause  a furuncle,  but  that  by  rubbing  they  must  be  made  to  enter 
into  the  skin.  How  this  entrance  is  really  effected'  is  a subject  of 
interesting  controversy,  some  holding  an  abrasion  of  the  skin  to  be 
necessary,  or  an  entrance  by  means  of  the  gland  ducts,18  while  it  is 
claimed  by  others  to  be  demonstrated  by  the  microscope  that  the 
staphylococcus  aureus  penetrates  the  skin,  not  by  way  of  surface- 
wounds  or  sweat-glands,  but  into  the  hair  follicles,20  working  down 
between  the  hair  and  the  root-sheath.  In  either  case  the  same  mode 
of  treatment,  whether  abortive,  curative,  or  preventive,  is  in  vogue 
with  all  who  accept  this  view  of  the  origin  and  infectiousness  of 
furuncles,  and  that  consists  in  the  destruction  of  the  cocci  by  the  use 
of  topical  applications.  Although  digressive,  there  may  be  men- 


SOME  RECENT  ADVANCEMENTS  IN  OTOLOGY. 


461 


tioned,  of  these,  kaliura  sulphuratum,21  corrosive  sublimate,22  carbolic 
oil,23  sublimate  alcohol,24  aluminium  aceticum,25  boric  acid  in  alco- 
hol,26 carbolic  acid  glycerine,27  menthol  in  petrolol,28  29  menthol  in 
alcohol,30  and  menthol  in  sweet  oil.31 32 

Coming  to  the  middle  ear,  we  find  the  roles  played  by  bacteria, 
according  to  recent  views,  to  be  exceedingly  important,  and  the 
amount  of  minute  and  exact  knowledge  concerning  them  which  is 
already  acquired  may  well  be  a matter  of  surprise.  Briefly  stated, 
it  is  held  that  bacteria  may  find  entrance  to  the  middle  ear33  either 
by  way  of  the  Eustachian  tube,  the  blood  circulation,  the  lymphatics, 
the  membrana  tympani,34  or  the  fissura  petro-squamosa,  and  that 
their  presence  may  induce  either  excessive  secretion  of  mucus,  plas- 
tic changes,  or  the  formation  of  pus.  It  is  held  by  some  that  in  the 
tympanic  cavity  may  always  be  found  a small  number  of  bacteria,35 
which  remain  harmless  and  quickly  perish  under  ordinary  condi- 
tions, but  which  may  be  aroused  to  activity  and  a virulent  develop- 
ment under  circumstances  which  favor.  It  has  been  experimentally 
demonstrated  that  such  is  the  condition  of  the  interior  of  the  Eus- 
tachian tube,36  but  all  authorities  agree  that  the  most  probable  source 
of  infecting  germs  in  the  tympanum  is  through  the  tube  from  the 
nasopharynx. 

In  otitis  media  suppurativa,  which,  of  all  forms  of  middle-ear  in- 
flammation, is  the  most  important  in  this  relation,  and  which  has 
been  the  most  carefully  investigated,  there  have  been  found  in  the 
secretions37  the  streptococcus  pyogenes,38  the  pneumococcus  of  Frsen- 
kel,  the  pneumobacillus  of  Friedlander,  and  the  staphylococcus  pyo- 
genes.39 The  first  named  is  found  the  most  frequently  and  in  the 
most  severe  cases,  which  may  be  complicated  with  mastoiditis,  puru- 
lent meningitis,40  cerebral  abscess,  phlebitis,  thrombosis,  or  pyaemia. 
This,  it  will  be  remembered,  is  the  same  microbe  that  produces  puer- 
peral fever  and  erysipelas.  In  mastoid  inflammation  this  strettococ- 
cus  is  almost  exclusively  found,41  while  its  presence  has  been  demon- 
strated upon  the  cerebral  meninges42  in  a case  of  caries  of  the  temporal 
bone,  and  in  the  labyrinth,43  in  fatal  cases  from  diphtheria  and 
measles.  It  is  also  this  coccus  which  is  present  in  the  destructive 
otorrhoea  of  scarlatina.  A less  severe  and  more  rapid  form  of  in- 
flammation, both  as  to  development  and  resolution,  is  thought  to  be 
induced  by  the  pneumococcus.  In  connection  with  these  four  micro- 
organisms, the  tubercle  bacillus  is  found  not  infrequently,45  46  while 


462 


world’s  homceopathic  congress. 


the  most  recent  discovery  has  been  the  presence  of  the  bacillus  pyo- 
cyaneus.47  The  presence  and  true  character  of  these  various  bacteria 
has  been  verified,  time  and  again,  by  the  inoculation  of  mice,  guinea- 
pigs,  and  rabbits  with  cultures. 

One  suppurative  case  which  underwent  examination  presented  an 
especially  interesting  sequel.  Re-examination  eight  weeks  later,  the 
discharge  having  continued,  showed  that  the  diplococcus,  which  was 
first  present,  had  disappeared,  but  had  been  replaced  by  the  staphy- 
lococcus pyogenes  albus.  This  condition  is  called  by  the  observer35 
a “ secondary  infection,”  and  it  is  argued  that,  in  the  same  way,  a 
tertiary  might  occur,  and  this  process  be,  perhaps,  a cause  of  the  long 
duration  of  many  suppurative  cases,  and  explain  their  marked  ten- 
dency to  become  chronic. 

In  the  middle-ear  suppuration  of  influenza  there  has  been  discov- 
ered,48 in  addition  to  the  streptococcus,  the  diplococcus  pneumonise 
and  the  staphylococcus,  a bacillus  of  peculiar  form,49  which  could 
not  be  made  to  grow  upon  the  usual  nutrient  material,  and  which  is 
considered  to  be  the  influenza  bacillus.50 

As  to  the  practical  importance  of  these  new  discoveries,  which 
have  been  so  laboriously  made,  they  teach  us  certainly  the  necessity 
of  the  most  absolute  cleanliness  and  antisepsis  in  our  manipulation 
of  aural  cases,  and  especially  in  the  care  of  instruments,  which  are 
used  from  one  patient  to  another.  Beyond  this,  as  a means  of  prog- 
nosis or  as  a guide  to  treatment,  very  different  estimates  are  held  of 
the  value  of  our  present  knowledge  of  these  bacteria.  It  is  thought 
by  some  that  the  fact  of  the  presence  of  a given  microbe,  whether  it 
be  regarded  as  the  primary  cause  of  the  diseased  condition  or  not,40 
will  determine  the  after  progress  of  the  disease  in  fixed  channels  f 7 
while  others  believe  that  the  finding  of  a certain  coccus  in  the  secre- 
tions can  give  no  aid  in  the  prognosis  of  aural  disease,  since  the  same 
microbe  will  at  one  time  occasion  only  slight  local  effects  and  at 
other  times  serious  general  disturbances,38  and  since,  indeed,  inflam- 
matory processes  differing  as  much  as  the  catarrhal  and  the  suppu- 
rative are  due  to  identically  the  same  micro-organism.51  It  is  more 
than  probable  that  the  present  store  of  knowledge  is  only  a step 
toward  the  ultimate  benefit  which  may  accrue  to  otology  from  the 
science  of  bacteriology,  and  it  is  hoped  that  this  will  eventually 
reward  the  zeal  of  the  workers  in  this  obscure  field. 


SOME  RECENT  ADVANCEMENTS  IN  OTOLOGY. 


463 


1.  Birmingham — Brit.  Med.  Jour.,  September  20,  1890. 

2.  Mills — Brain,  January,  1892. 

3.  H is.  Arch.  f.  Anat.  u.  Physiol.,  1890,  supplementary  volume, 

p.  45. 

4.  Ferrier— Lancet,  June,  1890. 

5.  Ferguson — Jour,  of  Anat.  and  Physiol.,  January,  1890. 

6.  Manourrier — Soc.  d’Anthropologie  de  Paris,  March,  1890. 

7.  Bichey — Trans.  Amer.  Otol.  Soc.,  1888. 

8.  Larsen — Archives  of  Otology,  April,  1892. 

9.  Bonnier — Comptes  rendues  de  l’Acad.  des  Science,  October  26, 

1891. 

10.  Gomperz — Monatsschr.  f.  Ohrenheilk.,  etc.,  1892,  No.  4. 

11.  Rumler — Arch.  f.  Ohrenheilk.,  vol.  xxx.,  p.  142. 

12.  Breuer — Arch.  f.  d.  ges.  Physiol.,  vol.  xlviii.,  p.  195-306. 

13.  Verworn — Paper  on  Assuming  Lectureship,  Jena,  1891. 

14.  Corradi — Arch.  f.  Ohrenheilk.,  1891,  vol.  xxxii.,  p.  1. 

15.  Habermann — Arch.  f.  Ohrenheilk.,  vol.  xxxiii.,  p.  105. 

16.  Rohrer — Arch.  f.  Ohrenheilk.,  vol.  xxix.,  p.  44. 

17.  Lindt — Arch.  f.  exprim.  Path.  u.  Pharm.,  vol.  xxv.,  3 and  4. 

18.  Loewenberg — Trans.  Ninth  Internat.  Med.  Congress,  1877. 

19.  Sutton — Jour,  of  Anat.  and  Physiol.,  vol.  xxi.,  p.  299. 

20.  Schimmelbusch — Archiv.  fur  Ohrenheilk.,  xxvii.,  p.  252. 

21.  Schwartze. 

22.  Kirchner — Monats.  f.  Ohrenheilk.,  No.  1,  1887. 

23.  Politzer. 

24.  Weber — Liel. 

25.  Grosch — Berlin,  klin.  Wochenschr.,  188,  No.  18. 

26.  Loewenberg- — Berlin,  klin.  Wochenschrift,  188,  No.  28. 

27.  Bronner — Year-book  of  Treatment,  1890,  p.  279. 

28.  Anton  and  Szenes — Prager  med.  Wochenschr.,  1889,  No.  33. 

29.  Szenes — Internat.  Klinische  Rundschau  Vienna,  June,  1890. 

30.  Hill — Year-Book  of  Treatment,  1890,  p.  279. 

31.  Cholewa — Therap.  Monatshafte,  June,  1889. 

32.  Cholewa — Monatsschr.  f.  Ohrenheilk.,  etc.,  1892,  No.  3. 

33.  Moos — Sec.  of  Otol.,  Internat.  Med.  Congress,  Berlin,  1890. 

31.  Moos — Deutsche  med.  Wochenschr.,  1890,  Nos.  11  and  12. 

35.  Zaufal — Prager  med.  Wochenschr.,  1889,  Nos.  6-12. 

36.  Maggiora  and  Gradenigo — Centralbl.  f.  Bacteriologie  u.  Para- 

sitenkunde,  vol.  viii.,  p.  582,  1890. 


464 


WORLD  S HOMCEOPATHIC  CONGRESS. 


37.  Metter — Ann.  des  mal.  de  l’oreille  et  du  larynx,  1888,  No.  10. 

38.  Levy  and  Schrader — Arch.  f.  experiment.  Path.  u.  Pharmakol., 

vol.  xxvi.,  p.  223. 

39.  Chattellier — Soc.  Anatomique,  November  23,  1888. 

40.  Zaufal — Prager  med.  Wochenschr.,  1888,  Nos.  20-21. 

41.  Creboisier  de  Vomecourt — “ Contribution  a l’6tude  du  role  des 

micro-organismes  dans  les  otites  moyennes  purulantes  et 
leur  complicacions  mastoid iennes.”  1892.  Paris. 

42.  Netter. 

43.  Moos. 

44.  Marie  Baskin — Central bl.  f.  Bacteriol.  u.  Parasitenkunde,  1889, 

Nos.  13  and  14. 

45.  Field — Harveian  Lectures  (Brit.  Med.  Journal,  December  3, 

1892). 

46.  Cohnstadt — Monatsschr.  f.  Ohrenheilk.,  etc.,  1892,  No.  5. 

47.  Martha — Arch,  de  medic,  experim.,  January,  1892. 

48.  Zaufal — Prager  med.  Wochenschr.,  1892,  No.  8. 

49.  Scheibe — Centralbl.  f.  Bacteriologie  u.  Parasitenkunde,  vol. 

viii.,  p.  225,  1890. 

50.  Scheibe — Miinch.  med.  Wochenschr.,  1892,  No.  14. 

51.  Maggiora  and  Gradenigo — Central blatt  fur  Bacteriologie  and 

Parasitenkunde,  etc.,  1891,  No.  19. 

Discussion. 

Francis  B.  Kellogg,  M.D.,  of  Tacoma:  It  is  with  consid- 
erable trepidation  that  I undertake  the  discussion  of  a paper  which 
I have  never  seen.  This  unfortunate  omission  was  unavoidable — 
sickness  having  prevented  its  completion  in  time  for  a preliminary 
transcontinental  journey.  If,  therefore,  my  observations  seem  to 
relate  to  the  subject  in  general  rather  than  to  the  paper  in  ques- 
tion, this  circumstance  will  serve  at  once  as  explanation  and  excuse. 

They  are,  in  the  main,  extracts  from  notes  recently  taken  in  Pol- 
itzer’s  clinic  in  Vienna. 

1.  Perforation  of  the  Membrana  Schrapuelli — This  form  of  per- 
foration is  peculiarly  subject  to  invasions  of  masses  of  exfoliated 
epidermic  cells  or  cholesteatomata.  These  cells  are  thrown  off  from 
the  skin  of  the  auditory  canal,  and  by  some  occult  process  emigrate 
towards  and  through  this  opening  into  the  attic  of  the  tympanum. 
Loaded  with  septic  germs,  they  become  in  this  location  a source  of 
no  small  danger  to  the  life  of  the  patient,  since,  if  neglected,  they 
are  liable  to  set  up  necrosis  of  the  thin,  bony  roof  of  the  attic,  which 


SOME  RECENT  ADVANCEMENTS  IN  OTOLOGY. 


465 


alone  separates  the  latter  from  the  brain.  To  dislodge  and  remove 
these  masses  from  the  tympanum  is  evidently,  therefore,  a matter  of 
great  importance.  It  is  also  one  of  no  small  difficulty.  With  the 
exception  of  the  measure  to  be  described,  Hartman’s  canula  offers 
the  most  effective  means  of  accomplishing  this  end.  It  is  open,  howr 
ever,  to  the  objection  that,  except  in  large  perforations,  the  canula 
itself  offers  an  obstruction  to  the  escape  of  the  masses.  The  desira- 
bility of  vis  a iergo  is  evident,  and  presents  a strong  argument  in 
favor  of  the  following  procedure  : A large-sized  catheter  is  inserted, 
its  presence  in  the  tube  demonstrated  by  the  air-bag  and  otoscope ; 
after  which  the  patient’s  head  is  tipped  towards  the  affected  side,  and 
he  is  given  a pus-basin  to  hold  under  the  ear.  He  is  directed 
to  open  his  mouth  widely,  and  to  make  (during  the  injection)  short, 
sharp  respirations,  with  the  accent  upon  the  expiratory  sound,  ma- 
king as  much  noise  as  possible  with  the  breath.  It  is  impossible  to 
do  this  without  closing  the  naso-pharyngeal  passage,  thus  preventing 
the  escape  of  water  into  the  throat.  A large  syringe,  full  of  warm 
boiled  water,  is  now  forced  through  the  catheter  and  tube  into  the 
middle  ear.  It  is  necessary  to  use  considerable  force,  as  much  water 
unavoidably  escapes  about  the  point  of  the  catheter,  which  fits  only 
loosely  into  the  mouth  of  the  Eustachian  tube.  Enough  water,  how- 
ever, enters  the  tympanum  so  that  it  is  seen  to  drop  from  the  exter- 
nal ear  into  the  basin.  The  passage  of  even  a few  drops  in  this  way 
is  exceedingly  effective,  bringing  away  masses  of  epithelial  debris,, 
and  softening  that  left  behind  so  that  it  may  be  removed  at  a sub- 
sequent sitting.  Nor  is  this  procedure  effective  alone  for  the  removal 
of  cholesteatomata.  According  to  Politzer,  cases  of  chronic  middle 
ear  suppuration  which  have  resisted  all  other  treatment,  have  yielded 
to  injections  of  boiled  water  alone  when  applied  in  this  manner. 

In  adopting  this  treatment  there  is  a single  phenomenon  for  which 
it  is  necessary  to  be  prepared,  viz.,  vertigo.  It  is  caused  by  the 
pressure  of  the  water  in  the  middle  ear  upon  the  oval  window,  and 
through  this  upon  the  labyrinthine  fluid.  With  a clear  appreciation 
of  its  cause,  its  relief  is  prompt  and  brilliant.  The  proper  instru- 
ment for  this  purpose  is  an  air-bag  fitted  with  a rubber  tube  about 
a foot  long,  terminating  in  an  ear-piece.  The  patient  must  be  watched 
for  symptoms  of  vertigo,  as  they  will  sometimes  be  so  affected  as  to 
be  unable  to  speak  for  a moment,  and  first  show  the  affection  by  un- 
steadiness in  the  chair.  Upon  the  first  complaint  or  evidence  of  diz- 
ziness, exhaust  the  air-bag,  insert  the  ear-piece  air-tight  into  the 
canal,  and  exert  suction  upon  the  drum.  The  relief  is  magical. 

Vertigo,  resulting  from  manipulations  in  the  ear  is  always  caused 
by  a disturbance  of  the  pressure-equilibrium  of  the  labyrinthine  fluid. 
Usually,  this  disturbance  is  in  the  form  of  pressure  from  without, 
consequent  upon  syringing  into  the  middle  ear,  either  through  the 
tube  or  through  a perforated  drum.  It  may  also  be  incidental  to 

30 


466 


world’s  homoeopathic  congress. 


operations  in  the  middle  ear.  In  either  case,  the  proper  steps  for  its 
relief  should  never  be  forgotten. 

Surgical  Treatment  of  Deafness. — In  this  field,  the  American  aur- 
ists  have  distanced  those  of  other  countries. 

Extraction  of  the  hammer  is  discouraged  at  Vienna,  except  for 
caries.  Mobilization  and  circumcision  of  the  stapes  are  the  only 
surgical  procedures  having  as  their  aim  the  restoration  of  hearing 
which  are  practiced  there.  In  performing  these,  the  opening  in  the 
drum-membrane  is  made  either  with  the  knife  or  galvano-cautery 
over  the  inco-stapedial  articulation.  A delicate  paddle-shaped  knife, 
cutting  at  the  end  of  the  blade,  is  pushed  in  below  the  foot-plate  of 
the  stapes  into  the  oval  window,  and  any  existing  adhesions  are  thus 
severed.  It  is  a harmless  but  radical  procedure,  and  should  be  un- 
dertaken in  appropriate  cases  without  hesitation. 

Extraction  of  the  stapes,  however,  as  recently  undertaken  by 
Blake,  of  Boston,  is  a much  more  radical  proceeding.  The  verdict 
as  to  its  justification  cannot  yet  be  rendered.  Two  questions  must 
first  be  answered, — first,  is  the  improvement,  if  attained,  permanent? 
second,  are  there  dangers  attending  the  operation  which  would  over- 
balance the  possible  gain  ? 

The  first  question  time  alone  can  answer.  Presumption,  however, 
is  in  its  favor.  It  is  urged,  that  the  space  in  the  oval  window,  for- 
merly occupied  by  the  foot-plate  of  the  stapes,  is  replaced  after  the 
operation  by  membrane  which  must,  naturally,  respond  to  sound 
vibrations  more  freely  than  anchylosed  bone.  It  is  difficult  to  see 
how  this  membrane  can  be  other  than  a permanent  one,  although,  it 
may  be  subject  to  modifications,  in  course  of  time,  which  would  im- 
pair its  usefulness  as  a conductor  of  sound.  With  reference  to  pos- 
sible risks,  the  operations  thus  far  undertaken  have  been  unattended 
with  any  unpleasant  consequences.  Vertigo,  sometimes  protracted, 
is  to  be  expected,  although  frequently  altogether  absent.  The  opera- 
tion is  unattended  with  pain  when  performed  under  the  influence 
ot  Cocaine  injected  per  tubam.  Solutions  of  Cocaine  dropped  into 
the  external  ear  are  comparatively  impotent.  If  injected  into  the 
middle  ear  through  the  catheter,  however,  perfect  local  ansesthesia 
results. 

The  results  of  stapedectomy  will  be  watched  with  great  interest 
by  the  aurists  of  the  world.  Should  its  promises  be  fulfilled,  it  will 
be  chronicled  as  one  more  triumph  of  American  surgery. 


OCULAR  REFLEX  NEUROSES. 


467 


OCULAR  RELEX  NEUROSES. 

By  James  A.  Campbell,  M.D.,  St.  Louis,  Mo. 


Medical  literature  of  all  ages  is  full  of  recorded  cases  of  ocular 
reflex  neuroses.  In  former  times  they  were  recorded  more  as  pecu- 
liar and  not  understood  phenomena ; as  curiosities,  rather  than  in  a 
scientific  sense  admitting  of  explanation.  Each  year  as  conducted 
experiment  and  investigation  is  carried  on,  and  as  the  nervous  physi- 
cal and  psychical  functions  and  their  intricate  relationship  are  gradu- 
ally unravelled,  and  become  better  understood,  the  curious  gives  way 
to  the  matter  of  fact,  and  the  former  phenomena  to  natural  and  fairly 
well  understood  laws. 

The  subject  is  very  extensive  and  far-reaching.  We  have  neither 
time  nor  space  to  attempt  exhaustive  treatment.  Ours  a duty  to 
schedule  and  classify;  to  record  action  and  reaction;  to  collect 
authentic  cases,  of  every  possible  variety,  and  from  this  maze  and 
aggregation  endeavor  to  deduce,  in  the  future,  some  general  and  well 
established  laws. 

Definition. — Nerve  reflex  is  a direct  transference  of  centri- 
petal excitations  to  centrifugal  paths,  or  vice  versa , without  the  co- 
operation of  the  will. 

All  animal  activity  and  functional  force  depend  upon  and  is  the 
result  of  physiological  reflex  action,  whose  general  laws  and  path- 
ways are  understood. 

The  reflex  is  physiological  as  long  as  it  is  in  harmony  with  normal 
functions  and  activities. 

When  the  reflex  excitations  result  either  in  over  or  under  activity, 
it  then  becomes  an  abnormal  reflex,  or  a neurosis. 

Physiological  reflex  action,  as  well  as  reflex  neurosis,  may  be  mani- 
fested either  as  motor,  sensor,  or  functional  phenomena. 

The  contraction  of  the  pupil  to  light  is  an  example  of  physiologi- 
cal reflex  ; here  impression  is  conveyed  by  the  nerves  of  special  sense 
(retina  and  optic  nerve)  to  the  brain  centres,  and  then  reflected  back 


468 


world’s  homceopathic  congress. 


through  a motor  nerve  (third  nerve)  producing  contraction  of  the 
pupil.  Or  the  sight  of  a disgusting  object  may  produce  nausea; 
here  the  pathway  of  the  nervous  reflex  is  through  the  same  nerve  of 
special  sense  to  the  pneumogastric,  and  hence  the  consequent  nausea, 
a neurosis.  Or  the  fluttering,  increased  rapidity  of  the  heart  beat ; 
or  the  blanching  of  the  cheeks,  in  the  presence  of  great  danger,  will 
again  represent  the  functional  features  of  a reflex  neurosis. 

The  fact  that  these  nerve  impulses,  originating  in  one  system  of 
nerves,  may  be  transmitted  to  another  system  and  reflected  back 
again,  from  sensor  to  motor  or  functional,  presupposes  a close  con- 
nection and  intimate  correlation  between  the  cerebro-spinal  and  the 
sympathetic  systems  of  nerves.  Such  intimate  relationship  and 
blending  are  anatomical  and  physiological  facts. 

The  great  sympathetic  system  of  nerves  is  a series  of  closely  con- 
nected ganglia,  extending  along  each  side  of  the  spinal  column,  from 
the  head  to  the  cocyx,  communicating  with  itself  from  side  to  side, 
as  well  as  with  both  roots  of  the  spinal  cord  as  they  emerge.  It  com- 
municates likewise  with  all  the  other  nerves  of  the  body,  uniting  with 
the  fourth  and  sixth  nerves,  in  the  cavernous  sinus ; and  with  the 
olfactory  and  auditory  at  their  ultimate  expansion,  as  well  as  being 
in  close  connection  with  all  the  other  cranial  nerves,  through  its 
cranial  ganglia ; forming  thus  the  great  blending  and  binding  path- 
way and  influence.  While  at  the  summit  of  the  spinal  cord  is  the 
medulla  oblongata,  a congregation  of  ganglionic  centres,  and  series 
of  sensory  ganglia  from  which  arise  the  seventh,  eighth,  ninth,  tenth, 
eleventh  and  twelfth  nerves ; and  also  gives  root  to  fibres  of  all  the 
remaining  six  cranial  nerves  in  its  centre,  the  fourth  ventricle.  In 
addition  to  this,  it  is  united  by  commisural  bands  in  all  parts  of  the 
brain  proper,  and  contains  most  of  the  fibres,  which  are  distributed 
to  the  other  parts  of  the  encephalon  ; and  hence  it  transmits  both  the 
motor  and  sensory  impulses,  as  they  pass  from  and  enter  the  cerebrum. 

In  the  light  of  this  intimate  blending  and  interpenetration  of  the 
cerebro-spinal  and  sympathetic  systems  of  nerves,  their  mutual  in- 
fluence, one  upon  the  other,  would  seem  to  be,  not  phenomenal,  but 
almost  an  anatomical  and  physiological  necessity. 

Since  the  normal  processes  and  pathways  of  reflection  are  so  nu- 
merous and  complex,  it  is  easily  intelligible  how  numerous  and 
complicated  the  disturbances  of  motility,  sensation  and  function  may 
be,  and  from  how  many  different  points  abnormal  influences  may  be 


OCULAR  REFLEX  NEUROSES. 


469 


excited  and  reflected,  in  motor,  sensor  and  functional,  as  well  as  in 
psychic,  centres.  The  form  and  character  of  the  neurosis  may  thus 
be  extremely  numerous,  and  hence  the  recognition  of  the  primary 
cause  may  be  not  only  difficult,  but  at  times  impossible  to  locate. 

Starting  out  with  the  above  statements  clearly  in  mind,  the  dis- 
cussion of  ocular  neuroses  resolves  itself  into  a simple  statement  of 
observed  and  recorded  facts,  without  the  necessity  of  delay  for  ex- 
tended and  elucidating  argument. 

Ocular  reflex  neuroses  may  be  considered  under  two  general  head- 
ings : 

I.  — Reflex-neuroses  from  the  eyes  to  and  implicating  other  parts 
and  organs. 

II.  — Reflex-neuroses  from  other  parts  and  organs,  affecting  the  eyes. 

These  reflex  activities  may  be  variously  manifested,  for  the  same 

cause  may  result  either  in  sensory,  motor,  functional  or  organic  dis- 
turbances, and  there  is  no  known  fixed  law  to  determine  which  it 
will  be ; in  fact,  these  groups  often  present  no  sharp  lines  of  demar- 
cation, but  frequently  overlap  each  other  at  many  points,  so  that,  in 
certain  cases,  we  meet  with  symptoms  characteristic  of  two  or  more 
groups. 

Under  the  first  heading,  or  reflexes  from  the  eyes  producing  dis- 
turbances in  other  parts  and  organs,  the  most  important  and  the  most 
frequently  met  with,  are  those  resulting  from  optical  anomalies,  viz., 
myopia,  hyperopia,  astigmatism. 

Various  and  distinctly  different  results  may  follow  from  the  same 
apparent  cause,  such  as  pains  in  and  about  the  eyes,  headaches,  neu- 
ralgia, photophobia,  nictitation,  diplopia,  nausea,  vertigo,  dizziness, 
restlessness,  insomnia  and  mental  aberrations. 

Local  inflammations  may  follow  same  cause,  as  conjunctivitis, 
blepharitis,  styes,  corneal  inflammation  or  ulceration,  retinal  hyper- 
semia  or  optic-nerve  congestion,  etc.  These  are  all  the  direct  results 
of  irritation  produced  by  eye-strain,  transmitted  through  the  optic 
nerve  to  and  through  the  cerebro-spinal  and  sympathetic  systems  of 
nerves,  finding  outlet  either  as  a perverted  sensation,  a motor  impulse, 
or  causing  functional  disturbance,  and,  may  be,  organic  changes  in 
various  parts. 

Under  this  heading  we  must  also  place  heterophoria  and  its  dis- 
turbing consequences,  for  it  is  not  the  deviation  in  direction  of  the 
eyes  themselves  directly  which  causes  such  unpleasant  results,  which 


470 


world’s  homoeopathic  congress. 


are  almost  identical  with  those  caused  by  optical  anomalies,  but  it  is 
through  the  resulting  lack  of  visual  equilibrium,  and  the  difficulty 
or  impossibility  of  forming  retinal  images  and  impressions  on  the 
necessary  “ identical  points,”  which  is  the  prime  cause  of  the  long 
list  of  troubles  which  may  follow  in  the  wake  of  this  lack  of  muscu- 
lar equilibrium  of  the  eyes. 

If  we  ask  why  the  same  apparent  condition  may  produce  such 
widely  different  results,  we  should  remember,  as  before  remarked, 
that  the  laws  of  reflex  action  are  not  universal.  The  same  irritation, 
functional  or  organic,  may  produce  radically  different  reflexes  in 
different  subjects,  or  in  the  same  subject  at  different  times.  While 
in  other  cases  the  same  apparent  optical  or  muscular  error  does  not 
seem  to  be  attended  by  the  least  irritating  reflex  results.  There 
must  be  some  nervous  predisposition  existing  in  the  subject  afflicted 
aside  from  the  local  points  of  irritation.  This  would  seem  to  be 
proved  by  the  fact  that  they  in  whom  reflex  troubles  are  most  com- 
mon are  usually  of  a neurasthenic  temperament. 

To  illustrate  this  variety  of  susceptibility  coming  under  my  per- 
sonal observation,  a few  brief  cases,  which  are  familiar  and  numer- 
ous, may  be  given  : 

A scholarly  minister,  about  50,  had,  for  years,  suffered  with  neu- 
ralgic pains  in  and  about  the  eyes,  frequent  nausea,  nervous  prostra- 
tion, etc.,  the  familiar  picture.  A -j-  .25  Dc.  ax.  90°,  brought  perfect 
relief  and  restored  health. 

In  another  case,  a neurotic  boy,  age  15,  had  frequent  epileptoid  at- 
tacks, which  a — .5  Dc.  ax.  horizontal  removed,  thus  showing  the 
small  amount  of  error  producing  aggravated  results  in  predisposed 
neurasthenic  subjects. 

A typical  case,  showing  an  utter  lack  of  susceptibility,  may  now 
be  examined.  A gentleman,  age  30,  applied  to  me  for  aid  in  defec- 
tive vision.  He  had  never  seen  as  well  as  other  people.  Had  never 
been  subject  to  headaches,  neuralgia,  nor  other  signs  of  reflex  irrita- 
tion ; only  “ could  not  see  well.” 

Examination  showed  V = With  -f-  6 Ds.  O + 1-25  Dc.  ax. 
45°  in  the  R.  eye,  and  same  combination,  with  ax.  135°  in  L.  eye, 
gave  him  V— y|.  He  continues  to  wear  this  glass  with  great 
physical  comfort  and  personal  satisfaction.  Under  ordinary  cir- 
cumstances we  would  have  expected  much  nerve  reflex  irritation  to 
be  associated  with  such  an  optical  condition. 


OCULAR  REFLEX  NEUROSES. 


471 


Again,  a young  lady,  18  years  old,  wore  a -j-  2 D.  for  six  or  eight 
years,  with  great  relief  to  former  sufferings.  At  the  end  of  this 
time  she  again  began  to  have  reflex  irritation  symptoms  to  a very 
annoying  degree.  The  addition  of  a .25  Dc.,  ax.  90°  brought  in- 
stant and  permanent  relief,  thus  showing  that  the  neurasthenic  pre- 
disposition may  be  different  in  the  same  individual  at  different  times, 
influenced,  no  doubt,  by  other  general  conditions  and  nerve  irrita- 
tions, originating  at  parts  other  than  the  eyes. 

Under  peculiar  reflex  symptoms  may  here  be  mentioned  the  case 
of  a lady  with  myopic  astigmatism  who  felt  a severe  pain  run  down 
her  right  leg  every  time  she  tried  to  read  more  than  a few  minutes. 

In  the  above  consideration  of  the  resulting  sensory  neuroses, 
above  given,  as  pain,  neuralgia,  headaches,  etc.,  we  should  remem- 
ber, as  Erb  well  states  it,  that  pain  is  a common  sensation  that 
belongs,  not  to  a peculiar  kind,  but  only  to  a certain  degree  of  sen- 
sation, and  it  thus  has  no  specific  quality.  It  is  only  a question  of 
intensity  ; hence  pain  is  only  the  aggravation  of  normal  sensations, 
and  this  is  the  chief  difference  between  a physiological  reflex  and  an 
abnormal  or  reflex  neuroses.  The  sensation  of  pain  depends  upon 
two  factors,  its  intensity  and  individual  susceptibility. 

The  various  forms  of  reflex  neuroses,  which  may  result  from  opti- 
cal anomalies,  will  illustrate  the  different  reflex  pathways  through 
which  perverted  nerve  action  may  be  exhibited. 

While  the  attention  of  the  ophthalmologist  is  principally  directed 
to  the  various  forms  of  reflex  neurosis  originating  in  the  eyes,  he 
should  carefully  keep  in  mind  that,  in  keeping  with  the  laws  of 
reflex  nerve  action,  irritation  of  any  character,  having  origin  in  any 
organ  or  at  any  part  of  the  body  remote  or  near  the  eyes,  may  be 
transmitted  back  to  and  affect  the  eyes  through  the  same  pathways 
which  the  first-mentioned  efferent  neurosis  travelled.  Indeed,  many 
of  the  most  obstinate  and  annoying  cases  of  eye  trouble  we  meet  can 
only  be  remedied  by  the  discovery  and  mastery  of  the  remote  causes 
which  produce  them.  The  eye  is  in  a state  of  responsive  sympathy 
with  every  organ  and  region  of  the  body. 

Tabes  dorsalis  or  allied  diseases  are  accompanied  by  contracted 
pupils  and  at  times  by  paralysis  of  the  eye  muscles.  Paresis  of  the 
occulo  motorius  and  abducens  occur  in  the  early  stages  of  locomotor 
ataxia. 

In  seventy  cases  of  locomotor  ataxia  reported  by  Graniger  Stew- 


472 


world’s  homoeopathic  congress. 


art,  ( cj . Med.  W.,  1882)  there  were  20  cases  of  squint;  3 of  ptosis; 
4 diplopia,  without  manifest  squint;  7 of  myosis ; 4 difference  in 
pupillary  diameter;  8 with  Argyll-Robertson  pupil,  etc. 

On  the  other  hand,  irritation  of  the  cilio-spinal  region  will  often 
be  associated  with  partial  mydriasis  and  optic  nerve  congestion, 
while  paresis  or  paralysis  of  the  cervical  sympathetic  will  produce 
myosis  as  well  as  partial  ptosis.  This  is  through  the  sympathetic 
system  of  nerves.  According  to  Hensen  and  Volckers,  the  pupil- 
lary fibres  of  the  sympathetic  leave  the  cord  at  the  upper  dorsal  and 
lower  cervical  vertebrse,  going  through  the  superior  cervical  gan- 
glion and  entering  the  carotid  plexus.  They  then  pass  through  the 
ciliary  ganglion  in  the  orbit.  The  whole  of  the  fibres  do  not  take 
this  course,  because  it  is  found  that  when  the  ciliary  ganglion  is  ex- 
tirpated, irritation  of  the  trunk  of  the  sympathetic  will  still  dilate 
the  pupil.  The  ophthalmic  branch  of  the  fifth  nerve,  and  probably 
other  nerves  connecting  with  the  inner  eye,  also  furnish  channels  of 
access  for  other  sympathetic  fibres.  The  partial  ptosis  is  caused  by 
paresis  or  paralysis  of  the  sympathetic,  which  sends  motor  fibres 
to  the  musculi  palpebrales.  This  form  of  partial  ptosis  is  not  un- 
common in  women,  and  is  frequently  associated  with  reflexes  from 
the  uterine  or  ovarian  system. 

Hystero-neuroses  form  a special  and  frequently  met  with  group. 
It  is  noteworthy,  however,  that  the  severity  of  the  uterine  disease 
does  not  predicate  the  presence  or  absence,  the  severity  or  the  mild- 
ness of  the  reflex.  Authority  tells  us  that  structural  diseases  of  the 
uterus  and  its  appendages  are  not  so  apt  to  be  followed  by  reflex 
phenomena,  as  functional  troubles. 

In  his  very  interesting  discussion  of  “ Visual  Disturbances  and 
Uterine  Disease,”  A.  Mooren  (A./.  A.  vol.  x.),  declares,  from  his 
large  experience,  that  there  is  no  part  of  the  eye  which  (either  from 
a physiological  or  pathological  point  of  view)  is  beyond  the  in- 
fluence of  the  uterine  system.  He  assigns  the  reflex  theory  as 
the  direct  cause. 

The  suppression  of  menstruation  has  frequently  produced  eye 
complications.  McKay  {Jour.  Med.  Sciences,  1882,)  gives  twelve 
cases  of  ocular  affections  from  suppressed  menstruation,  numbering 
among  them  choked  disc,  diplopia,  asthenopia,  defective  vision  in 
some,  etc. ; while  M.  F.  Comes  {Am.  Med.  Herald,  Oct.,  1882,) 
gives  four  cases  of  menstrual  amblyopia,  varying  from  slight  loss 


OCULAR  REFLEX  NEUROSES. 


473 


of  vision  to  almost  total  blindness,  deep  seated  pains  in  eyes, 
with  burning  stinging,  etc. — all  of  which  were  restored  after  men- 
struation had  been  re-established. 

Sexual  excesses,  especially  masturbation,  are  frequent  causes  of 
reflex  ocular  trouble.  The  latter  is  a prolific  cause  of  much  irrita- 
tion, and  it  is  generally  very  difficult  to  trace,  especially  in  females. 
It  is  frequent  cause  of  spasm  of  the  accommodation,  hypersemia  of 
the  fundus  and  optic  disc,  obstinate  neuralgic  pains  in  and  about 
the  eyes,  and  in  some  cases  paresis  of  the  accommodation. 

Connected  with  hysteria,  that  general  neurosis  of  the  whole 
nervous  system,  there  are  frequent  and  various  forms  of  eye  complica- 
tions, embracing  partial  or  complete  amblyopia,  hemiopia,  scotoma, 
phosphenes,  floating  clouds,  myosis,  mydriasis,  ptosis,  photophobia, 
spasm  or  paresis  of  the  accommodation,  neuralgic  pains,  etc.,  all 
of  which  are  purely  reflex  ocular  neuroses,  a part  of  the  general 
neurosis. 

Orificial  irritations  are  frequent  causes  of  reflex  troubles.  This 
includes  hsemorrhoidal  and  other  anal  diseases,  phymosis,  stricture  of 
the  urethra,  or  cervix  uteri — all  of  which  are,  without  question, 
frequent  causes.  Recent  current  medical  literature  is  filled  with  cases 
fully  illustrating  this. 

Intestinal  irritation,  either  from  inflammation  or  from  worms,  has 
been  followed  by  ocular  reactions.  Both  of  these  conditions  may 
produce  similar  eye  reflexes,  such  as  temporary  strabismus,  diplopia, 
myosis  or  mydriasis,  ptosis  or  wide-open  eyelids.  Many  remark- 
able cases  have  been  reported  from  time  to  time.  Lawrence  (Am. 
Ed.,  1854,  p.  607,)  gives  case  of  a child,  seven  years  old,  who  had 
intolerable  paroxysms  of  pain  in  left  eye,  recurring  at  uncertain  in- 
tervals, without  visible  changes  in  the  eye,  which  was  entirely 
relieved  by  purgatives,  bringing  away  a coral  bead,  which  had  been 
swallowed. 

M.  AVishart  gives  a case  of  complete  amaurosis  of  the  left  eye,  in 
a boy  nine  years  old,  of  four  months’  duration,  who  made  immedi- 
ate recovery  after  free  purgative. 

Another  case  is  given  of  a boy,  eight  years  old,  who  could  not 
see  large  print,  who  was  rapidly  restored  after  turpentine  enemata 
brought  away  quantities  of  worms. 

In  a recent  case  of  my  own,  a young  man  of  twenty-six,  who 
had  a very  persistent  and  annoying  diplopia,  causing  vertigo  and 


474 


world’s  homoeopathic  congress. 


disagreeable  head  symptoms,  recovered  promptly  after  passing  several 
yards  of  tape- worm. 

There  are  many  cases,  similar  to  those  related,  on  record. 

The  great  trifacial  nerve  is  very  intimately  connected  with  all 
parts  of  the  visual  apparatus,  both  directly  and  indirectly  through 
the  sympathetic  nerves  and  the  ciliary  ganglion.  From  this  we 
might  expect  that  all  the  necessary  conditions  to  favor  frequent  and 
varied  forms  of  ocular  reflex  neuroses  were  present — and  such  is  the 
case. 

Many  authentic  cases  of  defective  vision  following  irritation  of  the 
fifth  nerve,  have  been  reported.  McKenzie  (Am.  Ed.,  1855,  p.  997,) 
gives  a case  of  a man  who  had  a small  tumor  on  the  crown  of  the 
head,  which  had  been  ten  years  coming.  It  was  not  painful  or  sen- 
sitive to  touch.  He  had  much  headache,  and  quite  a defective 
vision.  It  proved  to  be  a cartilaginous  cyst,  filled  with  a yellowish 
fluid.  Its  removal  restored  his  vision  and  remedied  his  headaches. 

Within  the  past  year  a patient  of  mine  had  a tumor,  size  of  a 
filbert,  about  one-half  an  inch  above  the  supra-orbital  foramen  of 
the  left  eye.  It  had  been  gradually  developing  for  some  years,  and 
the  vision  of  that  eye  had  been  as  gradually  growing  less  and  less. 
The  removal  of  this  growth  perfectly  restored  the  sight. 

Many  cases  of  partial  or  nearly  total  loss  of  vision,  caused  by 
diseased  teeth,  have  been  published.  I discussed  this  topic  in  a con- 
tribution, “ The  Eye-tooth  and  the  Eye,”  in  the  Chicago  Medical 
Investigator  (July,  1875),  and  gave  then  the  accepted  explanation  for 
it,  which  is  that  it  is  a reflex-neurosis  through  the  ciliary  ganglion 
and  the  other  sympathetic  connections  of  the  great  trifacial  nerve. 
Since  then  a number  of  interesting  cases  have  come  under  my  obser- 
vation. One  case  is  well  worthy  of  comment.  A lady  had  a large 
cavity  in  the  left  upper  bicuspid  tooth.  The  diseased  contents  were 
thoroughly  excavated  and  removed,  and  the  nerve  wTas  killed  by  a 
dentist.  The  tooth  was  filled  with  gold.  A month  or  two  after- 
ward, the  vision  of  the  left  eye  began  to  fail,  growing  less  and  less 
as  the  weeks  went  by.  The  tooth  was  not  sensitive,  but  the  gum  at 
one  side  of  it  seemed  painful  to  pressure.  The  tooth  was  extracted, 
and  the  sight  was  rapidly  restored.  Examination  of  the  tooth 
showed  that  in  the  filling  of  it  the  thin  side  wall  had  been  perforated 
at  one  point,  and  a little  plug  of  gold  had  been  forced  through  it, 
extending  about  one-tenth  of  an  inch  outside,  and  pressed  against 


OCULAR  REFLEX  NEUROSES. 


475 


the  wall  of  the  socket ; and  this  had  set  up  the  reflex-neurosis, 
through  the  well  known  pathways,  to  the  seeing-nerve. 

In  the  above  brief  examples  of  various  forms  of  ocular  reflex 
neuroses,  no  attempt  has  been  made  to  explain  why  the  reflexes 
should  be  so  varied  in  their  nature;  why  the  phenomenon  is  at  one 
time  sensor,  at  another  motor,  then  functional  and  again  organic ; 
for,  as  mentioned  before,  there  does  not  seem  to  be  any  known  law 
regulating  the  direction  which  the  reflex  may  take.  They  may  thus 
be  manifested  as 

I. — Sensor.  II. — Motor.  III. — Functional.  IV. — Organic. 

Under  sensor  reflex  neuroses  may  be  grouped  all  forms  of  abnor- 
mal or  perverted  sensations — hypersesthesia — anaesthesia. 

Under  motor  reflexes  will  be  included  all  forms  of  spasmodic 
action  (tonic,  clonic,  spastic),  paralysis  or  paresis. 

Under  functional  reflex  ocular  neuroses,  will  be  numbered  all  in- 
terference with  the  proper  nutrition  of  the  eye,  or  its  vaso- motor 
supply,  affecting  as  a result  either  the  seeing  nerve,  retina,  dioptric 
media,  accommodation  apparatus ; or  the  proper  support  of  any  of 
the  other  eye  tissues. 

Closely  related  to  this  last  heading  is  the  reflex  neuroses,  which 
may  result  in  organic  changes ; anaemia,  hyperaemia,  inflammation, 
tissue  or  anatomical  changes,  hyperplasia,  neoplastic  formations,  de- 
generative processes,  hypertrophy  or  atrophy.  Eye  literature  is  full 
of  examples  of  the  above  statements. 

McKenzie  relates  a case  of  a man,  aged  45,  with  an  old  discharg- 
ing ulcer  on  his  leg,  which  was  suppressed  by  his  getting  wet.  This 
was  followed  by  blindness,  in  fourteen  days  afterward.  The  ulcer 
was  restored  and  vision  then  returned.  The  same  authority  tells  us 
that  Beer  claimed  to  have  cured  twenty  such  amaurotic  patients,  by 
restoring  suppressed  ulcerations.  Such  conditions  can  only  be  ex- 
plained by  reflex  sympathy  from  the  sentient  surfaces  to  the  cere- 
bro-spinal  centre,  transferred  to  the  sympathetic  system,  and  through 
this  to  the  optic  nerves  and  retinal  expansion,  or  their  brain  centres. 

A.  Moore  has  discussed  this  question  in  his  paper,  “ Influence  of 
the  Skin  and  its  Diseases  upon  the  Eye.” 

An  important  additional  heading  should  be  likewise  mentioned, 
which,  while  distinct  from  the  others,  is  very  markedly  influenced 
by  any  one  or  all  of  the  above  subdivisions  given.  It  may  be  intro- 
duced under  the  term  psychic,  or  the  influence  of  ocular  neuroses 


476 


world’s  homoeopathic  congress. 


upon  the  brain  centres  proper,  which  may  result  in  illusions,  aber- 
rations, chorea,  epileptoid  seizures,  vertigo  and  even  insanity.  Both 
optical  anomalies  and  heterophoria  have  been  followed  by  such 
results. 

Experiment  has  demonstrated,  that  section  or  paralysis  of  the  cer- 
vical sympathetic  will  be  followed  by  hypotony,  and  that  irritation 
of  the  same  nerve  will  produce  the  reverse  effect,  hypertony;  thus 
proving  conclusively,  that  tension  of  the  eye  is  largely  influenced,  if 
not  entirely  regulated  by  the  sympathetic  nerve.  The  well-known 
fact  that  the  irritation  of  the  fifth  nerve  may  cause  increased  T.  and 
its  paralysis  a reduced  T.,  does  not  disprove  it,  for  this  latter  effect 
may  be  explained  by  the  intimate  relationship  and  reflex  blending 
of  these  nerves,  brought  about  through  the  ciliary  ganglion.  Hence, 
since  it  is  thus  proved  that  T.  of  the  eyes  may  be  increased  by  irri- 
tation of  the  sympathetic  nerves,  and  decreased  by  its  partial  or 
total  paralysis,  and  since  the  nutrition  of  the  eye  itself  is  largely  in- 
fluenced by  the  same  sympathetic;  and  finally,  since  the  sympathetic 
may  be  irritated  by  reflex  action,  from  other  nerves,  it  would  seem 
reasonable  to  assume  that  glaucoma  is  merely  a reflex  neurosis, 
arising  from  a continued  irritation  of  the  sympathetic  nerves,  con- 
nected with  the  eye,  which  irritation,  as  we  have  seen,  may  have 
origin  in  any  part  of  the  body  near  or  remote  from  the  eyes.  Indeed 
the  frequency  with  which  we  find  glaucoma  associated  with  other 
bodily  diseases,  gives  emphasis  to  this  proposition.  I have  been 
struck  with  the  frequency  of  the  coexistence  of  rheumatism  and 
similar  disorders,  and  glaucoma.  It  has  followed  sudden  shock, 
fright,  fear  and  even  joy.  The  suddenness  of  its  onset,  at  times 
again  points  strongly  to  its  reflex  nervous  origin. 

Following  this  same  line  of  thought  in  the  light  of  the  phenomena 
presented,  it  is  not  difficult  for  me  to  believe,  that  sympathetic  oph- 
thalmia is  likewise  a reflex  neuroses,  from  a diseased  eye,  to  similar 
and  corresponding  parts  in  the  other  eye.  This,  to  me,  seems  more 
reasonable,  and  in  accordance  with  facts  and  conditions,  than  the 
strained  effort  to  explain  it  by  any  microbian  meanderings  or  con- 
tiguous inflammatory  transmission,  or  through  the  lymphatics. 

In  the  discussion  of  this  subject  I have  realized  thoroughly  its 
immensity,  and  the  utter  impossibility  of  describing  and  including 
all  the  numerous  phenomena  connected  with  it,  in  the  limits  of  a 
paper  on  such  an  occasion  as  this.  My  effort  has  been,  to  bring  out, 


OCULAR  REFLEX  NEUROSES. 


477 


for  discussion,  in  a brief  and  simple  way,  some  of  the  most  salient 
points  connected  with  the  topic,  and  to  offer  a certain  few  debatable 
propositions  for  discussion. 

A brief  notice  of  a new  book,  The  Relation  of  the  Visual  Organ 
and  its  Diseases  to  the  Other  Diseases  of  the  Body  and  its  Organs , by 
Dr.  Max  Knies,  has  recently  attracted  my  attention.  I very  much 
regret  my  inability  to  secure  a copy  of  it,  for  it  is,  no  doubt,  a most 
valuable  contribution  to  the  subject  I have  endeavored  to  introduce. 


R E PO  RT 


OF  THE 

SECTION  IN  GYNAECOLOGY. 


Chicago,  III.,  May  31, 1893. 

The  Section  was  called  to  order  at  3 p.m.  on  Wednesday,  May 
31,  1893,  in  the  hall  of  Washington,  Art  Institute  Building.  O.  S. 
Runnels,  M.D.,  of  Indianapolis,  Ind.,  Chairman  of  the  Section,  pre- 
sided. 

The  first  business  in  order  was  the  delivery  of  the  Chairman’s 
Inaugural  Address,  entitled  “The  Sine-Qua-Non.” 

Following  the  address,  Dr.  L.  A.  Phillips,  of  Boston,  Mass.,  read 
a paper  on  “ Homoeopathy  in  Gynsecology.”  It  was  discussed  by 
Drs.  A.  C.  Cowperth waite,  of  Chicago,  111. ; W.  P.  MacCracken,  of 
Chicago,  111.;  Julia  Ross  Lowe,  James  C.  Wood,  of  Ann  Arbor, 
Mich. ; R.  Ludlam,  of  Chicago,  111. ; Alfred  C.  Hawkes,  of  Liver- 
pool, England ; Chester  G.  Higbee,  of  St.  Paul,  Minn. ; Flora  A. 
Brewster,  of  Baltimore,  Md. ; J.  M.  Lee,  of  Rochester,  N.  Y.;  and 
by  the  author  of  the  essay. 

A paper  on  “Some  of  the  Clinical  Aspects  of  Septic  Invasion,” 
by  Edward  T.  Blake,  of  London,  England,  was  presented  by  title, 
and  was  discussed  by  Dr.  M.  O.  Terry,  of  Utica,  N.  Y. 

Dr.  Charles  E.  Walton,  of  Cincinnati,  O.,  read  an  essay  on  “The 
Relation  of  Surgery  to  Gynaecology.”  It  was  followed  by  a discus- 
sion, participated  in  by  Drs.  H.  E.  Beebe,  of  Sidney,  O. ; W.  H. 
Hanchett,  of  Omaha,  Neb.;  M.  Ayres,  of  Rushville,  111.;  Phoebe 
J.  B.  Waite,  of  New  York,  N.  Y.;  Martha  J.  Ripley,  of  Minneapolis, 
Minn. ; Alonzo  Boothby,  of  Boston,  Mass. ; and  H.  W.  Roby,  of 
Topeka,  Kan. 

The  next  paper  was  read  by  Dr.  W.  E.  Green,  of  Little  Rock, 
Ark.  It  was  on  “ Plastic  Surgery  of  the  Vagina,”  and  was  dis- 
cussed by  Dr.  M.  T.  Runnels,  of  Kansas  City,  Mo.,  whose  remarks, 


REPORT  OF  SECTION  IN  GYNAECOLOGY. 


479 


in  the  absence  of  Dr.  Runnels,  were  read  by  Dr.  M.  O.  Terry.  The 
discussion  was  also  participated  in  by  Drs.  L.  C.  Grosvenor,  of  Chi- 
cago, 111.;  T.  L.  Macdonald,  of  Washington,  D.  C. ; Martha  G. 
Ripley,  of  Minneapolis,  Minn. ; J.  W.  Streeter,  of  Chicago,  111. ; 
J.  C.  Wood,  of  Ann  Arbor,  Mich. ; and  by  Dr.  Green,  the  writer 
of  the  paper. 

The  sectional  meeting  then  adjourned  until  Thursday  evening. 

Chicago,  June  1,  1893. 

The  Section  in  Gynaecology  re-convened  at  7.30  P.M.,  Chairman 
Runnels  presiding. 

Dr.  II.  F.  Biggar,  of  Cleveland,  O.,  read  a paper  on  “ Caesarian 
Section/’  The  paper  was  discussed  by  Drs.  J.  W.  Streeter,  of  Chi- 
cago, 111. ; O.  S.  Runnels,  Chairman  ; E.  H.  Pratt,  of  Chicago,  111.; 
and  by  Dr.  H.  F.  Biggar,  author  of  the  paper.  As  the  discussion 
was  about  to  close,  Dr.  R.  Ludlam,  of  Chicago,  111.,  entered  the 
room  and  proceeded  to  discuss  the  subject.  He  was  followed  briefly 
by  Dr.  Biggar. 

Next  came  an  essay  by  Dr.  J.  W.  Streeter,  of  Chicago,  111.,  on 
“ Uterine  Fibroids.”  It  was  debated  by  Drs.  Henry  W.  Roby,  of 
Topeka,  Kan. ; George  Royal,  of  Des  Moines,  la. ; E.  B.  Finney, 
of  Lincoln,  Neb. ; H.  F.  Biggar,  of  Cleveland,  O. ; and  H.  Tyler 
Wilcox. 

Dr.  J.  M.  Lee,  of  Rochester,  N.  Y.,  next  presented  a paper  on 
“ Vaginal  Hysterectomy.”  Discussion  of  the  paper  was  by  Dr.  R. 
Ludlam,  of  Chicago,  111. 

The  final  essay  presented  in  the  Section  was  entitled  “ Removal  of 
the  Entire  Uterus,  Together  with  the  Appendages,  for  Uterine  Fi- 
broids,” by  Homer  I.  Ostrom,  M.D.,  of  New  York,  N.  Y.  In  the 
absence  of  the  author  it  was  read  by  Dr.  Thomas  Franklin  Smith, 
of  New  York,  N.  Y.  The  discussion  was  participated  in  by  Dr. 
Alonzo  Boothby,  of  Boston,  Mass. 

After  a few  congratulatory  remarks  by  the  Chairman,  the  Section 
was  declared  adjourned. 


480 


world’s  homceopathic  congress. 


IN  A UG  URAL  ADDRESS. 

By  O.  S.  Runnels,  M.D.,  Indianapolis,  Ind.,  Chairman. 


The  Sine-Qua-Non. 

The  danger  that  confronts  every  specialist  is  a too  intense  and 
contracted  specialism.  Having  a circumscribed  field  of  operation — 
a portion  only  of  the  physical  territory — under  jurisdiction,  he  is 
apt  to  narrow  his  field  of  vision  accordingly,  to  recognize  bounda- 
ries that  do  not  exist,  and,  thus,  to  get  onesidedness  or  inadequacy 
of  view. 

In  the  development  of  a particular  branch  of  knowledge,  concen- 
tration of  the  mind  upon  the  single  object  follows  of  necessity,  but 
care  must  be  taken  lest  the  intensity  of  the  effort  to  reach  the  heart 
of  the  subject  shall  shut  out  what  is  of  equal  importance.  There 
must  be  equivalent  energy  displayed  in  the  study  of  relationships — 
in  discerning  the  effect  new  facts  will  have  upon  facts  already  accu- 
mulated and  vice  versa.  The  centripetal  must  ever  be  opposed  by 
the  centrifugal  if  the  golden  mean  is  to  be  established  and  progress 
maintained.  Every  specialist,  therefore,  should  be  a generalist — an 
authority  not  only  upon  the  pin  point  of  his  habitual  observation^ 
but  also  upon  all  the  avenues  leading  to  it. 

In  the  study  of  that  highest  expression  of  God’s  handiwork,  the 
human  body,  with  all  the  forces  that  actuate  it,  it  behooves  the  stu- 
dent to  recognize  the  unity  of  the  organism  with  which  he  has  to 
deal,  and  to  know  at  the  outset  that  a touch  anywhere  upon  or  within 
it  is  a touch  not  only  of  a part  but  of  the  whole ; that  he  has  not 
merely  a section  to  take  into  account  but  an  entirety,  and  that  no 
electric  battery  can  ever  show  greater  sensitiveness  than  does  the  life 
of  man  from  remotest  nerve  fibril  to  central  ganglion. 

Unlike  the  machinery  of  a great  mill,  the  parts  of  which  may  act 
co-ordinately,  or,  without  special  detriment,  may  not  act  at  all, 
while  the  great  central  movement  goes  on,  the  human  machine  is  a 
combination  which  must  act  harmoniously  in  all  its  parts,  inasmuch 
as  there  is  genuine  community  of  interest  throughout,  and  no  part 
can  be  discordant  without  affecting  the  tranquillity  of  the  whole. 


INAUGURAL  ADDRESS. 


481 


The  thing  that  characterizes  the  animal  organism,  making  it  dis- 
similar from  every  other  aggregation  of  applied  forces,  is  the  all- 
important  factor  we  call  life.  It  is  this  pervasive  force  everywhere 
resident  within  the  body  that  calls  to  itself  the  material  for  building 
and  repair,  that  keeps  the  machinery  in  motion,  that  stands  guard 
and  fights  battles  when  dangers  menace,  and  that  establishes,  through 
its  manifold  agencies,  that  vicegerent  of  Highest  Power  recognized 
as  soul,  mind,  spirit  or  vital  energy,  together  with  all  that  these 
imply. 

Life  is  that  force  which  precedes  organization,  which  sways  the 
forces  of  nature  to  its  will,  and  which  reigns  supreme  in  the  domain 
of  vital  technics.  Here  is  an  instinct  that  molds  and  controls  all 
that  pertains  to  existence,  and  which  must  be  taken  into  account  in 
every  synthesis  and  analysis  made  by  the  physician.  There  can  be 
here  no  such  thing  as  segregation,  no  such  thing  as  independent  ex- 
ercise. It  matters  little  how  many  thousand  grains  of  pabulum  a 
grain  of  pepsin  can  digest  outside  of  the  body,  or  what  the  chemi- 
cal affinities  and  reactions  may  be  in  the  laboratory.  The  great 
question  is  what  will  be  the  result  when  these  are  called  upon  to 
act  in  the  presence  of  life? 

The  bacteriologist,  with  his  culture-tube,  for  example,  has  made 
in  these  last  decades  vast  acquirement,  thus  putting  the  world  under 
the  most  lasting  obligations;  but  no  one  knows  so  well  as  he  that 
his  problem  is  hedged  by  limitations,  that  results  gained  uniformly 
in  the  laboratory  cannot  be  duplicated  at  will  in  the  human  body, 
and  that  germs,  to  grow,  require  a favorable  habitat.  There  must 
be  a proper  medium  and  right  conditions,  or  a nidus  cannot  be 
made. 

It  is  common  observation  that  all  persons  exposed  to  deadly  bac- 
teria do  not  succumb  to  their  influences  ; that  in  all  epidemics — such 
as  la  grippe,  yellow  fever  or  cholera — the  number  that  contracts  the 
disease  is,  after  all,  less  than  a moiety  of  those  exposed,  and  that  of 
those  even  in  whom  the  germ  finds  lodgment  75  per  cent,  or  over 
recover.  Many  persons  are  found  who  cannot  be  inoculated,  or  who 
take  the  sepsis  to  a very  slight  extent,  the  malign  influence  rolling 
from  them  like  water  from  a duck’s  back,  leaving  them  unimpaired. 

Why  is  it  that  garbage-men,  sewer-men,  workmen  in  fertilizing 
establishments,  in  dissecting-rooms  and  rag  factories,  and  all  those 
in  touch  with  contagion  and  pollution  of  every  sort,  who  are  breath - 

31 


482 


world’s  homceopathic  congress. 


ing  or  swallowing  myriads  of  death-producing  germs  every  instant 
of  their  lives,  do  not  sicken  and  die  to  the  last  man  of  them  ? 
Wherefore  is  it  that  millions  of  mothers  who  give  birth  to  their  off- 
spring in  stifling  and  stinking  apartments,  and  upon  beds  of  polluted 
rags  worse  than  a dung-heap,  do  not  become  extinct  through  the 
ravages  of  septicaemia  ? 

On  every  hand  can  be  found  instances  of  harmless  disregard  of 
all  those  precautions  accounted  indispensable  in  these  days  of  Joseph 
Lister.  Lawson  Tait  and  Knowsley  Thornton,  holding  opposite 
views  on  the  uses  of  germicides,  go  on  reducing  the  death-rate  in 
laparotomy  in  about  equal  proportions,  leaving  to  their  respective 
adherents  the  task  of  reconciling  their  theories  in  the  light  of  such 
diverse  practices.  Whether  the  brilliant  advancement  made  in  sur- 
gical, gynaecological  and  obstetric  art  in  the  last  twenty  years  is  due 
to  antisepsis,  severe  cleanliness  or  improved  technique,  I do  not  care 
now  to  argue.  They  all  hold  vital  place  in  the  record  of  progress, 
and  will  have  due  award. 

The  thing  that  I want  to  centre  your  minds  upon  to-day  is  the 
fact  that  there  is  a greater  Richmond  in  the  field  than  the  germicide, 
or  than  the  thing  even  that  the  germicide  kills.  I want  to  emphasize 
the  intrinsic  meaning  of  the  thing  we  call  life.  I would  like  to 
make  the  thought  material,  that  when  life  is  here  in  all  its  potency 
we  have  a complete  wall  of  defense  against  all  intruders,  a fort  gar- 
risoned against  all  foes,  a battery  invulnerable  against  all  paralysis. 

It  is  coming  to  be  understood  that  all  disease  is  a sequence  of 
paralysis,  a record  of  incapacity  of  function — telling  of  enervated, 
defenseless,  non-resistant  organs ; and  that  it  is  only  “ where  the 
carcass  is  ” that  “ the  eagles  are  gathered  together,”  only  in  decaying 
or  non-vital  tissues  that  bacteria  can  work  their  devastations.  They 
are  here  as  the  vultures  and  maggots  are  here  on  the  dead  animal — 
post  hoc,  but  not  propter  hoc.  They  do  not  create  the  death,  but 
find  it ; other  processes  having  been  precedent  to  pave  the  way.  They 
came  as  scavengers  to  clean  up  an  unsanitary  city,  and,  under  all 
conditions  favorable  to  them,  may  be  expected  to  fulfill  their 
mission. 

Susceptibility  to  their  invasion  is  only  one  of  the  evidences  of  a 
lame  and  crippled  vitality.  It  is  one  of  the  proofs  that  the  soldier 
is  not  fit  for  the  battle.  Some  time  in  the  near  or  remote  past  his 
line  of  defence  has  been  broken  down  ; paralysis  of  function,  in  wdiole 


INAUGURAL  ADDRESS. 


483 


or  in  part,  has  taken  place  ; some  lethargy  has  stolen  over  the  repel- 
lent forces  of  life,  making  surrender  a legitimate  sequence. 

In  an  organism  endowed  with  its  full  complement  of  vigor — a 
vis-a-tergo,  strong  and  valiant  to  the  remotest  capillary — all  the 
erectile  tissues  will  be  on  the  alert  and  fully  fortified  ; a volume 
of  oxygenated  blood  will  be  pulsing  at  full  current  through  all  its 
channels,  clearing  every  deck  for  action,  holding  every  tar  to  his 
work,  and  keeping  the  flag  at  the  mast-top. 

In  other  words,  life  depends  upon  what  is  called  vascular  tone  ; 
upon  a normal  circulation  of  the  blood  ; upon  the  accomplishment 
of  a perfect  nutrition.  And,  conversely,  disease  depends  upon 
vascular  atony,  upon  enfeebled  circulation,  upon  mal-nutrition. 
This  is  the  very  bed-rock  of  all  progress  in  pathology  and  thera- 
peutics. Out  of  this  nutshell  must  grow  all  that  is  enduring  and 
serviceable  in  the  work  of  physical  salvation.  It  becomes  obliga- 
tory upon  all  workers  to  gain  mastery  of  these  axioms  before  pro- 
ceeding farther. 

Going  down  to  the  capillaries,  both  near  and  remote,  where  all 
the  life-battles  are  fought,  we  must  discover  the  ways  of  impressing 
them  ; study  their  modes  of  expression,  and  all  that  will  conduce  to 
their  integrity  and  most  vigorous  activity.  We  must  note  at  the 
outset  their  exceeding  sensitivity  ; their  dependence  upon  live  blood- 
disc  and  cell-growth  ; their  ready  embarrassment  and  perversion  of 
function  ; and  that  no  coarse  disease  expression  can  ever  announce 
itself  upon  the  broad  plain  of  the  body  until  long  after  the  battle 
has  been  waged  and  lost  in  these  infinitesimal  structures. 

Whether  in  the  elephant,  the  tiniest  human  embryo,  or  the  amoeba, 
life  is  wholly  dependent  upon  the  maturity  and  prolificacy  of  the 
ephemeral  cell ; upon  vigorous  cell-growth  and  segmentation,  and 
this,  in  turn,  upon  nutrition.  It  is  all  a question  of  lifeless  pabulum 
and  its  conversion  by  the  cells  into  living  germinal  matter — for  it  is 
only  in  the  yolk  that  cell-cleavage  takes  place.  The  ceaseless  arrival 
in  the  capillaries  of  the  blood-disc,  freighted  with  all  that  goes  to 
the  nourishment  of  the  cell,  and  its  quick  departure  on  the  venous 
current,  bearing  with  it  the  dead,  the  broken  and  the  useless — this 
is  life,  and  all  the  rest  follows.  Insure  a good  circulation  of  the 
blood,  and  you  make  certain  the  vigor  and  full  maturity  of  the  body 
in  all  its  parts. 

But  how  vascular  tone  is  to  be  engendered,  how  vaso  motor  energy 


484 


world’s  homoeopathic  congress. 


is  to  be  maintained,  is  the  universal  problem.  This  is  the  trysting- 
ground  of  all  curative  effort,  and  to  this  accomplishment  all  theory 
and  practice  must  apply — whether  it  be  physical  culture,  dietetics, 
hot  or  cold  baths,  massage,  electricity,  climate,  surgery  or  medicines, 
the  common  end  sought  is  better  energy  of  blood -circulation  — the 
innervation  or  invigoration  of  the  nerves  that  creep  along  all  the 
arteries,  and  insure  healthy  vegetation.  The  question  is  how  can 
the  reserves  be  called  into  action  ; how  can  the  worn  and  tired  col- 
umns at  the  front  be  strengthened  and  rested  ; how  can  the  magazine 
and  commissary  be  resupplied  ? 

Before  going  further  with  this  deliberation  I desire  to  remind  you 
that  the  ne'rves  that  supply  the  muscular  coat  of  the  arteries  with 
power  to  contract  and  relax  are  efferent,  motor  or  outward-bound  ; 
that  they  receive  their  stimulus  from  within  instead  of  from  without 
as  is  the  case  with  the  afferent,  sensory  qr  inward-bound  nerves,  and 
that  the  messages  sent  to  and  from  them  are  for  the  most  part  silent 
ones.  That  they  are  not  under  the  domination  of  the  will  as  are  the 
motor  nerves  generally,  but  issuing  mainly  from  the  ganglia  of  the 
great  sympathetic,  are  almost  wholly  under  its  control.  That  they 
report  to  and  get  their  orders  from  the  ganglia  of  the  sympathetic 
rather  than  the  cerebro-spinal ; that  while  they  do  not  have  sensory 
power  themselves,  or  have  it  to  a very  feeble  extent,  they  have  the 
ability  in  a large  degree  to  call  upon  any  sensitive  nerve  in  the  body  to 
voice  their  complaints.  While  apparently  the  sympathetic  is  subser- 
vient to  the  cerebro-spinal,  the  latter  is  in  reality  the  servant  of  the 
former.  There  is  mutual  dependence  and  inter-dependence,  but  when 
it  comes  to  the  question  of  rank  the  highest  authority  is  found  with  the 
sympathetic.  It  is  the  sympathetic  that  rules  the  vegetative  sphere  ; 
that  presides  over  all  the  innermost  details  of  body-growth  and 
maintenance,  and  that  has  the  sole  command  during  all  that  stage  of 
life  precedent  to  conscious  existence,  and  all  that  latter  portion  also, 
passed  in  sleep  or  unconsciousness  from  whatever  cause.  The  sympa- 
thetic nervous  system  is  the  connecting  link  between  the  animal  and 
the  vegetable  worlds — making  the  line  of  demarcation  between 
sensitive  animal  and  sensitive  plant  almost  if  not  quite,  undiscover- 
able.  It  takes  possession  of  the  individual  at  his  conception — when 
the  spermatozoon  makes  union  with  the  ovum — and  rules  with 
sleepless  vigil  from  that  instant  till  the  time  when  the  last  spark  of 
vital  response  is  obtainable  at  the  general  death.  It  is  the  first  and 


INAUGURAL  ADDRKSS. 


485 


last  nerve  of  existence,  and  serves  to  make  supply  and  waste — 
revictualing  and  consumption — proportionate. 

That  the  ganglia  of  the  sympathetic  are  the  ultimate  reservoirs  of 
life — the  last  to  respond  to  stimuli — is  conclusively  shown  when 
appealed  to  in  cases  of  apparent  death  and  in  occasional  instances 
also  after  complete  expiration  by  the  expulsion  of  the  child  from  the 
womb,  and  of  urine  and  faeces  from  bladder  and  rectum.  The  great 
effectiveness  of  rectal  dilatation  in  the  resuscitation  of  the  still-born, 
and  of  others  asphyxiated  or  drowned,  or  under  the  deadly  influence 
of  anaesthetic  or  narcotic  agent,  has  been  conclusively  proven  in 
numberless  instances  of  last  resort. 

The  sympathetic  was  here  in  what  may  be  termed  the  paleozoic 
times  of  human  history,  while  the  cerebro-spinal,  is  its  product  and 
of  comparatively  late  development.  While  the  cerebro-spinal  is  the 
outgrowth  of  the  sympathetic,  possessing  many  of  its  attributes  and 
modes  of  speech,  there  are  yet  heights  and  depths  of  vital  expression 
unknown  to  it. 

Integrity  of  life  is  maintained  through  the  play  and  exercise  of 
involuntary  forces,  which,  if  normal,  go  noiselessly  and  peacefully 
forward  like  the  deep  and  still  current  of  a mighty  river. 

I have  dwelt  at  such  length  upon  these  distinctions  because  I be- 
lieve that  all  true  progress  in  our  art  is  dependent  upon  the  deeper 
study  and  better  understanding  of  the  ways  and  means  of  the  Great 
Sympathetic;  because  I am  impressed  by  the  thought  growing  ever 
clearer  to  me,  that  the  ability  of  the  individual  to  cope  with  the 
forces  inimical  that  confront  him  here  is  dependent  wholly  upon  the 
unembarrassed  sympathetic  nervous  system.  When  I interrogate 
life-processes  closely,  either  in  the  animal  or  vegetable  world,  I find 
that  wherever  nature  has  a fair  chance  she  makes  a perfect  growth. 
If  she  has  not  been  teased,  nagged  nor  irritated  through  indefinite 
periods;  if  her  finished  product  has  not  been  wasted  ; if  her  gangli- 
onic or  battery-power  has  not  been  exhausted,  but  is  at  hand,  like  a 
Leyden-jar  charged  with  electricity  ready  for  powerful  discharge, 
you  can  depend  upon  it  there  will  be  no  evidence  of  incompetency 
anywhere  manifest.  Neurasthenia,  fatigue  and  all  candidacy  for 
disease  invasion  is  evidence  that  the  battery  is  not  operative  at  its 
best,  and  that  some  one  or  all  of  the  thousands  of  storage  centres  in 
the  body  have  been  exhausted  in  whole  or  in  part  of  their  power. 

The  measure  of  life-ability  and  the  number  of  milliamperes  of 


486 


world’s  homoeopathic  congress. 


vitality  yet  possessed  are  correlative.  The  reason,  why  Mr.  Tait  is 
able  to  make  one  hundred  and  thirty-nine  laparotomies  without  anti- 
septics and  without  a death  is  found  in  the  fact  that  he  husbands  the 
physical  reserve  to  the  utmost.  His  work  is  speedy,  and  there  is  as 
little  mopping  and  friction  of  nerve-terminals  as  possible.  When  I 
saw  him  remove  multilocular  cysts  and  diseased  appendages  in  from 
five  to  twelve  minutes  without  ever  putting  a sponge  or  other  mop 
within  the  cavity,  I understood  that  it  was  not  a little  free  blood  in 
the  abdomen  that  he  feared,  but  the  unnecessary  discharge  of  vital- 
force  through  a long  and  slovenly  operation.  It  was  all  over  so 
quickly  that  when  the  patient  recovered  from  her  very  short  anaes- 
thesia she  hardly  realized  that  she  had  been  hurt.  Improved  tech- 
nique consists  in  nothing  so  much  as  the  acquisition  of  masterful 
ability  to  do  the  work  required  at  the  least  possible  cost  to  the  vital 
remnant. 

Coming  now  to  the  application  and  conclusion  of  this  matter,  I 
say  that  it  is  the  business  of  every  specialist  and  every  generalist  as 
well,  to  go  behind  the  returns  made  by  the  patient  and  get  back  to 
the  initial  departure.  If  he  is  to  do  any  lasting,  worthy  service,  he 
must  not  only  make  the  best  of  the  bad  condition  immediately  before 
him,  but  taking  the  backward  trail  he  must  be  able  to  ascertain  why 
things  have  reached  the  present  pass.  If  he  would  know  how  to 
set  the  switch  that  shall  save  the  train  he  must  be  able  to  discern  the 
evidences  of  mal-nutrition  at  their  very  inception.  He  must  be 
trained  not  only  to  report  when  the  storehouse  is  more  or  less  empty, 
but  how  to  preserve  or  restore  its  contents. 

The  golden  days  of  our  art  will  not  have  arrived  until  its  devotees 
shall  have  reached  that  higher  plane  of  service  embodied  in  preven- 
tion rather  than  in  cure;  in  enabling  people  to  reach  the  highest 
excellence  of  physiology  rather  than  in  rescuing  them,  with  more  or 
less  of  failure,  from  the  death-grip  of  pathology. 

It  is  vastly  more  to  the  credit  of  those  in  charge  of  great  systems 
of  travel  to  be  found  inspecting  road-bed,  bridges  and  rolling-stock 
— detecting  weak  places  in  order  to  head  off  disasters — than  to  be 
found  at  the  head  of  a wrecking-crew,  however  well  equipped,  wait- 
ing for  expected  catastrophe,  or  endeavoring  to  make  the  best  of  a 
smash-up. 


HOMOEOPATHY  IN  GYNAECOLOGY. 


487 


HOMOEOPATHY  IN  GYNAECOLOGY. 


By  L.  A.  Phillips,  M.  D.,  Boston,  Mass. 


The  question,  “ What  has  Homoeopathy  done  for  Gynaecology  ? ” 
having  been  raised  and  proposed  as  a theme  for  one  of  the  essays  at 
this  meeting,  our  honored  chairman  assigned  it  to  me,  and  it  was 
accepted  with  the  expectation  that  an  answer  to  such  a question, 
even  if  not  altogether  satisfactory,  would  be  tolerably  easy;  but  the 
task  has  proved  a much  more  difficult  one  than  I anticipated.  The 
difficulty  lies  not  in  any  doubt  of  the  good  work  done  by  Homoeop- 
athy in  this  field,  but  in  the  absence  of  positive  evidence  regarding 
the  administration  of  any  one  remedy  in  any  given  class  of  cases, 
the  uncertainty  regarding  the  conditions  for  which  remedies  are  pre- 
scribed in  many  instances — especially  when  based  wholly  upon  sub- 
jective symptoms — and  in  the  want  of  knowledge  regarding  the 
pathogenesy  of  the  remedies  reported  as  curative.  If  possessed  of 
that  unquestioning  and  implicit  faith  which  knows  or  recognizes  no 
conditions  or  exceptions  to  the  power  of  Homoeopathic  medication 
to  overcome  and  cure  each  and  every  human  ill,  regardless  of  cause 
or  character,  it  would  be  very  easy  to  claim  that  Homoeopathy  had 
at  least  furnished  the  means,  if  we  but  make  ourselves  competent  to 
use  it,  by  which  all  that  gynaecology  or  any  other  class  of  diseases 
presents  for  relief  may  be  successfully  met;  and  with  the  exalted 
power  of  imagination  which  can  see  the  most  marvellous  effects  fol- 
low the  administration  of  a drop  of  water  or  a grain  of  sugar,  it 
would  not  be  difficult  to  demonstrate,  to  our  own  satisfaction,  at  least, 
that  by  such  means  more  remarkable  cures  have  been  and  are  being 
effected  than  by  any  or  all  other  methods.  But  I cannot  treat  the 
subject  from  any  such  standpoint.  A general,  sweeping  claim  with- 
out evidence  amounts  to  nothing.  We  want  to  know  if  definite  and 
unquestionable  results  can  be  shown  as  the  direct  effect  of  Homoeo- 
pathic treatment  in  women’s  diseases,  whether  independent  of  or 
associated  with  other  measures. 


488 


world’s  homoeopathic  congress. 


While  we  all,  doubtless,  believe  and  feel  sure,  from  experience 
and  observation,  that  such  results  are  produced,  to  define  and  dem- 
onstrate this  so  that  it  cannot  be  gainsaid  is  a very  different  matter, 
and  while  I do  not  expect  to  succeed  in  doing  this  to  any  great  ex- 
tent, I shall  hope  to  prepare  the  way,  and  perhaps  indicate  the  lines 
along  which,  by  the  testimony  of  those  who  may  bear  witness  in  the 
discussion  to  follow,  the  demonstration  may  be  made  and  the  fact 
established.  Let  us,  then,  seek  to  make  all  our  claims  rational  and 
based  upon  known  facts,  not  upon  theories  or  assumptions.  Thus 
only  can  we  command  or  reasonably  expect  a fair  and  respectful 
hearing. 

In  the  consideration  of  such  a question  as  this  the  term  gynaecol- 
ogy must  be  understood  to  mean  broadly  the  diseases  and  derange- 
ments of  the  female  generative  organs,  not  only  in  the  degrees  which 
bring  them  under  the  care  of  the  gynaecologist,  but  in  all  degrees  as 
presented  to  the  general  practitioner  or  family  physician  as  well,  and 
we  must  all  realize  that  it  is  less  from  the  gynaecological  specialists 
than  from  the  family  physicians  that  the  evidence  of  the  cuiative 
power  of  Homoeopathic  remedies  must  be  expected.  While  this  by 
some  may  be  deemed  a concession,  or  even  an  admission  of  the  pre- 
ferred charges  that  gynaecologists  are  not  good  Homoeopaths,  I 
shall  deny  this,  and  maintain  that  it  is  but  a natural  and  necessary 
consequence,  inasmuch  as  Homoeopathy,  per  se , has  to  do  with 
nothing  but  the  therapeutics  in  any  case,  and  it  is  generally  recog- 
nized that  therapeutic  means  are  most  marked  and  definite  in  their 
effects  upon  functional  derangements  and  the  early  manifestations  of 
disease  in  all  departments  of  practice;  and  because  the  work  to  be 
done  by  specialists  is  largely  that  which  other  physicians,  by  thera- 
peutic methods,  have  not  succeeded  in  doing,  and  which  generally 
demand  some  form  of  surgical  or  mechanical  treatment. 

From  the  recorded  evidence  of  the  skillful  prescribers  of  Homoeo- 
pathic remedies,  we  may  reasonably  clainf  that  by  this  means  a large 
proportion  of  the  functional  derangements  of  women  are  speedily 
and  perfectly  corrected  without  the  need  of  any  other  form  of  treat- 
ment, and  that  a very  considerable  proportion  of  the  diseases — that 
is,  the  pathological  changes  to  which  the  uterine  organs  are  subject 
— are  prevented  or  cured  at  the  very  outset  by  the  same  means. 
Now,  while  this  may  not  be  capable  of  absolute  or  positive  proof, 
we  certainly  have  strong  circumstantial  evidence  for  it  in  the  fact 


HOMCEOPATHY  IN  GYNAECOLOGY. 


489 


that  women  who  from  childhood  have  been  under  the  care  of  the 
Homoeopathic  physicians  have  far  less  of  this  class  of  diseases  than 
those  who  have  not  been  so  fortunate,  and  also  in  the  fact  that  the 
general  practitioners  of  Homoeopathy  have  few  cases  which  they  feel 
compelled  to  send  to  the  gynaecologists  as  compared  with  those  of 
the  Old  School,  who  have  not  the  means  of  relief  which  our  Homoeo- 
pathic medicines  afford. 

Now,  while  we  know  that  in  all  spheres  and  relations  of  life  little 
credit  is  given  those  who  guard  and  protect  from  impending  dangers, 
as  compared  with  that  accorded  those  who  rescue  the  victim  from  the 
very  teeth  of  the  destroyer;  yet  it  is  as  true  in  this  as  in  any  other 
instance  that  “an  ounce  of  prevention  is  better  than  a pound  of 
cure,”  and  who  will  not  agree  that  to  save  a woman  from  the  mental 
as  well  as  physical  suffering  which  attends  the  development  and 
course  of  a uterine  or  mammary  cancer,  for  instance,  is  to  bestow  a 
far  greater  blessing  than  it  is  possible  for  even  the  most  skilful  sur- 
geon to  bring  when  his  services  are  necessitated,  and  because  the  life 
which,  if  saved  by  the  surgeon’s  skill,  is  a shattered  and  blighted  one 
at  best,  by  the  other  means  is  enabled  to  develop  all  its  powers,  to 
ripen  and  produce  its  fruits  free  from  the  torture,  the  impending 
danger  of  which  was  no  less  real  because  only  in  its  incipiency.  And 
so,  while  the  surgeon  who  succeeds  in  saving  the  fragments  of  such 
lives,  even  for  a few  years,  wins  honor,  fame,  and  wealth,  they  who 
have  done  so  much  more  by  protecting  and  saving  lives  in  their 
entirety  are  unrecognized  and  without  reward  ; often  without  even 
the  gratitude  of  the  patients,  who  do  not  realize  what  has  been  done 
for  them. 

In  this  very  way  Homoeopathy  is  doing  for  its  friends  and  ad- 
herents vastly  more  than  they  realize  or  even  suspect,  and  in  such  a 
gentle  and  unpretentious  manner  that  little  credit  is  given  and 
scarcely  any  evidence  recorded.  Innumerable  cases  of  this  class, 
that  is,  of  prevention  or  cure  in  the  embryonic  stages  of  disease, 
many  times  unknown  to  either  the  patient  or  the  physician,  are  to  be 
credited  to  a system  of  healing  which  is  competent  .to  meet  the 
enemy  at  any  point  and  in  any  form  ; to  fortify  against  and  ward  it 
off  without  being  compelled  to  wait  its  full  development  or  to  learn 
its  exact  name  and  nature  before  active  measures  for  relief  can  be 
adopted.  This  claim  will  not  be  allowed,  I am  well  aware,  except 
by  those  who  know  and  feel  the  influence  and  power  of  this  law  of 


490 


world’s  homoeopathic  congress. 


cure  ; but  though  we  cannot,  of  course,  prove  prevention  in  any  in- 
dividual case,  we  could,  were  it  practicable,  by  a comparison  of  our 
lists  of  patrons  with  a like  number  differently  treated,  demonstrate 
its  validity.  We  cannot  wonder  nor  much  blame  our  Old-School 
brethren  for  doubting  our  claim  when  we  remember  that  they  have 
so  generally  lost  all,  or  nearly  all,  faith  in  the  power  or  virtue  of 
drugs  except  as  opiates  to  destroy  the  consciousness  of  pain,  tonics 
to  stimulate  nature’s  efforts,  or  alteratives  to  disturb  existing  func- 
tional derangements,  hoping  that  out  of  the  disturbance  nature  may 
evolve  an  improved  condition.  But  to  any  physician  who  has  had 
any  considerable  experience  in  the  Homoeopathic  application  of  reme- 
dies, numberless  instances  of  relief  and  cure  will  be  recalled  to  mind 
by  the  mere  mention  of  Aconite,  Arsenicum,  Bryonia,  Belladonna, 
Cimicifuga,  Colocynthis,  Gelsemium,  Ilelonias,  Mercurius,  Thuja, 
Viburnum,  and  scores  of  other  remedies;  and  if  you  would,  one  and 
all,  furnish  definite  and  accurate  reports  of  your  experiences,  we 
could  compel  a recognition  of  the  claim  that  Homoeopathic  remedies 
in  the  hands  of  skilled  prescribers  can  and  do  cure  most  cases  of 
functional  derangement  and  prevent  or  cure  in  their  incipiency  a con- 
siderable portion  of  the  diseases  of  women. 

Here,  then,  before  reaching  the  sphere  of  the  gynaecologist,  w^e  find 
the  proofs  of  Homoeopathy  in  gynaecology  of  which  we  may  well 
feel  proud.  But  it  does  not  end  here,  the  opinion  of  some  of  our 
critical  brethren  to  the  contrary  notwithstanding.  I think  I am  safe 
in  claiming  that  in  the  practice  of  Homoeopathic  gynaecologists  fully 
one-half  the  cases  which,  under  Old-School  treatment,  would  remain 
uncured  or  be  subjected  to  surgical  operation  are  cured  by  Homoeo- 
pathic treatment.  Not  every  case  is  thus  curable,  and  many  demand 
surgical  treatment.  But  wedo,  by  combining  Homoeopathic  medica- 
tion with  the  needed  mechanical  measures,  cure  many  pathological 
conditions;  such,  for  example,  as  metritis  and  endometritis,  pelvic 
peritonitis,  ovaritis,  uterine  dislocations,  fibroid  tumors,  salpingitis, 
etc.  And  we  have  some  well-authenticated  cases  in  which  ovarian 
cysts  have  disappeared  during  the  continued  application  of  the  indi- 
cated remedy;  and  not  only  this,  but  very  many  who  have  endured 
for  a longer  or  shorter  season  the  attempts  of  the  Old-School  special- 
ists to  cure,  come  to  us  and  find  the  relief  they  had  previously  failed 
to  receive;  and  certainly  not  because  we  are  better  mechanics,  but 
because  we  have  the  Homoeopathic  remedies  to  aid  us ; and  this  is 


IIOMCEOPATHY  IN  GYNAECOLOGY. 


491 


equally  true  in  cases  which  require  surgical  treatment.  While 
the  knife  removes  the  cause  of  the  difficulty,  the  remedies  remove 
many  serious  effects,  and  afford  relief  to  the  suffering  nerves  un- 
known to  any  other  method  of  treatment.  And  not  only  this,  but 
the  healing  of  wounds  and  convalescence  are  more  rapid  and  perfect 
when  thus  treated  than  when  opiates  and  poisonous  drugs  and  dress- 
ings are  used. 

Inasmuch  as  it  is  becoming  ever  more  evident  that  the  sufferings 
of  women  which  gynaecologists  are  called  upon  to. relieve  are  very 
largely  neurasthenic,  or  of  nervous  origin,  and  that  even  the  removal 
of  pathological  conditions,  especially  by  surgical  means,  does  not 
always  give  complete  and  ofttimes  little  or  no  relief,  we  find  new  and 
increasing  reasons  for  endeavoring  to  find  Homoeopathic  remedies  to 
meet  these  conditions,  and  I believe  it  is  because  our  remedies,  rightly 
applied,  act  upon  and  through  the  nervous  system  chiefly  that  their 
effects,  even  when  intended  to  act  upon  a pathological  condition,  or 
a certain  organ,  have  been  more  potent  than  the  cruder  methods 
which  shock  or  numb  rather  than  regulate  the  nervous  forces. 

I feel  that  it  would  be  hardly  just  on  my  part  not  to  state  that 
the  specialists  (or  perhaps  I need  speak  only  for  myself)  do  not 
adhere  strictly  or  exclusively  to  highly  attenuated  medicaments  nor 
to  the  more  common  method  of  administration  per  oris.  Experi- 
ence has  taught  me  that  in  treating  the  diseases  and  derangements 
of  the  pelvic  organs  I can  get  much  more  decided  and  speedy  effects 
by  applying  glyceroles,  triturations,  cerates,  or  in  some  cases  crude 
substances  to  the  mucous  or  denuded  surfaces,  the  medication  being 
selected  to  correspond  with  the  symptoms  just  as  in  any  other  class 
of  cases,  or  for  the  ordinary  manner  of  administration.  And  we  can 
maintain  with  the  highest  of  authority,  Hahnemann  himself,  that 
such  medication  is  no  less  Homoeopathic  than  giving  the  same  reme- 
dies for  similar  conditions  by  the  mouth. 

While  in  our  surgical  cases,  by  the  use  of  Calendula,  Hypericum, 
Hamamelis,  Arnica,  etc.,  rapid  healing  is  promoted,  suffering  is 
greatly  lessened,  and  with  the  further  aid  of  other  indicated  reme- 
dies before  and  after  operations,  opiates  are  rendered  unnecessary  in 
nearly  all  cases,  and  convalescence  thus  promoted  and  hastened  ; 
and  while  in  our  office  practice  we  are  curing  active  congestion  of  the 
uterine  organs,  attended  by  the  characteristic  symptoms  of  Bella- 
donna by  a local  application  of  glyceroles  of  that  drug,  the  passive 


492 


world’s  homoeopathic  congress. 


or  venous  congestions  with  Hamamelis,  syphilitic  ulcers  with  Mer- 
curius  corr.,  indurations  or  hyperplasia  with  Iodine,  etc.,  and  doing 
it  much  more  surely  and  speedily  than  it  can  be  done  otherwise,  who 
shall  deny  that  Homoeopathic  gynaecologists  are  as  truly  and  effec- 
tively demonstrating  the  power  of  Homoeopathy  as  they  who  pre- 
scribe these  same  remedies  in  attenuated  form  and  by  the  mouth  for 
more  like  conditions  ? 

Feeling  as  we  do  that  we  have  a right  to  claim  much  for  Homoeo- 
pathy in  gynaecology,  it  must  still  be  admitted  that  much  more  might 
and  should  be  accomplished  in  this  field  ; and  I am  granted  the  pri- 
vilege of  indicating  some  of  the  means  by  which  more  definite  and 
convincing  results  may  in  future  be  obtained. 

First  of  all,  we  must  have  more  thorough  provings  of  our  reme- 
dies by  women,  and  with  competent  observation  of  their  effects  upon 
the  pelvic  organs.  As  it  is,  we  have  very  few  pathogenetic  symp- 
toms to  guide  us  in  selecting  remedies,  and  hence  empiricism  plays 
too  large  a part  in  our  use  of  remedies;  and  while  we  may  claim 
that  the  remedy  which  effects  a cure  is  therefore  Homoeopathic,  un- 
less we  have  a proving  to  correspond  to  our  case  we  cannot  establish 
our  claim  before  an  impartial  jury.  We  have  at  present,  more  than 
ever  before,  women  wTho,  as  members  of  the  profession,  must  realize 
the  importance  of  this  work,  and  some  measures  should  be  adopted 
to  establish  and  endow,  if  necessary,  a school  of  proving  to  which 
they  might  be  induced  to  lend  their  aid,  where  thorough  work  and 
reliable  observations  could  be  secured  and  recorded.  When  this  has 
been  done,  it  will  enable  the  general  practitioner  to  cure  a still 
larger  proportion  of  incipient  diseases  without  the  aid  of  the  gynae- 
cologist, and  at  the  same  time  will  give  to  the  specialist  greatly  in- 
creased means  of  successfully  treating  the  more  serious  diseases  of 
women,  and  rendering  surgical  treatment  a much  less  frequent  neces- 
sity. 

Secondly,  there  should  be  greater  accuracy  in  the  observation  and 
reporting  of  cases  in  order  to  make  clinical  experience  a more  reli- 
able guide.  Accurate  diagnosis  by  physical  examination  is  essential 
in  every  case  if  we  are  to  pretend  to  state  the  pathological  condition. 
Yet  so  many  instances  are  on  record  in  which  cures  of  definite  con- 
ditions, as  of  endometritis,  or  even  tumors,  for  instance,  are  claimed, 
in  which  it  is  found  upon  investigation  that  no  examination  was 
made  and  hence  no  knowledge  possessed  of  the  pathological  changes 


HOMOEOPATHY  IN  GYNECOLOGY. 


493 


present,  that  it  not  only  renders  these  reports  worthless  as  evidence, 
but  it  throws  suspicion  upon  all  such  claims.  And  again,  cases  in 
which  no  records  are  kept,  and  which  may  have  occurred  some  con- 
siderable time  previous  to  being  reported,  are  so  likely  to  be  smoothed 
over  and  rounded  out  with  the  lapse  of  time  that  they  take  on  a form 
and  appear  to  have  a significance  which  could  not  be  depended  upon 
and  which  destroy  their  value  as  evidence.  It  is  important,  then, 
that  wTe  keep  written  records  of  the  cases  we  report,  and  that  we  have 
a definite  knowledge  of  the  objective  as  well  as  subjective  symptoms 
in  each  case.  Who  can  doubt  that  with  these  conditions,  with  the 
greater  knowledge  of  the  Homoeopathic  remedies  which  thorough 
provings  by  educated  women  would  afford,  a showing  could  be  made 
of  Homoeopathy  in  gynaecology  which  would  surprise  even  its  most 
ardent  friends.  This  we  may  hope  for  at  some  future  World’s  Con- 
gress, but  at  this  time  I can  only  ask,  in  closing,  that  the  army  of 
family  physicians  here  present  substantiate  my  claim  that  Homoeop- 
athy in  their  hands  cures  a large  proportion  of  women’s  diseases  and 
renders  its  adherents  much  less  subject  to  such  ills  than  those  other- 
wise treated  ; and  by  the  gynaecologists  I hope  to  be  reinforced  in  my 
claim  that  we  have  in  Homoeopathy  a means  of  curing  many  condi- 
tions which  baffle  all  other  resources,  and  that  in  aid  of  surgery  it  has 
proved  itself  a reliable  and  powerful  ally. 


Discussion. 

A.  C.  Co wperth waite,  M.D.  : As  I heard  this  most  excellent 
paper  read,  the  thought  came  to  me,  what  if  it  were  possible  to-day 
to  have  presented  to  us  a panorama  of  those  silent  yet  actual  wit- 
nesses to  the  benefit  that  Homoeopathy  has  been  to  gynaecology. 
We  ourselves  would  be  astounded  at  that  which  has  been  accom- 
plished without  even  our  own  knowledge.  At  the  same  time  another 
thought  struck  me  in  a little  different  direction,  and  that  was,  that 
in  all  that  Homoeopathy  has  done  for  gynaecology  it  has  not  done 
one-half,  or  one-tenth,  of  what  it  would  have  been  glad  to  do  if  it 
had  only  been  given  half  a chance. 

We  must  admit  that  when  a man  becomes  a specialist,  his  tendency 
as  the  first  speaker  of  the  afternoon  said,  is  to  become  an  intense 
specialist,  and  so  we  find  that  while  not  all,  a great  many  gynaecolo- 
gists become  so  wedded  to  their  instruments  and  their  mechanical 
measures  that  they  forget  the  power  of  the  armamentarium  that  they 
have  behind  them. 

I am  glad  to  hear  a paper  like  this,  even  if  our  brother  does  pre- 


494 


world’s  homoeopathic  congress. 


scribe  his  remedies  in  crude  doses  and  apply  them  locally.  I have 
always  been  one  of  the  number  that  believe  we  had  to  do  that.  I 
remember  I had  to  get  out  of  the  hotel  at  Milwaukee  where  I was 
one  of  the  charter  members  of  the  International,  because  I would 
not  subscribe  to  the  doctrine  of  never  using  local  applications.  But 
at  the  same  time  that  does  not  fill  the  bill  entirely  and  exclusively. 
We  should  not  for  one  moment  forget  that  there  is  something  in  the 
powerful  action  of  potentized,  or  if  you  prefer,  “ attenuated  ” drugs, 
that  reaches  beyond  and  deeper,  and  does  more  than  the  mere  local 
applications  of  drugs,  no  matter  how  beneficial  that  may  be  to  cer- 
tain local  conditions  that  may  exist. 

I remember  reading  some  years  ago  a very  beautiful  account, 
written  by  Dr.  Mercy  B.  Jackson,  of  Boston,  now  deceased,  of  her 
own  experience  of  the  effects  of  Sepia  upon  her  own  person  when 
suffering  from  uterine  displacements.  She  said  that  she  could  feel 
that  medicine,  by  its  mighty  power,  raising  the  uterus  into  position, 
and  it  did  it  and  it  stayed  there;  and  there  are  plenty  of  Homoeo- 
pathic physicians  who  have  had  similar  experiences  in  their  own 
practice.  I want  to  ask  of  you  to-day  candidly,  how  many  gynae- 
cologists do  you  suppose  carry  Sepia  around  with  them  as  one  of 
their  chief  anchors  in  the  treatment  of  diseases  of  women?  I never 
have  known  one  yet.  I do  not  care  how  you  use  it,  we  have  in  this 
one  remedy,  Sepia,  one  of  the  grandest  remedies  of  Homoeopathy 
and  yet  one  of  its  most  neglected  ones. 

Now  to  come  to  the  point  made  in  this  paper  which  I consider  of 
far  more  benefit  to  us  here  to-day  as  being  of,  some  assistance  in 
helping  us  develop  something  in  this  line  than  any  other  part  of  this 
all-valuable  paper.  That  is  the  suggestion  that  has  been  made  to 
the  ladies.  I have  often  wondered  why  the  lady  gynaecologists  did 
not  band  themselves  together  for  the  good  of  their  common  sex. 
Why  it  was  that,  knowing  as  they  do  know  the  tortures  that  are 
being  continually  perpetrated  upon  their  sex  by  gynaecologists,  they 
do  not  put  their  heads  together  and  try  to  see  how  to  modify  these 
measures  ; yet  there  is  very  little  tendency  in  that  direction. 

I was  told  by  a gentleman,  and  I hope  if  he  is  present  he  will 
pardon  me,*that  while  he  had  nothing  to  say  about  male  gynaecolo- 
gists, if  he  wanted  one  that  was  real  harsh,  and  would  stretch  and 
tear  and  bend,  just  give  him  a woman  gynaecologist;  that  they  did 
not  seem  to  have  any  feeling  for  their  sex  in  these  matters.  Now 
that  may  be  not  altogether  so,  but  think  for  a moment  if  there  is  not 
some  truth  in  it,  and  if  it  is  not  a proper  thing  for  the  ladies  in  the 
Homoeopathic  profession  to  follow  the  suggestion  laid  down  in  this 
paper;  to  go  right  to  work  and  see  what  more  there  is  in  Homoeo- 
pathy that  has  not  been  applied  in  its  proper  methods.  Organize 
provers’  clubs,  which  you  alone  can  do;  conduct  them  according  to 
your  own  wise  methods;  establish  the  value  of  our  remedies  in  a way 


HOMCEOPATHY  IN  GYNAECOLOGY. 


495 


that  none  but  yourselves  can  possibly  do,  and  then  show  to  the  world 
by  the  practical  application  of  these  remedies  what  Homoeopathy 
can  do  for  gynaecology. 

I believe,  as  I am  one  of  those  who  have  always  very  strongly 
favored  ladies,  that  this  suggestion  will  be  taken  as  coming  from  a 
friend. 

And  so  we  find  that  Homoeopathy  has  done  something  for  gynae- 
cology. We  cannot  give  a long  row  of  blooming  statistics  here  to- 
day. We  might  give  many.  The  statistics  are  hidden  in  the  quiet 
recesses  of  many  hearts  and  even  some  of  those  hearts  that  have  been 
most  benefited  know  it  the  least ; and  so,  if  we  will  but  take  to  our 
bosoms  the  truths  that  have  been  given  us  by  Dr.  Phillips  and  have 
less  of  our  mechanical  and  surgical  measures  and  more  of  our  thera- 
peutics— combining  our  Materia  Medica  more  completely  and  thor- 
oughly with  our  mechanical  measures — in  ten  years  from  now  there 
can  be  a great  deal  more  said  as  to  what  Homoeopathy  has  done  for 
gynaecology,  than  can  possibly  be  said  to-day. 

W.  P.  McCracken,  M.D. : I would  like  to  make  a cry  against 
the  over-local  treatment,  and  to  do  it  clearly  and  concisely,  and  in 
five  minutes.  I will  give  you  a case.  A young  girl  of  twenty  in  the 
fall  of  1873  became  very  ill  suddenly.  She  was  taken  to  old  Dr. 
Foster  of  Clifton  Springs  Sanitarium.  It  was  pronounced  a ner- 
vous and  mental  trouble,  and  Dr.  Prince,  whom  some  of  you  may 
know,  was  her  physician.  She  was  there  six  months.  In  the  sum- 
mer of  1874,  at  her  own  request,  she  went  to  Dr.  John  P.  Gray,  of 
Utica,  and  between  the  summer  of  1874  and  the  fall  of  1878  she 
spent  three  years  and  one  month  in  the  Utica  Insane  Asylum  under 
John  P.  Gray’s  care  and  that  of  his  colleague,  Dr.  Andrews,  who 
has  since  become  superintendent  of  the  Buffalo  Insane  Asylum. 
The  first  time  she  was  there  was  twelve  months,  the  second  time 
twenty  months  and  the  third  time  six  months.  She  realized  as  well 
as  John  P.  Gray  did,  that  he  considered  her  case  hopeless,  and  he 
let  her  go  at  the  end  of  six  months,  thinking  that  she  would  return 
soon.  While  she  was  in  a comparatively  good  state  of  health,  he 
thought  she  might  as  well  be  at  home  with  her  widowed  mother. 
In  the  spring  of  1878  she  was  taken  as  a last  resort  to  Dr.  Robin- 
son, of  Albany — a Homoeopathic  physician — who  insisted  upon  a 
local  examination.  He  assured  all  her  friends  that  there  was  enough 
trouble  to  have  caused  all  the  nervous  and  mental  disturbance.  He 
gave  her  local  treatment  steadily  six  to  eight  months  at  a time,  from 
the  year  1878  until  fate  brought  her  to  Chicago  in  1883.  I do  not 
mean  that  he  was  all  the  time  giving  her  local  treatment,  but  that 
he  would  treat  her  for  a few  months,  dismiss  her  as  well,  and  a few 
months  afterwards  the  nervous  and  mental  disturbance  would  return, 
and  she  would  return  to  her  physician. 

In  1883 — pardon  me  for  the  allusion — Mie  came  to  Dr.  Ludlam, 


496 


world’s  homceopathic  congress. 


of  Chicago,  and  after  carefully  studying  the  case  and  carefully  affiliat- 
ing the  remedy,  he  prescribed  for  her.  He  did  not  examine  her. 
He  gave  her  no  local  treatment  and  she  only  took  twelve  of  his  pre- 
scriptions at  a dollar  each.  Ten  years  have  since  elapsed  without 
any  recurrence  of  her  nervous  or  mental  trouble. 

I should  also  like  to  say  a few  words  in  a very  humble  way  from 
my  own  office,  as  I only  graduated  in  1887.  It  has  always  been 
my  aim  and  policy  to  try  and  affiliate  the  remedy  without  local 
treatment.  When  my  knowledge  of  Materia  Medica  fails  me,  then 
I give  local  treatment,  and  with  the  result,  I presume,  that  you  all 
have  realized. 

Julia  Ross  Lowe,  M.D. : It  was  not  my  intention  to  say  any- 
thing this  afternoon,  but  I wish  to  speak  as  to  two  remarks,  one  in 
the  paper  and  one  in  the  discussion,  which  attracted  my  attention. 
Speaking  of  Sepia  restoring  a dislocated  uterus,  I believe  in  reme- 
dies effecting  a great  deal  but  I think  that  is  asking  too  much.  I 
do  not  believe  that  Sepia  or  any  other  remedy  will  restore  a dislo- 
cated uterus  any  more  than  it  will  a dislocated  arm. 

One  of  the  speakers  said  that  of  all  the  heroic  treatment  he  had 
ever  seen,  the  worst  came  from  women  gynaecologists.  I am  a prac- 
titioner of  many  years’  standing.  I have  had  in  my  office  many 
women,  the  victims  of  malpractice,  and  only  one  of  some  twenty-five 
that  I can  recall  came  from  the  neglect  of  a woman  physician.  I 
have  seen  women  sewn  and  torn  and  maltreated  by  men,  but  only 
one  can  I recollect  that  was  maltreated  by  a woman  physician,  and 
she  sent  the  patient  home  from  her  office  some  miles  with  a sponge 
tent.  I think  it  was  neglect. 

Now  this  is  not  a criticism  upon  men  practitioners,  and  I do  not 
wish  it  understood  in  that  sense.  I only  wish  to  refute,  from  my 
own  ten  years’  practice,  the  statement  that  was  made. 

J.  C.  Wood,  M.D. : A case,  apropos  to  the  one  that  was  recorded 
regarding  the  effects  of  general  treatment,  after  local  treatment 
had  failed.  Some  six  months  ago,  I was  called  in  consultation  with 
one  of  the  best  prescribes  in  our  State,  to  see  a young  lady  who  was 
suffering  from  melancholia,  so  much  so,  that  an  idea  of  removing  her 
to  an  insane  asylum  was  seriously  entertained.  The  various  prescrip- 
tions had  been  made  without  avail.  The  patient  kept  getting  worse 
and  worse.  Her  melancholia  was  of  a suicidal  type,  and  her  condi- 
tion was  most  deplorable.  An  examination  revealed  a bad  retro- 
flexion of  the  uterus,  which  was  overcome  by  a pessary.  Some  two 
weeks  ago,  the  patient  came  into  my  office  and  greeted  me.  I hardly 
knew  her;  and  she  said:  “ Doctor,  you  came  to  see  me,  some  six 
months  ago,  when  they  were  talking  about  taking  me  to  an  insane 
asylum.  I want  to  tell  you  how  perfectly  well  and  perfectly  happy 
I have  been  since  you  fitted  that  pessary.” 

This  was  a case  which  could  not  possibly  have  been  reached  by 


HOMCE<  >PATHY  IN  GYNAECOLOGY. 


497 


internal  medication.  At  least,  internal  medication  had  been  given 
a most  thorough  trial.  It  was  a case  eminently  proper  for  local 
treatment,  and  I think,  as  gynaecologists,  we  have  got  to  discrimi- 
nate in  those  cases.  I think  we  should  ordinarily  try  our  internal 
medication.  I believe  in  the  power  and  efficacy  of  the  Homoeopa- 
thic remedies  for  these  conditions,  under  suitable  circumstances  ; but, 
while  we  are  doing  this,  there  is  a danger  or  an  evil  which  is  more 
prevalent  in  the  Homoeopathic  than  in  the  Old  School,  becauce  of 
the  belief  in  the  efficacy  of  the  Homoeopathic  remedies,  and  it  is  that 
of  neglecting  local  examination,  and  overlooking  and  neglecting  the 
malignant  conditions.  We  expect  to  have,  this  afternoon,  a paper 
upon  the  subject  of  “Vaginal  Hysterectomy.”  That  very  import- 
ant subject,  and  very  important  operation,  has  reached  a point  where, 
if  we  get  our  cases  in  time,  we  can  save  a goodly  per  cent,  of  them  ; 
but  we  have  got  to  get  them  in  time,  and  there  is  danger,  I think, 
if  we  rely  too  absolutely  upon  our  internal  medication,  of  neglecting 
our  examinations  until  malignancy  comes,  particularly  in  that  class 
of  patients  approaching  the  so-called  cancerous  age;  and  I know, 
from  my  own  personal  experience,  that  the  general  practitioner  relies 
too  absolutely  upon  internal  medication  for  controlling  symptoms, 
the  cause  of  which  he  should  seek  by  local  examination. 

Now,  I say  that  I believe  in  the  efficacy  of  internal  medication, 
but  I was  glad  to  hear  one  of  the  other  sex  get  up  here  and  proclaim 
the  absurdity  of  trying  to  set  a uterus  by  the  internal  administration 
of  Sepia.  It  is  such  absurdities  as  this  that  make  Homoeopathy  ridic- 
ulous in  the  eyes  of  the  public.  Subjective  phenomena  are  liable  to 
be  mistaken. 

R.  Ludlam,  M.D. : I cannot  resist  having  one  word  on  this  sub- 
ject. First,  I want  to  express  my  thorough  appreciation  of  the 
paper  by  Hr.  Phillips,  which  we  have  been  discussing.  I like  such 
a paper.  We  do  not  have  enough  of  them.  It  is  careful,  practical, 
and  discriminating.  It  is  not  too  enthusiastic.  It  is  sensible,  and 
will  be  useful.  I like  the  suggestion  immensely  as  to  the  duty  of 
the  women  in  this  Institute. 

The  crowning  argument  for  the  admission  of  women  to  the  floor 
of  our  national  society,  after  Hr.  Mercy  13.  Jackson,  Hr.  Swazey, 
and  a lot  of  other  great  physicians,  who  have  gone  to  their  rest,  had 
knocked  at  the  door  for  several  years  without  getting  in,  was  made 
by  Hr.  Carroll  Hunham,  and  that  argument  was  in  exact  line  with 
the  recommendation  or  suggestion  of  Hr.  Phillips. 

W7e  want  the  women  in  the  Institute.  We  need  them  as  provers. 
They  can  make  provings  that  none  of  the  rest  of  us  can  make,  or 
can  even  superintend.  That  argument  brought  them  into  the  Insti- 
tute, and  it  was  my  pleasure  to  put  the  question  when  they  were  ad- 
mitted, and  I shall  be  proud  of  it  if  I live  a hundred  years. 

I am  glad  this  subject  has  been  discussed,  because  it  is  shown 

32 


498 


world’s  homoeopathic  congress. 


to-day  that  it,  like  every  other,  has  two  sides,  and  that  people  may 
he  very  honest  in  their  views  on  either  side,  that  we  grow  and  learn 
by  contact,  by  coming  together  and  comparing  our  experiences. 

I believe  most  heartily  in  the  efficacy  of  Homoeopathic  remedies 
for  many  diseases  of  women.  I am  perfectly  satisfied  that  the  scope 
of  the  remedies  will  grow  and  the  utility  increase  as  time  goes  on, 
and  we  will  learn  how  to  apply  them  ; and  that  just  in  such  ratio, 
the  coarser,  cruder  and  apparently  more  cruel  surgical  means  that 
we  have  to  resort  to  now,  will  be  used  less  and  less.  Upon  the  other 
hand  I believe  that  surgical  measures  in  the  right  hands,  guided  by 
the  right  brains,  are  useful  and  will  always  be  useful  in  this  specialty. 

I cannot  hear  any  reflection  upon  gynaecologists  as  a class,  I mean 
the  better  ones,  without  a little  bit  of  resentment.  What  under 
heaven  would  we  have  known  of  gynaecological  diagnosis  without 
the  gynaecologists,  and  what  would  our  testimony  be  good  for  as  to 
the  efficacy  of  Homoeopathic  remedies  if  we  were  not  competent  to 
make  a careful  diagnosis?  Therefore  I say  we  need  the  gynaecolo- 
gists. We  cannot  be  good  theoretical  gynaecologists  until  we  are 
good  diagnosticians. 

There  are  two  sides  to  this  question,  and  when  we  are  interested 
in  one  we  are  apt  to  forget  the  other.  I could  not  help  recalling 
the  story  told  by  Henry  Ward  Beecher  about  the  old  darkey  who 
fished  all  day,  and  toward  the  end  of  the  day  canght  a catfish.  He 
threw  it  back  into  the  water  disgusted  and  said,  “ When  I goes  cat- 
ting, I goes  catting;  but  to-day  I’se  piking.” 

We  must  be  careful  not  to  insist  too  radically  on  our  experience 
as  being  all  one  way,  or  all  the  other.  Let  us  be  well  balanced, 
well  poised,  and  then  our  experience,  and  what  is  more,  our  advice, 
will  be  worth  something. 

Alfred  E.  Hawkes,  M.D.,  Liverpool,  England  : I should  like 
to  add  my  testimony,  and  I cannot  say  how  delighted  I am  to  hear 
these  expressions  of  opinion.  My  position  is  just  in  a nutshell.  I 
believe  firmly  and  sincerely  in  our  medicines,  and  I try  as  far  as 
possible  to  put  off  an  operation.  I have  now  several  cases  that  come 
to  my  clinic  at  home  where  the  ovaries  and  what  not  have  been 
condemned  by  operation,  where  I have  been  able  t6  give  medicines 
and  get  a cure.  I have  had  the  happiness  of  talking  to  a good  man, 
a very  excellent  friend  of  mine  of  the  other  school  of  medicine,  who 
declared  that  whereas  an  operation  in  his  opinion  was  necessary  and 
called  for  on  a previous  occasion,  now  no  such  necessity  existed.  I 
think  that  such  medicines  as  Palladium  and  Apis,  with  Stannum  to 
come  after  Sepia,  when  the  Sepia  is  not  quite  efficacious,  will  do  a 
great  deal  with  these  cases,  and  that  operations  will  become  fewer  and 
tewer  as  we  understand  the  possibilities  of  our  Materia  Medica 
better. 

I am  glad  to  be  told  that  so  many  ladies  are  piacticing  medicine, 


HOMOEOPATHY  IN  GYNAECOLOGY. 


499 


and  I am  sure  the  greatest  possible  good  will  come  to  all  from  their 
combination  with  us  of  the  sterner  sex. 

C.  G.  Higbee,  M.D. : I can  endorse  everything  said  in  the  paper 
of  Dr.  Phillips.  There  is  one  remedy  which  I believe  to  be  Ho- 
moeopathic in  its  action,  which  I have  found  very  efficacious  in  treat- 
ing this  class  of  diseases,  which  has  not  been  mentioned.  I believe 
the  action  of  electricity  in  gynaecological  cases  is  Homoeopathic.  I 
have  had  quite  a large  experience  for  several  years  in  the  use  of 
electricity  in  these  cases,  and  with  excellent  effect. 

It  is  difficult  to  say  at  the  present  time  with  our  limited — I think 
I will  say — “ proving”  of  electricity,  just  how  it  acts,  but  I believe 
it  is  through  the  nervous  system,  and  that  it  re-establishes  the  capil- 
lary circulation  which  is  at  the  base  of  most  of  these  diseases.  I know 
from  the  experience  that  I have  had  with  it  that  it  clears  up  many 
of  those  cases  much  more  rapidly  than  I could  possibly  do  with  any 
drug  that  I have  ever  administered.  Perhaps  I did  not  select  the 
proper  drug  or  give  it  in  a potency  high  enough,  but  I did  the  best 
I could.  But  before  we  give  up  our  cases  let  us  thoroughly  try 
electricity. 

Flora  A.  Brewster,  M.D. : The  doctor  who  has  preceded  me 
has  stolen  a part  of  my  thunder.  I shall  have  to  begin  where  he 
left  off.  I believe  a chief  cause  of  the  troubles  which  we  gynaecolo- 
gists treat  in  our  offices  is  uterine  oedema.  I believe  that  in  all  the 
misplacements  that  we  are  called  upon  to  deal  with,  if  we  could  get 
the  patient  in  time  and  could  restore  the  muscular  tone,  we  could 
prevent  the  misplacements.  Unfortunately,  we  never  get  them  under 
our  care  until  the  person  is  crippled,  and  I believe  it  is  an  absurdity 
to  attempt,  when  all  the  bloodvessels  are  out  of  place,  when  the  blood 
easily  passes  into  the  organ  and  it  is  almost  impossible  for  it  to  escape, 
when  waste  matter  is  left  in  it  and  the  organ  is  growing  heavier,  to 
restore  that  organ  by  medicines  alone.  Why  should  not  we,  as  Hom- 
ceopathists,  use  the  very  best  means  in  our  power  to  gain  all  the 
knowledge  we  can  in  restoring  the  human  body  ? I believe  if  we 
would  do  that,  very  much  of  the  opprobrium  that  is  heaped  upon  the 
head  of  the  poor  Homoeopathist  might  be  averted.  And  I believe 
that  one  of  the  most  effective  means  we  have  in  restoring  uterine  tone 
is  electricity. 

Doctors  have  said  to  me:  “Oh,  the  worst  cases  I have  ever  seen 
have  been  women  that  have  been  to  an  electrician.”  It  is  because 
they  did  not  know  how  to  use  the  battery.  How  many  doctors  are 
there  that  know  what  a current  of  tension  means,  or  the  difference 
between  a current  run  through  a long  fine  wire  and  one  run 
through  a coarse  heavy  wire?  You  will  get  exactly  opposite  effects. 
One  kind  will  decrease  the  inflammation  and  the  other  will  in- 
crease it. 

I know  positively  that  a uterus,  retroverted  and  imbedded  in  a 


500 


world’s  homoeopathic  congress. 


mass  of  adhesion,  can  have  a current  passed  through  it  with  perfect 
safety,  and  these  adhesions  can  be  broken  up  and  the  uterus  lifted  to 
its  normal  position.  Not  in  one  treatment,  or  three,  or  five.  It  needs 
a person  of  good  judgment  and  large  experience. 

Dr.  Phillips:  I see  very  little  reason  for  occupying  more  time. 
Nothing  has  been  developed  which  makes  me  wish  to  express  a dif- 
ferent opinion  or  add  to  what  I have  said.  The  use  of  local  remedies 
and  internal  medication  goes  without  saying.  The  same  indications 
which  lead  to  the  local  use  of  Belladonna  would  lead  to  the  internal 
administration  of  the  same  drug,  and  the  internal  remedy  in  my  expe- 
rience is  almost  always  identical  with  the  local. 

In  regard  to  Sepia,  I would  like  Dr.  Cowperthwaite  to  know  that 
there  is  one  gynaecologist  in  the  United  States  that  carries  Sepia  in 
his  case,  for  I never  go  without  it.  I use  it,  not  to  replace  a displaced 
uterus  which  has  been  impacted,  but  to  strengthen  the  ligaments  after 
it  has  been  mechanically  replaced. 

J.  M.  Lee,  M.D. : It  was  stated  by  one  of  the  speakers  that  elec- 
tricity in  some  way  or  another  was  sufficient  to  break  up  or  to  cure 
all  cases  of  so-called  pelvic  cellulitis,  and  that  if  such  diseases  were 
not  cured  by  the  application  of  electricity  it  was  because  the  operator 
did  not  understand  the  use  of  the  agent.  There  are  cases  of  adhesions 
that  cannot  be  broken  up  with  the  fingers,  and  it  is  absurd  for  any- 
body to  get  up  before  an  audience  like  this  and  state  that  electricity 
can  cure  those  cases.  I want  to  protest  against  any  such  talk  as 
that. 

Dr.  Higbee  : I haven’t  heard  any  one  say  that  electricity  could 
break  up  those  adhesions.  I do  not  believe  they  can  be  so  broken 
up.  It  will  stop  their  growth. 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  INVASION.  501 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  IN- 
VASION. 

By  Edward  Blake,  M.D.,  London,  England. 


I do  not  doubt  that  you  will  all  be  prepared  to  admit  that  the 
most  elevating  conception  of  the  highest  and  noblest  of  all  pro- 
fessions is  that  which  views  it  as  a means  of  preventing  disease. 
Because  this  is  so,  it  is  difficult  to  overestimate  the  importance  of 
establishing  aetiology  on  a sound  and  scientific  basis.  So  swift 
have  been  recent  strides  towards  this  excellent  consummation  of 
our  desires  that  it  is  quite  impossible  for  a single  intelligence  to 
keep  pace  with  them. 

Though  it  is  undoubtedly  true  that  we  can,  with  some  measure 
of  success,  encounter  certain  manifestations  of  disease,  knowing  noth- 
ing of  their  real  causation,  it  is  equally  true,  that  without  aetiology 
we  cannot  do  our  best  by  our  client  to  protect  him  from  future 
visitations  of  the  same  malady. 

We  say  most  truly  felix  qui  potuit  cognoscere  causcts,  for  not  only 
is  some  knowledge  of  aetiology  needed  for  the  prevention  of  dis- 
ease, but  some  special  knowledge  of  predisponents  and  excitants 
must  deeply  tinge  our  general  selection  of  measures  designed  to 
afford  relief  to  those  entrusted  to  our  care. 

It  is  plain  that  there  could  be  no  State  medicine  without  sci- 
entific aetiology. 

Equally  there  can  be  no  fixed  basis  of  nomenclature  ; for  ex- 
ample, have  we  not  seen  that  the  selection  of  names  based  on  physical 
characters  alone  may  lead,  as  in  the  absurd  artificial  classifications 
of  skin  diseases,  to  the  most  ridiculous  results?  Arranging  small- 
pox with  ecthyma  antimoniale  and  erythema  mercuriale  with  scarlet 
fever. 

The  only  hope  of  a definite  scientific  taxonomy  is  to  have  the 
generic  terms  founded  on  physical  or  physiologic  characters  and 
the  specific  distinctions  based  on  causation.  Examples  are  “chon- 


502 


world’s  homoeopathic  congress. 

dritis  arsenicalis,”  “ synovitis  traumatica,”  and  “pharyngitis  sep- 
tica.” 

It  will  be  then  from  the  setiologic  side  that  I shall,  with  your 
permission,  approach  this  important  subject. 

Acute  Sepsis. — Concerning  acute  sepsis  I shall  have  very  little 
to  say.  In  women  its  most  typical,  and  certainly  its  most  appal- 
ling form,  is  child-bed  fever;  a disease  which  has  grown  to  be 
more  rare  since  Listerism  has  come  into  vogue.  A disease  des- 
tined, let  us  hope,  ere  long  to  disappear  altogether  from  civilized 
communities. 

I was  assured  by  Professor  Victor  Horsley,  when  he  acted  as 
Registrar  of  the  Maternity  Department  of  the  University  College 
Hospital,  London,  England,  that  the  substitution  of  vaseline  for 
lard  on  the  hands  of  students,  who  went  from  dressing  surgical 
injuries  to  the  lying-in  bedside,  effected  a perceptible  diminution 
in  the  number  of  cases  of  puerperal  septicaemia.  Inasmuch  as  this 
disease  is  easily  prevented  and  is  nearly  incurable,  all  our  energies 
should  be  devoted  to  rendering  the  parturient  woman  and  all  her 
surroundings  as  aseptic  as  possible. 

A few  words  as  to  the  chief  indications  for  managing  a case  : 

1.  See  that  the  uterine  cavity  is  absolutely  clear.  It  is  better  to 
remove  a part  of  the  wall  of  the  womb  than  to  leave  behind  the 
very  smallest  portion  of  chorion  after  an  abortion,  or  of  pla- 
cental membrane  after  miscarriage  or  labor  at  term. 

2.  Keep  the  cavity  constantly  irrigated  wdth  some  warm  solution 
of  harmless  antiseptic,  such  as  boric  acid,  taking  care  that  the  egress- 
tube  of  the  double  canula  employed  be  far  larger  in  internal 
sectional  area  than  the  ingress-tube. 

3.  Keep  the  cervix  patulous,  and  if  possible  arrange  that  the  patient 
be  in  an  appropriate  posture  for  easy  drainage. 

4.  Protect  or  remove  needless  absorbent  surfaces. 

Subacute  and  Chronic  Sepsis. — We  see  examples  of  rather 
less  acute  septic  intoxication  in  surgical  erysipelas,  established  gonor- 
rhoea, coprostatic  urticaria  resembling  the  form  which  arises  from  de- 
composing food,  extensive  cutaneous  burn,  diphtheria,  pyometra, 
pyocolpos,  otitis  suppurans,  and  disseminated  abscess,  infective  osteo- 
myelitis, and  in  the  so-called  “zymotic”  fevers. 

The  infinite  varieties  of  toxine  produced  during  these  invasions  of 
anabolic  and  katabolic  tissue-changes,  and  by  the  decomposition  of 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  INVASION.  503 


pus,  of  mucus,  and  of  other  liquid  products  of  the  body,  exhibit, 
when  we  consider  their  elaborate  differentiation,  a curious  unanimity 
both  in  method  of  attack  and  in  the  selection  of  sites  for  action. 

Thus,  they  all  prefer  to  act  on  the  endothelium  and  the  epithe- 
lium of  children.  They  prefer  the  nervous  system  of  women  and  the 
joints  of  men.  That  is,  of  course,  only  another  way  of  saying  that 
the  skin  and  mucosa  of  the  young,  the  cerebro-spinal  system  of  women 
and  the  joints  in  men,  are  either  their  weakest  points,  respectively,  or 
else  they  are  the  most  active  in  their  efforts  to  rid  themselves  of  pois- 
onous material. 

To  avoid  repetition  I will  consider  the  distinctive  characters  of 
subacute  septic  invasion  with  those  of  the  chronic  form,  for,  into  the 
latter  the  former  insensibly  merge. 

Skin. — Just  as  in  acute  sepsis,  the  skin  affection  is  usually  erythem- 
atous, so,  in  the  more  chronic  forms,  the  cutaneous  manifestation 
is  nearly  always  some  variety  of  nettle-rash.  In  the  ill-fed  and  the 
aged,  it  may  be  replaced  by  petechial  or  purpuric  affections. 

Urticaria  septica  is  sometimes  seen  in  the  course  ef  chronic  gon- 
orrhoea, when  it  may  be  complicated  with  certain  drug-rashes — such 
as  the  Copaiba  dermatitis,  which  occasionally  presents  features resent 
bling  nettle-rash. 

In  a pamphlet  entitled  “ Sepsis  and  Saturnism,”  in  which  I have 
shown  the  curious  resemblance  which  exists  between  the  modu& op- 
erand,} of  septic  matter,  and  of  the  soluble  salts  of  lead,  I have 
described  a form  of  acne  rosacea  of  the  face  arising  from  carious  teeth. 
This  may  be  compared  with  the  septic  rash  (roseola  enterica)  seen 
on  the  abdomen  of  the  typhoid  patient. 

Also,  at  page  15  of  my  work  on  Septic  Intoxication , I have  given 
an  example  of  multiple  symmetrical  petechiae  occurring  on  the  cheeks 
of  an  old  lady,  evidently  arising  from  suppurating  fangs,  for  it  dis- 
appeared after  the  removal  of  the  carious  roots.  / 

Purpurea  has  been  produced  by  direct  experimentation  of  poison- 
ing by  ptomaines,  and  there  is  little  doubt  that  the  diseases  roughly 
grouped  together  as  haemorrhagic  purpurea  are,  some  of  them,  septic 
in  origin. 

I have  elsewhere  shown  that  nearly  all  the  toxic  eruptions  may 
attack  any  portion  of  the  epithelium.  But  there  are  favored  sites. 

Internally,  the  throat  is,  for  many  reasons,  a preferred  locality,  as 
we  see  in  diphtheria,  scarlet  fever,  and  some  of  the  other  zymotics. 


504 


world’s  homoeopathic  congress. 


Outside  the  body,  the  forearm  is  the  most  common  site  of  septic 
rash.  The  musculo-spiral  distribution  is  the  area  most  frequently 
affected. 

The  musculo-spiral  has  a few  peculiarities  which  we  shall  be  repaid 
for  noting.  Developmental ly  it  is  a very  old  nerve,  being  found  in  the 
earliest  types  of  anterior  limbed  organisms.  In  its  personal  habits  it 
is  a punctiliously  polite  nerve,  and  it  never  encroaches  on  its  neigh- 
bors. Unlike  the  ulnar,  which  often  reaches  as  far  into  the  musculo- 
spiral  area  as  the  root  of  the  index  finger,  the  musculo-spiral  shows  no 
retaliatory  spirit.  It  is  a nerve  of  vicissitudes.  Besides  being  per- 
petually and  abruptly  stretched  during  pronation,  it  receives  most  of 
the  blows  which  reach  the  forearm.  Being  a silhouette  or  outline 
nerve,  it  is  much  exposed  to  the  changes  of  external  temperature. 
Many  toxic  eruptions  appear  first,  either  on  its  superficial  area  or  on 
that  of  the  fifth  cranial  pair.  An  example  is  iododerma,  which  is 
usually  best  seen  on  the  forearm  and  the  face.  It  follows  occasionally 
the  dressing  of  the  endometrium  with  iodized  Phenol. 

The  distribution  of  the  musculo-spiral  is  the  point  to  examine  for 
the  earliest  manifestations  of  the  peculiar  eruption  characteristic  of 
uraemia.  These  are  the  so-called  maculae  uraemicae,  first  described, 
with  anything  approaching  accuracy,  by  Le  Cronier  Lancaster,  of 
Swansea,  England.  Here  are  also  often  first  seen  the  xanthoma  of 
osteo-arthritis,  so  often  septic  in  origin. 

These  pigment  spots  on  the  forearm,  yellow  under  the  clothes,  and 
Sepia-like  where  they  are  exposed,  were  first  alluded  to  by  me  in  the 
British  Journal  of  Homoeopathy  in  1881.  The  various  forms  of  dys- 
chromia associated  with  rheumatism  were  afterwards,  in  1885,  most 
carefully  and  elaborately  described  by  Dr.  Kent  Spender,  of  Bath, 
under  the  name  of  multiple  xanthoma. 

Next  in  order  of  frequency  is  the  trigeminus  or  nerve  of  sensation 
of  the  face.  Then  come  the  cervical  spinal  nerves. 

It  is  full  of  interest  to  note  that  the  area  of  distribution  of  toxic 
skin — staining  corresponds  with  the  area  of  the  distribution  of  osteo- 
arthritis. But  I have  already  explained  elsewhere  why  this  should 
be  so.*  The  toxines  which  induce  abnormal  pigmentation  also  have 
the  property  of  causing  rheumatic  gout. 

The  xanthoma  of  septic  goitre,  of  glycosuria  septica,  and  of  puru- 

* See  pp.  19  et  seq.  of  Septic  Intoxication,  published  by  F.  A.  Davis  & Co.,  1231 
Filbert  Street,  Philadelphia. 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  INVASION.  505 

lent  infection  of  the  adrenals  (Addison’s  bronzing),  are  familiar  ex- 
amples of  the  chromatic  changes  induced  by  chronic  saprsemia. 

A form  of  ptomaine  pigmentation  has  been  recorded  by  Dr.  John 
Macpherson,*  of  Stirling  Asylum,  at  Larbert,  N.  R,  in  an  article 
entitled  “ Intestinal  Disinfection,”  where  he  found  that  by  destroying 
the  toxines  of  the  primse  vise  in  lunatics  by  means  of  Naphthalin  he 
could  relieve  insomnia  and  remove  the  morbid  pigmentation  of  the 
skin  which  occurs  in  cases  of  melancholia.  The  relief  given  by 
Macpherson  to  his  sleepless  maniacs,  by  rendering  their  intestinal 
canal  aseptic,  brings  us  naturally  to  the  consideration  of  the  influence 
of  sepsis  on 

Sleep. — It  must  not  be  taken  that  the  absorption  of  septic  master 
is  always  an  evil.  We  see  certain  persons  who  are  always  absorbing 
septic  matter  from  dirty  teeth  or  from  neglected  genito  urinary  catarrh, 
and  who  yet  enjoy  most  vigorous  health.  This  apparent  contradiction 
is  explained  in  the  following  way : 

1.  Degraded  tissue-material,  in  minute  doses,  forms  one  of  the 
normal  stimuli  of  the  heart;  witness,  for  example,  the  exhilaration 
which  follows  exercise. 

2.  Larger  doses  over-stimulate  the  heart — athletic  sleeplessness. 

3.  Over-doses  cause  profound  sopor — toxic  coma  of  extreme  fatigue, 
of  uraemia,  and  of  puerperal  septicaemia. 

Sleep  is  also  secondarily  disturbed  by  the  distressing  itching  of  the 
dermatitis  septica,  which  we  call  “ nettle-rash.”  Apis  and  Sulphur 
relieve  this.  I have  sometimes  stopped  it  completely  by  giving  a 
very  hot  bath,' followed  by  painting  over  the  affected  part;  after 
patting,  not  rubbing,  the  patient  dry,  the  following  solution  : 


Cocaine  mnr.,  . . . . . . . . . . gr.  2. 

Chloral  hydrat., gj. 

Glycerine, 3j. 


Camphor,  instead  of  Cocaine,  and  sometimes  Sal  ammoniac,  will 
give  relief. 

The  smarting  may  be  stopped  by 

Ichthvol, . . . gr.  20, 

Collodion  flexile,  .........  ^j. 

Applied  pure  three  times  a day. 


* Journal  of  Mental  Science , January,  1893,  London,  England. 


506 


world’s  homoeopathic  congress. 


The  Skill. — Disregarding  the  rarer  and  more  recondite  results 
of  saprxmia,  we  will  glance  quickly  at  the  ordinary  superficial 
phenomena  of  passive  poisoning  by  purulent  products  in  a female 
patient. 

As  the  subject  of  chronic  septic  absorption  enters  the  room,  we  are 
struck  by  her  death-like  pallor.  There  are  exceptions.  Some  women 
become  sal  low,, some  bronzed,  so  as  to  resemble  a case  of  Addison’s  dis- 
ease,* or  one  of  the  other  disorders  connected  usually  with  xanthe- 
lasma. Others  present  discrete  spots  of  melanosis,  the  favorite  sites 
being,  as  we  have  seen,  the  forearm  and  the  face. 

I have  already  noted  multiple  symmetrical  petechige  on  the  cheeks 
of  the  aged,  which  have  disappeared  on  removing  rotten  teeth.  Pur- 
pura has  been  caused  experimentally  by  injecting  toxines  into  the 
circulation.  Scorbutic  petechise  are  possibly  of  this  nature.  There 
are  grounds,  too,  for  looking  upon  general  haemorrhagic  purpura  as 
septic  in  origin.  Acne  rosacea  will  follow  pyorrhoea  alveolaris,  and 
vaginal  xanthorrhoea  is  often  associated  with  pustules  on  the  chin  (acne 
menti).  The  rose  spots  on  the  abdomen  of  an  enteric  patient  are 
probably  of  the  same  nature.  It  will  be  remembered  that  they  do 
not  appear  during  the  first  week  of  the  disease;  in  other  words,  till 
there  is  time  for  the  establishment  of  necrosis  in  the  neighborhood  of 
Peyer’s  patches. 

Raimondi  found  the  same  atrophy  and  degeneration  of  the  bone 
marrow  in  saturninecases  as  appears  to  occur  from  septic  causes  in  the 
course  of  male  urethritis. 

A profound  and  inexplicable  hydrsemiaf  should  always  arouse  our 
suspicions  of  septic  intoxication  or  of  lead  poisoning. 

In  old  cases  of  septic  invasion  the  corner  of  the  mouth  is  prone  to 
show  a fissure.  This  cracking  of  the  lip  commissure  appears  preferen- 
tially on  the  side  of  habitual  decubitus.  It  is  not  quite  so  insignificant 
a matter  as  might  at  first  blush  be  thought,  for  the  act  of  opening  the 
mouth  becomes  so  painful  that  the  patient  would  cease  to  eat  unless 
the  corner  were  protected.  A strip  of  adhesive  plaster  serves  suffi- 
ciently well  for  this  purpose.  I have  in  these  cases  tested  the  saliva 
both  before  and  after  food.  I have  found  it  acid  even  when  escaping 
from  the  salivary  duct,  antecedent  to  its  admixture  with  the  mucus  of 

* Addison’s,  Drummond’s,  and  Nothnagel’s  diseases  are  all  probably  septic. 

f Compare  with  recent  observations  by  Dr.  Archibald  Garrod  on  the  blood  changes 
of  rheumatism. 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  INVASION.  507 


the  mouth.  It  is  possible  that  the  mere  subalkalinity  of  the  blood 
which  passes  through  the  cortex*  may  induce  various  neuro-psychotic 
phenomena,  as  ill-temper,  headache,  despondency,  chorea,  or  epilepsy. 
We  know  that  the  last  of  these  is  iniluenced  by  the  various  salts  of  So- 
dium and  Potassium.  This  property,  possessed  by  the  alkalies,  of 
modifying  some  nerve  storms,  may  depend  on  mere  chemical  action 
rather  than  on  any  specific  relation  to  the  pathological  condition. 
The  advent  of  the  epileptiform  convulsion  is  aided,  doubtless,  by  the 
contracted  state  of  the  cerebral  arterioles. 

We  have  been  accustomed  to  view  puerperal  convulsions  as  in 
part  saprsemic,  but  chronic  idiopathic  epilepsy,  not  unusual  as  a 
result  of  lead  poisoning,  is  not  ordinarily  recognized  as  a septic 
symptom.  Professor  Wood,  of  Michigan  University,  has  narrated 
the  particulars  of  a case,  and  1 have  myself  placed  two  on  record. f 
One  showed  petit  malf  associated  with  depravity,  the  other  genuine 
epilepsy. 

Recurrent  nettle-rash,  as  well  as  lichen  urticatus,  especially  the 
post-partum  form,  should  lead  us  to  search  for  septic  intoxication, 
and  to  take  immediate  steps  for  its  remedy. 

Hyperidrosis  of  the  hands,  the  feet  and  the  axillae  is  by  no  means 
uncommon  in  sepsis.  Compare  this  with  the  localized  sweats  ob- 
served by  Dr.  Kent  Spender  in  the  course  of  osteo-arthritis. 

Drs.  Ord  and  Spender  have  also  pointed  out  various  sensory  per- 
versions as  occurring  in  the  course  of  rheumatic  gout,  itself  often 
septic  in  origin.  Such  are  lightning  pains  of  the  lower  extremity, 
a sense  of  tearing  up  of  the  skin,  spots  of  anaesthesia  and  of  hyper- 
aesthesia.  These  are  common  in  septic  cases.  They  serve  to  show 
that  rheumatic  gout  is  not  merely  a disease  of  the  joints.J  Rheu- 
matic tremors  point  in  the  same  direction. 

The  temperature  of  the  extremities  rises  during  the  chondritic 
stage  of  rheumatic  gout.  This  increase  in  surface  warmth  is  often 
diffused  in  the  neighborhood  of  an  articulation;  it  is  not  confined  to 
the  point  of  incidence  of  the  arthropathy.  Afterwards  the  limbs  are 
prone  to  be  purple  and  chilled.  The  arterial  tension  § is  heightened 

* Compare  observations  of  Hnghlings  Jackson. 

t Septic  Intoxication , pp.  52,  53.  Jb\  A.  Davis  & Co.,  Philadelphia,  1892. 

J Compare  with  Charcot’s  disease  and  with  tabes. 

\ On  September  6th  the  right  radial  of  a gentlemen,  aged  72,  recorded  9 ounces 
whilst  sitting  down.  Late  in  September  he  contracted  a sharp  attack  of  urethritis, 


508 


world’s  homceopathic  congress. 


at  first  by  septine  and  is  followed  by  increased  vigor  of  ventricular 
contraction.  But  there  is  a later  stage  in  septic  invasion,  where  the 
systole  is  defective  even  to  the  extent  of  developing  anginous  symp- 
toms, as  I have  more  than  once  witnessed. 

Mental  solicitude  and  gloom  are  nearly  always  present  in  septic 
patients.  The  memory  is  sometimes  seriously  impaired  during  or 
after  sepsis — as,  for  example,  from  enteric  fever  and  diphtheria. 

The  Digestive  Tract. — The  septic  tongue  is  peculiar,  the  type  of 
acute  sepsis  being  the  enteric  tongue ; in  chronic  cases  it  maybe 
coated,  sometimes  preternaturally  clean,  with  raised,  irritable  pa- 
pillae. Sometimes  very  thin  at  the  edge,  often  oedematous — showing 
the  marks  of  the  teeth. 

In  acute  sepsis,  as  after  diphtheria,  we  may  have  pharyngeal  pa- 
ralysis; in  acute  saturnism,  we  get  spasm  of  the  pharyngeal  con- 
strictors. Both  are  prone  to  be  followed,  at  a later  stage,  by  inco- 
ordination of  the  muscles  concerned  in  the  swallowing. 

Loss  of  appetite,  resulting  in  emaciation,  is  common  in  both  these 
poisonings. 

I have  seen  three  cases  of  recurrent  gastralgia — of  six  weeks’, 
three  years’,  and  ten  years’  duration  respectively — disappear  on  re- 
moving pus  deposits.  We  have  seen  that  Sepsin  appears  to  possess 
the  property  of  causing  pain,  called  “ gastralgia,”  in  the  terminal 
twigs  of  the  anterior  or  ventral  branches  of  the  fourth,  fifth  and 
sixth  dorsal  nerves. 

Drs.  Pearson  Irvine  and  Wm.  Pasteur  have  shown  that  death 
from  diphtheria,  especially  in  boys,  may  come  from  paralyzed  phre- 
nic. This  is  confirmed  by  Suckling,  of  Birmingham.  It  is  inter- 
esting as  showing  another  point  of  contact  between  septic  toxis  and 
lead  poisoning ; for  phrenic  palsy  occasionally  closes  the  scene  in 
acute  lead  poisoning. 

One  of  the  last  results  of  old-established  septic  intoxication  is 


and  the  tension  rose  to  10  ounces.  A man  of  36,  with  acute  urethritis,  showed  10 
and  8 ounces  in  right  and  left  radials.  Out  of  36  patients  suffering  from  various 
slight  disorders,  32  had  differing  radials.  In  26  the  right  was  the  more  vigorous  ; a 
greater  disproportion  was  observed  in  women,  whose  tension  rules  much  higher  than 
that  of  men.  Six  persons,  including  both  sexes,  had  the  left  higher.  Four  only 
were  symmetrical.  16  ounces  right,  12  left,  was  recorded  in  septic  goitre,  with 
chondritis,  eczema  and  severe  varicosis,  associated  with  suppurating  endometritis, 
in  a woman  of  51,  wife  of  a seafaring  man.  The  observations  were  taken  by  means 
of  Dr.  Rayner  Batten’s  manometer. 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  INVASION.  509 


hepatic  disease  of  lardaceous  type.  In  these  cases  the  liver  ceases 
to  seize  upon  and  change  the  various  degenerative  gastro-intestinal 
products,  which  now  enter  the  general  circulation  and  prove  most 
pernicious,  especially  to  the  nerve  centres. 

The  Eye. — The  eye-symptoms  of  sepsin  present  a superficial 
resemblance  to  those  of  lead,  but  there  is  a deep-seated  difference. 

The  septic  affections  of  the  oculo-motor  apparatus  generally  are 
familiar  to  us  after  diphtheria.  There  are  good  grounds  for  sus- 
pecting the  existence  of  a septic  glaucoma.  Dr.  John  Brown,  of 
Bacup,  Lancashire,  England,  in  his  graduation  thesis,  dated  1889, 
recorded  a case  of  acute  glaucoma,  which,  though  the  eye-symptoms 
came  on  in  the  course  of  plumbism,  may  be  viewed  as  saturnine ; 
for  it  occurred  in  a woman  fourteen  days  after  her  confinement,  so 
it  probably  had  septic  elements  in  it.  Mr.  Lennox  Brownie,  in  his 
work  on  diseases  of  the  upper  respiratory  tract,  gives  details  of  a very 
remarkable  case  of  septic  glaucoma.  Mr.  Browne  quotes  also  some 
American  observations  on  the  same  subject. 

Sepsin  is  very  prone  to  produce  supraorbital  pain,  sometimes  sym- 
metrical, more  frequently  sinistral,  rarely  on  the  right  side.  The 
lead  headache,  when  lateral,  is  on  the  right  side.  The  actual  re- 
corded relation  is  7 to  3.  Asthenopia  is  common  to  both  lead  and 
sepsin.  The  defective  vision  of  sepsin  is  usually  an  accommodation 
error  of  temporary  character,  but  persistent  blindness  from  optic 
atrophy  has  more  than  once  followed  poisoning  by  lead.  It  is  cu- 
rious that  sepsin  appears  to  pick  out  the  nervous  and  muscular 
structures  and  choroidal  coat.  Lead  first  attacks  the  vessels  (hyper- 
trophic peri-arteritis)  of  the  retina.  This  has  been  verified  by  John 
Couper.  The  observations  of  Dr.  Rayner  D.  Batten*  make  it  likely 
that  septic  saturation  may  intensify  myopia.  I once  saw  capsular 
cataract  with  descematitis  supervene  in  a man  of  forty,  on  ulceration 
of  the  gums,  probably  of  specific  character.  Mr.  Juler,  of  St.  Mary’s, 
tells  me  that  he,  too,  has  seen  cataract  co-existing  with  intra-oral 
suppuration. 

The  Ear. — Ten  persons  poisoned  by  lead  had  tinnitus  aurium, 
which  is  a common  symptom  of  saprsemia. 

An  aching  myalgia  is  very  typical  of  septic  poisoning  combined 
with  the  “ fidgets”  (ansemia  of  anterior  cornua),  reminding  us  of 


* Ophthalmic  Review , January,  1892. 


510 


world’s  homceopathic  com gr ess. 


saturnine  muscle-ache  and  of  the  actions  of  certain  vegetable  poisons, 
such  as  Actsea  racemosa,  of  Arnica,  Eupatoria,  Baptisia,  and  Rhus 
toxicodendron. 

We  have  seen  that  gastralgia  of  persistent  type  may  arise  from 
passive  septic  invasion.  There  is  little  doubt  that  many  of  these 
cases  are  associated  with  unsuspected  gastric  ulcer. 

I shall  seek  in  another  place,  and  at  another  time,  to  show  that 
there  is  a form  of  gastric  ulcer  related  to  Charcot’s  perforating  ulcer 
and  to  chronic  scrofulous  sinus.  It  is  a kind  of  circumscribed  caries 
of  the  stomach  analogous  to  dystrophic  dental  decay.  It  is  a local 
necrosis  of  neurotic  origin. 

The  Thyroid  Gland. — I have,  in  my  work  on  Septic  Intoxication. 
placed  on  record  some  curious  examples  of  paludal  and  septic  goitre. 
I say,  in  deference  to  ordinary  modes  of  speech,  “ paludal  ” and 
“septic,”  though  in  reality  these  are  identical.  It  may  be  supposed 
that  marsh  miasmata  consist  of  the  products  of  decaying  vegetable 
matter  only.  But  a little  thought  will  remind  us  that  there  is  no 
swamp  which  does  not  teem  with  myriads  of  minute,  short-lived 
animal  organisms.  These  perpetually  perish  and  become  putrescent* 
Their  toxines  mingle  with  the  products  of  decomposing  vegetable 
life.  Miasmatic  invasion  and  septic  invasion  are  then  one  and  the 
same  thing.  The  clinical  history  of  the  symptoms  closely  coincide, 
and  the  same  germicidal  remedies  benefit  both.  We  have  in  ague  a 
paralysis  of  the  sympathetic  with  the  natural  circulation  changes  and 
the  same  arrest  of  hsematopoiesis  as  in  passive  septicaemia.  The  stress 
of  ague  may  fall  in  women  with  its  greatest  impulse  on  the  nervous 
system  ; in  men,  on  the  articulo-muscular  apparatus. 

The  influence  of  the  miasmatic  poisons  may  forsake  the  general 
nervous  system  and  confine  its  effects  to  the  floor  of  the  fourth  ven- 
tricle, and  thus  lead  to  goitre.  In  the  same  way,  some  persons  ex- 
posed persistently  to  ordinary  toxines  will,  instead  of  rheumatism  or 
neuralgia,  show  a bronchocele  with  or  without  proptosis. 

Discussion. 

M.  O.  Terry,  M.D. : The  paper  which  we  have  just  heard  is  one 
deserving  of  our  serious  consideration.  Its  clinical  aspect  makes  it 
exceedingly  practical  and  causes  us  to  wander  into  other  fields  in 
line  with  the  subtle  invasion  of  sepsis  of  various  forms.  Many  years 
ago  I noted  the  fact  that  a mother  lost  her  life  by  kissing  her  son, 


SOME  OF  THE  CLINICAL  ASPECTS  OF  SEPTIC  INVASION.  511 


who  had  died  of  a malignant  diphtheria.  It  has  frequently  come  to 
my  notice  that  syphilitic  sores  have  been  contracted  in  kissing.  Rec- 
ognizing the  fact  that  there  are  many  diseases  septic  in  character 
which  may  be  communicated  from  person  to  person,  I took  the  posi- 
tion in  a public  address,  delivered  five  years  ago,  in  which  I criti- 
cized the  manner  of  administering  communion  service  as  given  by 
all  churches  excepting,  I believe,  the  Roman  Catholic.  I have  re- 
cently noticed  that  this  subject  has  been  under  serious  consideration 
by  the  Secretary  of  the  State  Board  of  Health  of  Ohio.  Only  a few 
months  since,  I had  a very  peculiar  case  of  septic  invasion.  I had 
a case  of  hysterectomy  nearly  well.  In  fact,  the  patient  was  sitting 
up.  The  abdominal  cicatrix  was  nearly  healed.  All  of  a sudden, 
to  my  surprise,  one  day  1 found  my  patient  having  a temperature  of 
105°.  As  she  had  been  given  vaginal  douches,  I became  suspicious 
at  once  that  septic  material  had  been  introduced  in  this  way.  I 
found  that  I had  good  reason  for  my  suspicion,  that  the  douche  tube 
had  been  used  on  other  cases,  and  that  simply  carbolic  acid  had  been 
used  for  cleansing  it.  Carbolic  acid  has  its  sphere  of  usefulness,  but 
is  hardly  adequate  as  an  antiseptic  to  destroy  certain  septic  germs. 
I had  an  opportunity  of  proving  that  a few  years  ago,  when  I poi- 
soned two  of  my  fingers.  I tried  a crystal  solution  of  carbolic  acid 
on  one  and  a strong  solution  of  nitrate  of  silver  on  the  other,  but 
still  my  fingers  continued  to  suppurate.  I was  speedily  relieved, 
however,  by  a solution  of  bromine  (1  to  100),  one  of  the  most  won- 
derful remedies  we  have  in  the  Materia  Medica  for  poisonous  wounds 
of  all  sorts.  We  have  a sample  of  septic  invasion  in  that  plain, 
everyday  boil,  when  it  becomes  a grandfather  in  its  carbuncular  state, 
the  pus  cell  insinuating  itself  into  the  surrounding  connective  tissue, 
or  when  it  is  carried  by  the  lymphatics  to  other  parts  forming  focal 
centres  for  septic  invasion,  which  begins  as  a small  boil,  developing 
frequently  into  a carbuncle.  The  practitioner  of  to-day,  if  enabled 
to  carry  out  his  instructions  in  a case  of  diphtheria,  no  longer  fears 
what  was  once  an  expected  direful  result  in  his  case,  for  scientific 
medicine  has  shown  that  a thorough  and  constant  disinfectant,  ap- 
plied to  the  throat  night  and  day  so  completely  as  to  thoroughly  re- 
move every  vestige  of  odor  will  prevent  the  septicemic  and  destruc- 
tive invasion  of  ptomanic  poison.  We  believe  the  paper  of  Dr. 
Blake  will  be  suggestive  for  many  more  causes  of  septic  invasion,  a 
few  of  which  I have  mentioned  being  samples  of  the  numerous 
causes  which,  if  remaining  unnoticed,  cause  the  death  of  many  a pa- 
tient. 


512 


world’s  homoeopathic  congress. 


THE  RELATION  OF  SURGERY  TO  GYNAECOLOGY. 

By  Charles  E.  Walton,  M.D.,  Cincinnati,  O. 


Some  years  ago  there  appeared  in  Madison  Square,  New  York 
City,  a colossal  hand ; neither  its  functions  nor  relationship  was 
readily  discerned.  It  projected  above  the  greensward  as  though 
some  mighty  Titan  had  been  poorly  buried,  or  as  though  some  myth- 
ical creature  were  again  emerging  from  the  dreamless  sleep  of  an 
ancient  sepulture.  Though  bared  to  the  wrist  only,  it  towered  high 
above  the  head  of  the  observer  who  gazed  with  awesome  curiosity 
upon  this  emblem  of  marvellous  skill  and  power  and  wondered  at 
its  significance.  It  was  the  hand  of  Bartholdi’s  Goddess,  destined 
to  light  a universe. 

Years  passed,  and  across  the  water  the  body  of  this  famous  god- 
dess was  assuming  form  under  the  deft  direction  of  its  originator. 
When  the  hand  was  next  seen  it  had  abandoned  its  long  divorcement 
and  appeared  as  the  crowning  glory  of  the  statue,  piercing  the  blue 
ether  far  above  its  Parisian  surroundings,  and  ready  to  again  cross 
the  ocean,  leading  the  fair  goddess  to  her  permanent  home,  where 
she  should  stand  beneath  the  effulgence  of  its  radiant  torch.  There 
she  stands  to  day,  personifying  “ Liberty  enlightening  the  world.” 

The  relation  of  surgery  to  gynaecology  is  not  unlike  that  of  the 
torch-bearing  hand  to  the  goddess  of  Bartholdi,  which  symbolizes 
the  upward  and  onward  progress  of  art,  and  illuminates  not  only 
itself,  but  also  all  that  comes  within  its  influence.  So  surgery  sym- 
bolizes the  growth  of  medical  art,  illumines  the  entire  gynaecological 
structure,  and  throws  its  light  upon  the  whole  world  of  medical 
science. 

What  has  surgery  done  and  what  is  it  doing  to  merit  so  great  an 
encomium?  It  has  turned,  and  is  turning,  doubt  into  certainty, 
ignorance  into  knowledge,  insecurity  into  safety. 

Gynaecology  was  but  a stumbling  and  a halting  child  before  the 
strong  hand  of  surgery  led  its  wavering  footsteps  firmly  by  the  pit- 


THE  RELATION  OF  SURGERY  TO  GYNAECOLOGY. 


513 


falls  of  uncertainty  and  developed  its  unsteady  gait  into  the  sturdy 
pace  of  athletic  progress. 

For  the  purposes  of  this  paper  we  take  gynaecology  to  mean  that 
branch  of  medical  science  which  pertains  to  the  anatomy  and  physi- 
ology of  the  special  organs  of  generation  and  their  immediate  sur- 
roundings— the  aetiology,  pathology  and  management  of  their  dis- 
eases. As  the  management  of  gynaecological  cases  must  be  either 
surgical  or  non-surgical,  we  take  the  term  surgery  to  mean  that  sci- 
ence which  develops  the  principle  of  mechanical  and  operative  pro- 
cedures for  the  relief  of  any  disease  and  determines  the  principles  of 
their  application. 

It  is  not  the  intention  to  institute  invidious  comparisons  between 
operative  and  non-operative  methods  of  treatment;  for  they  are  so 
intimately  joined,  and  their  objects  so  identical,  that  they  must  ever 
be  considered  as  forming  a union  whose  unity  of  purpose  is  its 
strongest  bond,  but  still  it  may  not  be  unprofitable  to  pass  in  review 
the  achievements  of  surgery  which  have  brought  fame  to  gynae- 
cology. 

The  progress  of  gynaecology  during  the  last  twenty-five  years  is 
marvellous,  but  rendered  so  by  the  triumphant  march  of  surgery,, 
which,  like  a veritable  Moses  has  led  and  is  still  leading  the  gynae- 
cological hosts  up  out  of  the  wilderness  of  crudity.  The  scalpel  in 
living  tissue  is  the  open  sesame  which  unlocks  both  pathological  and 
functional  mysteries  and  brings  nearer  to  our  grasp  the  very  secret 
of  life' itself! 

Before  passing  to  the  consideration  of  specific  performance  let  us 
emphasize  the  fact  that  in  antisepsis,  or  the  more  refined  asepsis,  we 
have  the  foundation  for  the  brilliant  surgical  exploits  of  which  we 
are  so  justly  proud.  The  renown  of  surgery  no  longer  depends 
upon  the  glamour  of  exceptional  success,  but  upon  that  uniformity 
of  result  which  must  ever  follow  the  recognition  and  application  of 
universal  principles.  Primitive  surgery  and  modern  surgery  do  not 
differ  alone  in  the  application  of  the  principles  of  antisepsis,  but  in 
the  development  of  principles  which  govern  the  process  of  repair 
and  the  recognition  of  pathological  methods  and  new  insight  into 
physiological  function.  Primitive  surgery  was,  of  necessity,  external 
surgery  and  experimental.  The  auto-amputation  of  extremities  led 
to  initiative  surgical  procedure.  Modern  surgery,  and  especially 
gynecian  surgery,  is  internal  surgery  and  demonstrative,,  and  marks 

33 


514 


world’s  homoeopathic  congress. 


the  highest  degree  of  adaptation  of  principles  deduced  from  external 
work.  The  so-called  citadels  of  life  are  no  longer  defended  against 
operative  attack,  yet  here,  as  in  primitive  surgery,  we  work  upon  the 
periphery. 

Accidental  surgery  has  been  the  precursor  of  deliberative  imita- 
tion, the  tamping-rod  emphasized  the  use  of  the  trephine,  and  the 
ripping  horn  of  the  infuriated  animal,  whilst  it  led  us  to  fear  the 
bull  more,  has  certainly  caused  us  to  dread  the  peritoneum  less. 
Two  cavities  were  thus  opened  whose  viscera  are  now  daily  attacked 
by  the  knight  of  the  bistoury. 

Primitive  abdominal  surgery  was  first  confined  to  the  repair  of 
accidental  injuries.  When  the  intestines  protruded  through  a wound 
in  the  abdominal  wall,  the  prudent  surgeon  cleansed  the  bowels  and 
replaced  them,  sewed  up  the  rent,  and  gave  his  patient  rest ; a rest 
which  was  not  always  the  one  which  knows  no  waking.  When  the 
intestines  were  wounded,  however,  long  and  patient  study  was  re- 
quired before  modern  surgery  evolved  the  rule  which  not  only  jus- 
tifies but  commands  the  immediate  laparotomy  which  furnishes 
exact  scrutiny  of  the  parts  injured,  and  an  opportunity  for  the  ap- 
plication of  exact  operative  methods.  In  this,  gynaecology  has  been 
the  gainer.  The  operative  problems  which  have  been  presented  to 
the  gynaecologist,  have,  many  times,  been  solved  in  advance  through 
the  development  of  surgical  truths  and  principles  which  are  found 
to  be  the  most  valuable  when  the  most  general  in  their  application. 
When  the  harassed  gynaecologist  of  the  non-operative  type  has  ex- 
hausted all  the  resources  of  mechanical  and  medicinal  methods  in 
the  vain  endeavor  to  restore  a retroverted  uterus,  and  asks  of  surgery 
for  assistance,  the  answer  comes  unhesitatingly — open  the  abdomen, 
release  the  adhesions,  and  anchor  the  uterus  to  the  abdominal  wall ; 
or,  after  the  method  of  the  A lguie- Alexander- Adams  operation,  take 
a reef  in  the  round  ligaments. 

Are  the  ovaries  and  tubes  caught  within  the  octopus  grasp  of  a 
pelvic  inflammation,  and  deprived  of  their  liberty  of  action,  the  ap- 
pendages are  removed,  and  the  patient  relieved  at  least  of  one  great 
source  of  irritation  or  nerve  waste.  Do  they  develop  a cyst  whose 
ever  increasing  pressure  not  only  imperils  the  comfort  but  the  very 
life  of  the  patient ; surgery  leads  the  gynecologist  to  remove  the 
cyst  as  soon  as  discovered,  and  not  to  still  further  jeopardize  the  pa- 
tient by  inane  assaults  of  the  aspirating  needle  ! Does  a persistent 


THE  RELATION  OF  SURGERY  TO  GYNAECOLOGY. 


515 


intra-metritic  haemorrhage  drain  the  vitality  and  resist  the  “ indi- 
cated remedy/7  surgery  curettes  that  uterus,  clearing  it  of  placental 
debris  or  granular  proliferations;  the  devastating  current  is  stayed 
and  damage  soon  repaired. 

Has  a cervix  or  perinaeum  yielded  to  the  force  of  a parturient 
assault,  surgery  restores  their  autonomy ; saving  the  patient  on  the 
one  hand  from  a cancer-breeding  nidus,  and  on  the  other  hand  from 
a displacement-courting  impairment. 

Do  fistulae  deflect  the  natural  course  of  rectal  and  bladder  contents, 
the  surgeon’s,  skill  repairs  the  openings  and  the  excretory  channels 
resume  their  normal  functions.  Does  vesical  wall  or  rectal  pouch 
encroach  on  vaginal  space,  the  surgeon,  with  the  skill  of  a modiste, 
takes  a tuck  in  the  tedundant  tissue  and  each  viscus  is  restored. 

Does  the  sturdy  gonnococcus,  ambitious  to  conquer  new  territory, 
invade  the  secluded  precincts  of  the  Fallopian  tube,  and  there  mul- 
tiply and  replenish  its  pus  until  the  confines  of  its  operations  swell  to 
dangerous  proportions,  surgery  again  rescues  the  patient,  and  puts 
those  tubes  where  the  coccus  must  cease  from  troubling,  and  men- 
struation takes  a rest. 

Does  the  erratic  myoma  explore  peritoneal  space,  or,  seek  the  outer 
world  through  polypoid  transmigration,  or,  stay  at  home  and  enjoy 
its  intra-mural  development,  it  falls  a prey  to  the  surgical  poacher, 
who  does  not  hesitate  to  remove,  not  only  the  game,  but  the  very 
preserves  in  which  it  abounds. 

Does  that  great  enemy  of  womankind,  the  cancer,  attack  with  all 
its  malignity  the  primitive  home  of  foetal  nativity,  and  seek  to  over- 
throw with  inevitable  encroachment  the  temple  dedicated  to  the 
cause  of  maternity,  the  alert  gynaecologist  knows  that  the  only  hope 
of  rescue  lies  in  a total  surgical  ablation.  Medicine  has  not  yet 
furnished  the  remedy,  and  surgery,  at  best,  furnishes  only  a possible 
reprieve. 

Does  pelvic  inflammation  run  riot  in  the  delicate  tissues  which 
form  the  uterine  surroundings,  and,  by  the  violence  of  its  assault, 
melt  all  before  it  in  the  fury  of  a purulent  conflagration,  the  early 
relief  of  the  surgeon’s  knife  furnishes  the  speediest  means  of  staying 
its  ravages,  and  supplements,  with  potent  co-operation,  all  therapeu- 
tic endeavor. 

Does  pain,  with  continuous  grasp,  wring  from  the  chronic  sufferer 
the  imperative  cry  for  help,  and  surgery,  with  deft  skill,  remove  the 


516 


world’s  homoeopathic  congress. 


innocent  appendages  and  leave  the  pain  behind,  gynaecology  has 
even  then  been  a gainer,  and  diagnostic  acumen  receives  a new 
impetus  and  finds  in  the  uterine  cavity  the  hitherto  unsuspected 
pathology. 

Does  gynecian  physiology  look  to  the  ovaries  for  the  explanation 
of  menstrual  phenomena,  and  call  upon  surgery  to  remove  them,  in 
the  vain  hope  of  preventing  the  periodic  flux,  it  finds  that  the  un- 
sacrificed tubes  have  a function  which  has  certainly  been  overlooked. 

Does  the  wily  tumor,  with  almost  sentient  perverseness,  defy  diag- 
nostic skill,  the  scalpel  lets  in  the  search-light  of  observation,  and 
the  wandering  kidney,  the  cystic  kidney,  the  hydro-nephritic  cyst, 
the  renal  calculus,  the  mesenteric  sarcoma,  the  tubercular  agglutina- 
tion, the  lithopedion,  the  stay-liver,  the  malarial  spleen,  the  pancre- 
atic cancer,  are  all  revealed,  and  a prognostic  prediction  saved  from 
a diagnostic  defeat. 

Does  the  question  arise  whether  ovarian  autonomy  depends  upon 
uterine  persistence,  the  hysterectomy  determines  that  ovarian  life  is 
a separate  life,  and  exists  just  as  certainly  as  the  human  face  after  the 
mirror  which  reflected  it  is  shattered. 

Does  a tuberculous  peritonitis  invade  the  abdominal  cavity,  thick- 
ening the  delicate  lining  of  that  enormous  lymph  sac,  studding  in- 
testinal wall  and  swelling  mesenteric  glands,  surgery  gives  gynae- 
cology another  triumph,  and,  by  its  exploratory  incision,  changes  the 
whole  aspect  of  affairs — a pathological  miracle  is  wrought,  and  the 
grave  literally  robbed  of  its  victim. 

But  enough!  Why  multiply  examples?  Modern  gynaecology  is 
a splendid  structure,  but  the  hand  that  holds  the  torch  is  the  hand 
that  holds  the  knife. 

Discuss  ton. 

H.  E.  Beebe,  M.D. : The  subject  is  certainly  one  which  has  been 
well  handled,  and  I gladly  admit  my  incapacity  to  add  to  or  justly 
criticise  the  paper  of  my  friend  Dr.  Walton. 

To  any  candid  observer  it  must  be  plain  that  progress  is  stamped 
upon  the  doings  of  everything  closing  the  scenes  of  the  nineteenth 
century,  whatever  be  the  department. 

Effective  work  in  all  branches  of  science  and  art  is  the  basis  of 
success.  Specialists  are  ever  in  demand. 

Positive  specific  results  must  be  attained  to  merit  worthy  com- 
mendation. To-day  “fads”  are  short  lived;  the  twentieth  century 
is  to  be  inaugurated  with  fewer  shams.  Perfection  is  the  goal  in 
view. 


THE  RELATION  OF  SURGERY  TO  GYNECOLOGY. 


517 


Surgery  is  not  an  exception,  and  it  is  impossible  to  ignore  the 
prominence  which  gynaecological  surgery  has  everywhere  assumed. 
It  is  called  to  accomplish  what  non-surgical  agencies  have  failed  to 
do — mechanically  correct  false  physiology  and  pathology. 

Abnormalities  are  to  be  ameliorated,  and  cured,  if  possible,  and 
that  too  by  the  most  conservative  measures.  This  may  be  by  simple 
methods  or  the  most  expert  work. 

Effective  surgery  depends  upon  knowing  when  to  use  it,  skill  and 
thoroughness  in  its  performance  and  efficient  after-treatment.  Many 
surgeons  are  good  operators,  but  are  careless  in  the  subsequent  atten- 
tion. To  avoid  infecting  the  wound  is  as  important  as  brilliant 
operating. 

Surgical  diseases  of  women  are  no  small  part  of  the  gynaecolo- 
gist’s practice.  Of  morbid  growths  alone,  both  malignant  and  benign, 
affecting  the  human  race,  more  than  75  per  cent,  belong  to  the  female 
organs  of  generation  and  are  either  uterine,  ovarian  or  mammary. 

With  this  fact,  and  knowing  that  morbid  growths  are  but  a small 
part  of  the  surgical  diseases  of  women,  certainly  there  is  a broad  field 
for  surgery  in  this  specialty. 

About  one-third  of  all  physicians  claim  to  be  gynaecologists.  To 
fully  ninety-nine-hundredths  of  this  number  the  teachings  of  dis- 
eases of  women  have  not  been  thorough  and  practical.  The  average 
gynaecological  specialist  is  capable  of  doing  many  of  the  simpler 
operations  through  the  natural  passages,  but  it  is  a great  mistake  for 
amateurs  who  have  never  done  major  surgery  to  attempt  operations 
through  artificial  openings  involving  the  peritonaeum,  such  as  are 
considered  in  this  paper. 

The  surgical  novices  have  no  business  doing  this  internal  major 
surgery.  Few  gynaecologists  are  trained  abdominal  surgeons;  they 
have  not  spent  enough  time  in  the  study  of  visceral  anatomy  in  the 
dead-house,  nor  been  in  the  clinical  fields,  eye-witnesses  “ to  the 
scalpel  to  living  tissue”  by  experienced  operators.  Training  and 
experienced  observation  are  very  necessary  for  so  important  a work. 

To  depend  upon  self-experience  alone  to  learn  major  surgical 
gynaecology  at  the  patient’s  risk  is  a responsible  matter.  Abdomi- 
nal surgery  is  a specialty  within  itself,  and  needs  as  much  prepara- 
tion as  any  specialty. 

There  are  too  many  laparotomies  done  and  too  many  untrained 
operators  are  doing  them  to  the  great  detriment  of  justifiable  work. 
The  surgeon  lacks  acquired  knowledge  and  skill,  besides  the  facili- 
ties for  doing  good  work.  Seldom,  except  in  emergency,  is  lapa- 
rotomy warrantable  without  a room  thoroughly  prepared  for  it. 

Skilled  abdominal  surgeons  to-day  have  a uniform  mortality  of 
only  about  10  per  cent.,  and  a per  cent,  greater  than  this  usually 
means  incompetency. 

The  advance  made  in  this  field,  and  so  well  shown  in  the  paper, 


518 


world’s  homoeopathic  congress. 


has  been  by  experts  well  trained  in  antisepsis  and  the  anatomy, 
physiology  and  pathology  of  the  female  organs  of  generation. 

They  knew  what  to  do,  when  to  do  it,  and  how  to  do  it.  They 
knew  “ the  relation  of  surgery  to  gynaecology,”  and  that  “ the  hand 
that  holds  the  torch  is  the  hand  that  holds  the  knife.” 

Dr.  Hanchett,  of  Omaha:  I am  not  here  to  criticise  this  noble 
paper  which  has  been  read,  but  to  say  “ amen  ” most  heartily  to  it. 
I make  no  claim  to  being  a gynaecologist.  I treat  some  cases  in  my 
office,  as  all  physicians  in  general  practice  do,  but  I want  to  say  to 
every  general  practitioner  here  that  when  we  have  a case  of  operative 
surgery  in  the  line  of  gynaecology  we  should  send  it  to  a specialist. 
I have  seen  in  my  own  city,  and  many  of  the  western  cities  of  this 
country,  many  a life  lost  by  foolish  operative  surgery  on  the  part  of 
so-called  gynaecologists  who  did  not  understand  their  business. 

M.  Ayers,  M.D.,  of  Rushville,  Illinois  : I live  in  a little  country 
town,  and  we  have  a few  patients  of  the  kind  referred  to  by  the  last 
speaker.  Ninety-nine  out  of  a hundred  of  them  haven’t  got  money 
enough  to  get  out  of  town.  What  are  you  going  to  do  about  it? 
I say  do  the  work  the  best  you  can. 

Phceise  J.  B.  Waite,  M.D. : I have  enjo}7ed  the  paper  most 
heartily.  I am  frequently  in  the  habit  of  passing  down  the  bay  in 
New  York  and  observing  Liberty  enlightening  the  world — a beauti- 
ful statue,  to  be  sure — and  I admire  the  application  made  in  the 
paper.  However  much  I may  admire  surgery,  I would  make  the 
plea  for  medical  treatment  in  gynaecological  practice.  The  surgeon 
has  come  to  be  prominent  in  gynaecological  practice,  and  surgeons 
and  physicians  are  too  fond  of  using  the  knife.  I have  seen  too 
many  young  women  who  have  passed  under  the  surgeon’s  knife,  from 
whom  the  ovaries  have  been  removed,  single  women  and  married 
women,  who,  in  my  opinion,  might  have  been  spared  this  infliction, 
because  it  is  a very  great  infliction.  I have  in  mind  a beautiful 
young  wife  who  came  to  me  about  nine  months  ago  in  a very  de- 
spondent frame  of  mind,  very  much  distressed  over  a diagnosis  which 
had  been  made  in  her  case,  and  had  been  told  there  was  no  help  for 
her  except  in  the  removal  of  the  ovaries.  Said  I:  “ You  are  a 
stranger  to  me,  but  if  you  were  my  daughter  I would  as  soon  you  had 
your  head  cut  off  as  to  have  your  ovaries  removed.”  She  consented 
to  give  up  the  operation  and  placed  herself  in  my  hands.  She  had 
been  told  that  she  could  have  no  more  children,  and  she  was  very 
anxious  to  become  a mother.  I took  the  case,  and  three  months  ago 
she  came  to  me  looking  bright  and  happy,  and  informed  me  that  she 
was  three  months  pregnant.  So  much  for  taking  hold  of  a case 
medically. 

I have  also  in  my  mind  a young  unmarried  woman  who  suffered 
from  dysmenorrhoea,  and  she  passed  under  this  skilled  surgeon’s 
hands ; the  ovaries  were  removed,  and  she  did  not  get  better.  She 


THE  RELATION  OF  SURGERY  TO  GYNECOLOGY. 


519 


grew  worse,  and  to-day  she  is  hopelessly  insane.  I believe  she  might 
have  been  cured  if  the  Homoeopathic  remedies  had  been  carefully 
studied  in  her  case. 

While,  as  I say,  I have  great  respect  for  surgery,  I have  still 
greater  respect  for  medical  treatment. 

Martha  J.  Ripley,  M.D. : I wish  to  emphasize  the  remarks 
made  by  the  last  speaker.  While  agreeing  with  the  very  able  paper 
in  cases  of  dire  necessity,  I should  not  be  true  to  my  convictions  as 
a physician  and  as  a woman  if  I did  not  say  call  a halt  on  your  ope- 
rations upon  women.  It  is  high  time  that  you  did  so,  because  to-day 
many  a woman  is  being  operated  on  in  all  of  our  large  cities,  and  in 
some  of  our  small  ones,  who  needs  no  operation  at  all.  I could  re- 
call case  after  case  of  women  who  are  to-day  in  insane  asylums. 
My  dearest  friend  went  to  her  grave  a week  ago  from  an  operation 
by  a skilled  gynaecologist'  Those  operations  are  needed,  but  beware 
how  you  practice  them  upon  women  who  do  not  need  them.  Prac- 
tice and  study  your  Materia  Medica.  It  is  well  that  some  of  you 
do  live  in  small  towns  where  you  cannot  get  skilled  surgeons,  or  I 
fear  there  would  be  very  few  of  your  women  patients  left. 

Now,  I am  looking  in  the  faces  of  young  men  who  come  here  and 
listen  to  the  words  of  the  older  surgeons,  and  I recall  what  a student 
of  my  own  said.  He  came  to  me  and  said  he  was  going  to  perform 
what  I considered  quite  a difficult  operation  on  a lady.  I said  to 
him,  “Do  you  think  you  are  able  to  do  that;  are  you  skillful  enough?” 
He  said,  “Well,  I have  got  to  learn  some  time,  why  shouldn’t  I be- 
gin now?”  If  you  have  got  to  learn  upon  women,  go  where  those 
who  are  your  teachers  can  teach  you. 

You  understand  that  I believe  there  are  operations  that  are  needed, 
and  when  needed  they  should  be  promptly  done,  and  you  that  have 
patients  that  are  beyond  your  skill  send  them  to  those  that  you  think 
can  do  better;  but  I call  a halt  upon  operations  upon  women  that 
are  being  done  to-day.  Turn  to  your  own  sex  and  see  if  they  don’t 
need  it,  too. 

Alonzo  Boothby,  M.D. : I did  not  propose  to  say  anything  upon 
Dr.  Walton’s  paper,  but  it  has  been  criticized  in  such  a spirit  that  I 
feel  called  upon  to  say  a word.  I do  not  believe  that  my  brother 
Walton  intended  in  any  way  to  convey  the  idea  that  unnecessary 
and  improper  operations  should  be  made.  It  is  not  the  skilled  sur- 
geon nor  the  skilled  gynaecologist  that  operates  when  he  ought  not 
to.  It  is  in  those  cases  where  there  is  a diseased  ovary  or  a diseased 
tube  that  is  beyond  curative  measures.  You  know  it  as  well  as  I 
do.  Every  physician  that  has  ever  opened  the  abdominal  cavity 
knows  it,  and  when  you  come  to  the  statistics  there  is  not  ten  per 
cent,  of  fatalities.  I would  speak  very  modestly  for  myself,  and  say 
that  if  three  cases  that  were  operated  on  before  I came  here  shall  re- 
cover, it  will  make  102  (in  the  Homoeopathic  hospital  and  my  own 


520 


world’s  homoeopathic  congress. 


institution)  successful  cases,  and  that  includes  12  or  15  hysterecto- 
mies and  6 cases  of  appendicitis,  and  the  various  other  cases  that 
come  up.  When  we  can  do  this  and  have  these  results  it  is  entirely 
out  of  place  to  assume  that  we  are  removing  a woman’s  ovaries  when 
we  would  not  do  the  same  thing  to  a man. 

H.  W.  Roby,  M.D.,  of  Topeka  : In  all  medical  conventions  that 
I have  ever  attended  I have  heard  similar  discussions  to  this,  and  I 
believe  their  necessity  grows  out  of  the  fact  that  some  minds  are 
organized  in  one  direction  and  some  in  another.  Some  men  and 
some  women  in  the  practice  of  medicine  give  their  time  and  their 
study  and  thought  along  the  lines  of  Materia  Medica  and  therapeu- 
tics ; others,  of  surgery,  gynaecology,  and  so  on,  and  each  become 
enthusiastic  in  their  line  and  in  their  specialities,  and  very  often 
overlook  the  powers  and  capacities  of  the  other  field  of  practice. 

The  thing  that  we  need  is,  to  know  so  much  about  surgical  capa- 
city, and  medical  capacity,  and  therapeutic  capacity  that  we  shall  be 
able  to  make  a wise  and  just  discrimination,  and  use  medicines  where 
medicines  are  efficient,  and  where  they  are  inefficient  to  resort  to  that 
which  is  efficient.  I have  seen,  and  you  have  seen  many  a time,  pa- 
tients subjected  to  medical  treatment  day  after  day,  week  after  week, 
and  month  after  month,  through  long  and  weary  years,  without  re- 
sult, who,  if  they  had  been  handed  over  to  a skillful  surgeon,  a slight 
operation  might  have  set  him  on  the  pedestal  of  life  and  happiness. 
I plead  here  for  a just  discrimination  between  medical  and  surgical 
cases.  They  are  both  useful  in  their  place. 

Homoeopathy  has  a grand  field  in  which  it  may  be  successful,  but 
outside  of  that  field  there  are  other  possibilities,  other  capacities,  and 
other  powers.  If  you  have  given  time  and  attention  to  medical  prac- 
tice do  not  be  too  sure  that  that  is  all  there  is  within  our  command 
for  the  relief  of  suffering  humanity. 

The  Chairman:  If  that  is  all,  I will  call  upon  Dr.  Walton  to 
clo^e  the  debate. 

Dr.  Walton:  Consider  it  closed. 


PLASTIC  SURGERY  OF  THE  VAGINA. 


521 


PLASTIC  SURGERY  OF  THE  VAGINA. 

By  W.  E.  Green,  M.D.,  Little  Rock,  Ark. 


There  is,  probably,  no  branch  of  surgery  that  requires  more 
thought,  ingenuity,  and  operative  dexterity,  than  do  the  plastic 
operations  for  the  restoration  of  the  pelvic  structures  in  women.  A 
study  of  the  anatomy,  physiology,  natural  and  acquired  relation  of 
parts,  immediate  and  remote  effects  of  injury  and  their  reflex  influ- 
ences, is  essential  to  a correct  understanding  of  the  subject.  When 
the  pelvic  floor  is  weakened  by  a rupture  of  its  supporting  struc- 
tures, the  functions  of  all  the  pelvic  organs  are,  more  or  less,  dis- 
turbed, and,  ultimately,  the  entire  human  organism  may  become  af- 
fected. 

The  levator  ani  muscles  form  the  floor  of  the  pelvis.  They  are 
two  broad,  thin  muscles,  which  have  their  origin,  principally  from  the 
posterior  aspect  of  the  body  and  ramus  of  the  pubes  ; posteriorly, 
from  the  inner  surface  of  the  spine  of  the  ischium.  They  pass  down- 
wards, and  unite  in  the  middle  line.  The  most  posterior  fibres  are 
inserted  into  the  sides  of  the  coccygeal  apex.  The  middle  fibres, 
which  form  the  bulk  of  the  muscle,  are  inserted  into  the  side  of  the 
rectum,  blending  with  the  sphincters. 

The  transverse  perinaei  arises  from  the  inner  side  of  the  tuber- 
osity of  the  ischium  and  is  inserted  into  the  sides  of  the  sphincter 
vaginae  and  levator  ani.  These,  in  conjunction  with  other  less  im- 
portant muscles,  and  the  fasciae,  make  up  the  perineal  body.  The 
levator  ani,  which  constitutes  the  bulk  of  the  perinaeum,  supports 
the  lower  end  of  the  rectum,  the  vagina,  and  the  bladder.  A rup- 
ture of  these  parts,  such  as  often  occurs  during  labor,  disturbs  the 
muscular  equipoise  of  the  region.  The  torn  fibres  separate,  the 
transversus  perinaei  muscles,  instead  of  holding  the  central  raphe  in 
a state  of  tension,  pull  open  the  vaginal  orifice.  The  anus  is  drawn 
upwards  and  backwards,  towards  the  coccyx.  The  fascia,  having 
lost  its  attachments,  allows  the  anterior  rectal  wall  to  pouch  forward, 


522 


world’s  homoeopathic  congress. 


forming  a rectocele,  which  drags  the  vaginal  wall  downward.  The 
vaginal  muscle  which  has  its  principal  attachment  to  the  recto- 
vaginal fascia,  loses  its  tonicity,  permits  the  cervix  to  fall  forward, 
changing  the  position  of  the  uterus,  which  becomes  more  or  less 
prolapsed,  dragging  down  the  bladder,  preventing  its  entire  evacua- 
tion, which  causes  increased  relaxation  and  stretching  of  tissue,  cys- 
tocele.  The  bloodvessels  having  lost  their  support,  a general  venous 
stagnation,  with  its  consequent  engorgement  of  the  pelvic  viscera  and 
discomfort,  ensues. 

The  variety  and  complexity  of  vaginal  and  perineal  tears  is,  in- 
deed, surprising.  It  has  always  been  my  habit  to  make  a careful 
inspection  of  the  parts  after  every  confinement,  and,  I believe  that 
I have  seen  almost  every  form  that  could  be  produced.  The  orthodox 
central  lesion  is  the  most  frequent,  but  not,  by  any  means,  the  most 
injurious.  Lateral  internal  vaginal  ruptures,  that  are  often  made 
with  the  tip  of  the  blade  of  the  forcep  when  removing  it,  before 
the  head  is  born,  are  among  the  most  mischievous.  I have  seen 
these  extend  from  near  the  cervix  uteri  to  the  vaginal  orifice,  the 
outside  structures  being  intact,  and  so  deep  that  the  cellular  fat 
protruded  through  the  gap.  A superficial  observer  would  never  have 
detected  them.  An  infrequent  tear,  of  which  I have  seen  three,  is 
where  the  vaginal  outlet  is  torn  away  from  its  attachments,  being 
pushed  forward  by  the  head  ; the  mucous  membrane  gives  way  just 
within  the  orifice.  The  most  extensive  one,  extended  upward,  on 
either  side,  almost  to  the  urethra,  and  downward  to  the  sphincter  ani 
muscle,  making  a pocket-like  chasm,  in  which  the  four  fingers  of  the 
hand  could  be  inserted.  A small  central  laceration,  through  which 
the  child’s  shoulder  emerged,  existed,  yet  the  sphincter  was  not  torn. 
Another  most  significant  lesion  that  is  often  overlooked,  is  where  the 
muscular  structures  of  the  perinseum  are  torn  in  two  and  the  skin 
remains  uninjured;  these  tears  are  often  deep,  form  pockets  for  the 
retention  of  septic  matter,  do  not  unite  but  granulate,  and  form  large 
cicatrices,  and  yield  disastrous  results  to  the  pelvic  viscera.  A rare 
condition  that  I once  repaired,  was  an  oblique  laceration,  one  and 
one-half  inches  long,  that  existed  well  forward  near  the  urethra.  It 
bled  furiously,  and  was  difficult  to  close.  I have  repeatedly  seen  a 
submucous  separation  of  the  perineal  structure  where  the  mucous 
membrane  of  the  vagina  and  the  skin  on  the  outside  remained  in- 
tact. 


PLASTIC  SURGERY  OF  THE  VAGINA. 


523 


The  power  to  prevent  many  of  the  severe  disasters  to  the  general 
health  that  follow  ruptures  of  the  perinseum  and  vagina,  lies  with 
the  accoucheur.  It  is  his  imperative  duty  to  make  a critical  exam- 
ination of  the  genitalia  after  every  labor,  and  if  he  finds  any  form 
of  rupture,  it  matters  not  how  insignificant  it  may  seem  to  him,  it 
may  in  some  remote  way  produce  trouble  ; therefore,  it  should  be 
repaired  before  he  leaves  his  patient.  This  should  be  done  in  the 
most  systematic  and  painstaking  way.  If  necessary,  an  anaesthetic 
should  be  given.  The  genital  tract  and  adjacent  parts  should  be 
most  carefully  cleansed,  and  douched  with  an  antiseptic  lotion  ; the 
torn  surfaces  trimmed  of  all  ragged  and  contused  tissue,  rendering 
the  parts  even  and  clean  cut.  The  wound  should  then  be  closed  with 
two  sets  of  catgut  sutures  deep  and  superficial,  coaptating  like  struc- 
tures. Too  much  care  cannot  1$  exercised  in  doing  the  operation. 
If  properly  executed,  the  results  are  most  satisfactory,  and  failure 
will  rarely  follow. 

When  a laceration  has  been  sustained,  and  the  evil  consequences 
manifest  themselves,  the  case  then  becomes  one  for  the  surgeon’s 
consideration,  and  the  question  that  confronts  him  is,  how  can  a 
restoration  be  accomplished  ; how  can  the  over-distended  and  everted 
vaginal  tissue  be  replaced,  and  the  proper  support  given  to  the  pelvic 
viscera  and  bloodvessels  ? The  relaxed  tissue  in  front,  that  forms  a 
cystocele,  must  be  removed  ; the  separated  levator  ani  muscles  must 
be  brought  together,  the  retracted  pelvic  fascia  united  so  as  to  lift 
the  posterior  vaginal  wall  in  contact  with  the  anterior,  obliterating 
the  rectocele  and  closing  the  gaping  vulva.  When  all  this  is  suc- 
cessfully done,  the  normal  support  is  returned  to  the  pelvic  viscera 
and  bloodvessels,  the  stagnant  capillary  circulation  is  relieved,  the 
hyperplasiac  deposits  absorbed,  the  hypertrophied  organs  reduced 
and  a healthy  function  restored. 

The  operator  who  does  not  fully  appreciate  the  requirements  of 
each  case,  and  deal  with  it  according  to  its  individual  demands,  but 
simply  endeavors  to  restore  an  imaginary  perinseum — a dam-like 
obstruction  to  the  prolapsing  structures — will  meet  with  disappoint- 
ment in  almost  every  instance. 

The  time  allotted  to  read  a paper  does  not  admit  of  my  taking  up 
the  entire  list  of  plastic  operations  upon  the  vulva  and  vagina  ; 
therefore  I shall  only  attempt  to  deal  with  three,  viz.,  Removal  of 
scars,  cystocele  and  perineal  injuries. 


524 


world’s  homceopathic  congress. 


It  is  an  established  truth  with  all  close  observers  who  treat  dis- 
eases of  women,  that  cicatrices  of  the  vagina  produce  both  local  and 
reflex  irritation,  disorder  the  nervous  system,  and  thereby,  more  or 
less,  impair  the  entire  bodily  nutrition  ; and  I will  say  here,  for  the 
benefit  of  those  who  oppose  an  immediate  repair  of  vaginal  and 
perineal  lacerations,  that  it  is  bad  surgery  to  leave  any  wound  of 
those  parts,  whether  it  occurs  during  parturition  or  from  other 
causes,  to  heal  by  granulation.  For  aside  from  the  ultimate  injury 
that  the  pelvic  viscera  sustains,  these  reflex  troubles  may  arise,  and 
will  yield  to  no  treatment  excepting  the  removal  of  the  scar.  Consid- 
ering the  above  facts,  amputation  of  the  uterine  cervix  or  operations 
about  the  vagina  ought  not  to  be  performed  with  either  the  ecraseur 
or  the  galvano-cautery.  The  knife  or  the  scissors  should  be  used? 
and  the  denuded  surfaces  covered  whh  mucous  membrane. 

These  scars  of  the  vagina  demand  serious  attention  at  the  hands 
of  the  surgeon  ; they  should  be  managed  with  the  same  care  accorded 
laceration  of  the  cervix.  All  tender  or  contracting  cicatrices  should 
be  dissected  away  and  the  resulting  wound  closed  with  sutures. 
Remnants  of  a lacerated  hymen  and  thickened  and  sensitive  nym- 
phae  should  be  excised,  excrescences  about  the  meatus  clipped  away, 
adhesions  of  the  clitoris  broken  up,  and,  if  necessary,  a V-shaped 
piece  cut  from  its  hood.- 

Cystocele. — A cystocele  is  a pouching  deformity  of  the  anterior 
vaginal  wall,  caused  by  a laceration  or  an  over-distension  of  the 
structures.  It  contains  the  base  of  the  bladder,  and  is  gradually 
increased  by  the  frequent  straining  at  micturition — an  ineffectual 
effort  to  evacuate  the  urine  that  constantly  remains  therein.  The 
constant  irritation  increases  the  vascularity  and  causes  a thickening 
of  the  walls.  The  condition  is  one  that  entails  great  suffering  and 
is  often  overlooked  by  operators.  Like  other  conditions  about  the 
vagina  that  demand  repair,  many  devices — some  of  them  extremely 
complicated — have  been  instituted  for  its  correction.  Its  successful 
management  is  simple  enough  if  the  requirements  are  fully  under- 
stood. The  object  sought  is  to  change  the  convex  to  a plain  surface; 
take  all  the  slack  out  of  the  anterior  vaginal  wall,  but  not  shorten  it 
to  any  great  degree.  No  stereotyped  or  set  rules  can  be  laid  down 
to  govern  beforehand  the  amount  of  tissue  to  be  removed  or  to  des- 
ignate the  shape  of  the  denuded  surface. 

Before  beginning  any  of  the  operations  for  the  repair  of  the  vagi- 


PLASTIC  SURGERY  OF  THE  VAGINA. 


525 


nal  or  perineal  structures,  it  is  proper  to  dilate  and  curette  the  uterus, 
if  necessary,  and  repair  any  laceration  of  the  cervix  that  may  exist. 
If  the  cervix  be  badly  diseased,  as  it  often  is  in  old  subjects,  an 
amputation  is  demanded.  All  the  required  operations  may  be  done 
at  one  sitting  or  divided  into  two,  as  the  necessity  of  the  case  may 
demand.  It  has  generally  been  my  habit  to  do  the  operations  upon 
the  womb  and  anterior  vaginal  wall  first,  leaving  the  rectum  and 
perinaeum  for  a subsequent  time,  before  the  patient  leaves  her  bed. 

With  the  patient  anaesthetized  and  in  the  lithotomy  position,  with 
the  parts  in  an  aseptic  condition,  the  surgeon  takes  a sharp  tenacu- 
lum in  either  hand,  hooks  them  in  the  mucous  membrane  on  either 
side  of  the  cystocele,  and  draws  the  tissues  to  the  centre  until  all  the 
slack  has  been  taken  up.  In  this  way  he  estimates  the  amount  of 
tissue  to  be  removed,  and,  in  his  mind,  outlines  the  shape  and  extent 
of  his  incision.  It  is  often  the  case  that  a urethrocele  coexists,  when 
it  will  be  necessary  to  carry  the  dissection  well  up  to  the  meatus. 
At  times  the  broadest  area  may  be  near  the  os  uteri.  After  making 
out  the  area  to  be  denuded,  as  before  described,  the  vaginal  wall  is 
seized  in  its  central  line  by  one  or  two  pairs  of  T-forceps  which  are 
held  and  drawn  forward  by  an  assistant.  Then  with  a sharp  scalpel, 
beginning  down  at  the  os  uteri,  an  incision,  that  extends  through  the 
vaginal  muscle,  is  carried  forward  on  one  side,  along  the  line  of  elec- 
tion, to  near  the  meatus;  another  one,  in  like  manner,  is  made  on  the 
opposite  side.  Then  with  a few  strokes  of  the  knife,  the  loose  cellu- 
lar tissue  which  connects  the  vaginal  muscle  with  the  bladder  is 
divided  and  the  flap  removed.  Any  irregularity  or  unevenness  of 
surface  may  then  be  cut  away  with  a pair  of  sharp  scissors.  The 
bladder  is  then  evacuated  with  a catheter,  the  parts  irrigated  with 
hot  water,  to  control  the  oozing,  and  the  sutures  introduced.  This 
should  be  accomplished  with  medium-sized  catgut,  introduced  in 
two  rows,  deep  and  superficial.  Beginning  at  the  cervical  end  of 
the  wound,  the  needle  is  introduced  just  within  the  cut  surface,  so  as 
not  to  include  the  mucous  membrane,  and  made  to  pass  straight 
through,  across  and  emerging  in  the  opposite  side  a like  distance 
inside  the  cut  surface.  A continuous,  or  running,  stitch  is  carried 
in  this  way  up  to  the  meatus,  and  the  end  left  long.  Commencing 
at  the  same  point,  another  row  of  sutures,  that  take  a strong  hold  in 
the  mucous  membrane,  is  introduced ; the  two  ends  that  emerge  at 
the  meatus  are  tied.  This  closely  unites  the  divided  edges  of  the 


526 


world’s  homceopathic  congress. 


mucous  membrane  and  makes  a strong  seam,  and  is*  a successful 
measure.  The  posterior  vaginal  wall  is  then  treated  according  to 
the  demands  of  the  case. 

Various  changes  follow  lacerations  in  the  pelvic  floor,  depending 
upon  the  amount  of  injury  done;  therefore,  a satisfactory  manage- 
ment of  the  condition  depends  upon  a restoration  of  the  natural 
anatomical  relation  of  the  parts.  This  cannot  be  done  by  a super- 
ficial denudation  of  the  mucous  membrane.  The  mucous  membrane 
and  submucous  tissue  down  to  the  muscular  structures  must  be  dis- 
sected up  and  all  scar  tissue  removed  (scar  tissue  is  wanting  in  vas- 
cularity and  does  not  unite  well),  like  tissue  brought  together  and 
the  normal  contour  restored.  To  accomplish  this  established  opera- 
tions will  not  answer ; every  case  must  be  a law  unto  itself,  and  the 
individual  requirements  must  guide  the  surgical  procedure.  I can 
probably  give  a clear  idea  of  my  views  by  dividing  perineal  opera- 
tions into  three  classes.  1.  Where  the  tear  is  of  moderate  extent 
and  not  extending  far  up  into  the  vagina.  2.  Where  the  tear  is 
deep,  extends  well  up  into  the  vagina,  and  a resulting  rectocele 
exists.  3.  Where  the  sphincter-ani  muscle  is  involved — a complete 
laceration. 

The  operation  for  the  first  condition  is  simple  and  easy  of  execu- 
tion. The  sphincter-ani  muscle  having  been  stretched  and  the  lower 
bowel  evacuated  and  thoroughly  douched,  the  labia  is  seized  at  its 
muco-cutaneous  junction  on  either  side,  with  a pair  of  T-forceps,  just 
anterior  to  the  point  to  which  we  intend  to  carry  the  dissection. 
These  are  handed  to  an  assistant,  who  puts  the  parts  upon  the  stretch 
laterally.  One  or  two  fingers  are  then  introduced  into  the  rectum 
as  a guide,  while  a sharp  scalpel  in  the  right  hand  is  entered  flat- 
wise at  the  raphe  and  pushed  inwards  toward^ the  os  uteri,  beneath 
the  vaginal  tissue  to  the  point  that  it  is  desired  to  carry  the  dissec- 
tion, the  highest  point  of  the  tear.  With  a sawing  motion  the  flap 
is  loosened  up  on  either  side ; then,  with  the  scissors,  a pear-shaped 
piece  is  cut  out  of  the  flap.  With  a curved  needle,  threaded  with 
medium-sized  catgut,  beginning  above,  two  or  three  deep  sutures  are 
taken  at  right  angles  with  the  vaginal  axis,  the  last  one  lying  just 
inside  of  the  vaginal  outlet,  drawn  moderately  tight,  securely  tied, 
and  cut  short.  Then,  beginning  at  the  highest  point  in  the  vagina, 
a superficial  row  of  sutures  is  applied,  which  coaptates  the  mucous 
membrane  in  the  vagina  and  the  skin  on  the  outside;  the  parts 


PLASTIC  SURGERY  OF  THE  VAGINA.  527 

dusted  with  iodoform  and  a strip  of  iodoform  gauze,  for  protection 
and  drainage,  applied.  This  is  removed  at  the  expiration  of  the 
fifth  or  sixth  day,  and  a vaginal  douche  used  every  twelve  hours. 

This  gives  a most  satisfactory  result.  The  process  of  healing  is 
comparatively  free  from  pain  ; there  is  no  cutting  of  stitches,  swell- 
ing and  distortion  of  parts,  and  consequent  cicatrices  and  unevenness 
of  surface  as  in  the  older  methods,  and  if  the  operation  has  been  dex- 
terously done,  the  parts  present  an  appearance  that  is  not  distinguish- 
able from  the  natural  condition. 

When  a rectocele  exists,  the  preceding  operation  is  somewhat  modi- 
fied. The  dissection  is  carried  much  higher,  the  recto-vaginal  sep- 
tum is  divided  well  up  toward  the  uterine  cervix,  but  the  flap  is  only* 
cut  away  as  high  as  the  internal  perineal  border.  Beginning  at  the 
highest  point  at  which  the  recto-vaginal  septum  was  separated,  a 
needle,  threaded  with  a medium-sized  catgut,  is  entered  on  the  left 
side  and  made  to  penetrate  the  flap,  carried  across  the  space,  and 
brought  out  in  the  vagina  on  the  right  side;  re-entered  one-third  of 
an  inch  nearer  the  vaginal  outlet,  again  passed  across  the  space,  and 
brought  out  in  the  vagina  at  a like  distance  (one-third  of  an  inch) 
from  the  first  point  of  introduction.  One  or  two  of  these  sutures  (as 
may  be  necessary)  are  introduced,  then  tied  in  the  vagina,  bringing 
together  laterally  the  cut  surfaces,  making  a heavy  ridge  in  the  vagi- 
nal floor,  taking  up  all  the  slack  tissue.  The  outer  part  of  the 
wound,  from  which  the  flap  has  been  cut  away,  is  then  closed  as  in 
the  previous  operation.  This  procedure  not  only  eradicates  the  rec- 
tocele, but  gives  an  additional  posterior  support. 

When  complete  laceration  of  the  pmnaeum  exists,  greater  com- 
plexities follow.  The  torn  muscular  fibres  contract  and  atrophy 
from  non-use;  the  severed  ends  of  the  sphincter  muscle  separate  and 
retract ; there  is  a thinning  and  stretching  of  the  recto-vaginal  wall, 
relaxation  and  sagging  of  the  vagina,  and,  at  times,  prolapsus  of  the 
rectum.  All  these  conditions  must  be  considered  and  corrected.  The 
operative  measure  adopted  must  be  one  that  will  establish  the  nor- 
mal relation  of  the  severed  parts,  support  the  pelvic  viscera,  relieve 
the  over-distended  circulation,  and  restore  the  functional  activity  of 
the  sphincter-ani  muscle. 

From  the  many  different  methods  in  vogue  for  the  repair  of  a com- 
plete laceration,  and  from  the  fact  that  I have  known  patients  who 
have  been  operated  upon  two  or  three,  and  even  four,  times  without 


528 


world’s  homceopathic  congress. 


successful  issue,  leads  me  to  think  that  perfection  in  method  is  yet  to 
be  desired.  In  fact,  even  in  partial  ruptures,  I have  on  several  occa- 
sions been  called  upon  to  do  the  work  again  where  other  reputable 
surgeons  had  failed  in  their  efforts.  Indeed,  my  successes  in  this 
line  have  been  very  flattering.  I have  the  record  of  over  one  hun- 
dred consecutive  cases  without  a single  failure. 

For  the  restoration  of  the  perinaeum  in  complete  laceration,  I have 
devised  the  following  method,  which,  in  my  experience,  meets  all  the 
requirements  better  than  any  other.  I have  now  performed  it  many 
times  with  complete  success  in  every  instance.  The  healthy  bowel 
brought  down,  protects  the  wound  from  infection  and  obviates  the 
necessity  of  rectal  flaps  and  bringing  stitches  into  the  gut,  with  its 
attendant  dangers  of  rectal  fistula. 

First  rendering  tense  the  recto-vaginal  septum  with  two  pairs  of 
T-forceps  in  the  hands  of  assistants,  an  incision  is  carried  along  the 
line  of  junction  of  the  rectal  and  vaginal  structures,  and  then  upwards 
on  either  side  to  the  highest  point  of  the  tear,  splitting  the  recto- 
vaginal septum  and  dividing  the  skin  from  the  vaginal  mucous  mem- 
brane, after  which  an  anterior  vaginal  flap  is  dissected  up  to  the  de- 
sired extent.  The  first  step  of  the  American  operation  is  then  done, 
viz. : the  mucous  membrane  of  the  gut  is  seized  on  a line  with  the 
upper  border  of  the  internal  sphincter,  drawn  down  and  divided  all 
round  by  a circular  incision,  dissected  down  and  removed  at  the 
muco-cutaneous  junction.  The  ends  of  the  torn  sphincter  are  next 
loosened  up  and  secured  with  medium-sized  catgut,  uniting  them 
accurately.  If  there  is  much  tension  upon  the  parts,  two  or  three 
heavy  silk  approximating  ligatures  should  be  introduced,  taking  a 
good  hold  on  either  side,  as  in  an  ordinary  perineal  operation.  The 
deeper  portions  of  the  wound  are  then  brought  together  with  buried 
catgut,  so  as  to  leave  no  gaping  spaces.  The  silk  ligatures  tightened 
and  tied,  the  flap  trimmed  up  and  the  necessary  coaptating  catgut 
sutures  applied.  The  gut  is  then  grasped  with  forceps,  drawn  down, 
and  united  all  round  to  the  skin,  completing  the  American  operation. 

Discussion. 

Moses  T.  Runnels,  M.D. : Believing  that  all  gynaecologists  agree 
about  the  anatomy  of  the  vagina  and  floor  of  the  pelvis,  I need  not 
discuss  the  part  of  Dr.  Green’s  excellent  paper  relating  to  that  sub- 
ject. Nor  have  I the  time  to  review  the  different  kinds  of  lesions  of 


PLASTIC  SURGERY  OF  THE  VAGINA. 


529 


the  vagina  and  perinseum.  The  character  and  extent  of  these  lesions 
are  not  overstated  in  the  paper.  I have  seen  the  different  kinds  men- 
tioned, and  have  had  much  to  do  with  their  repair.  The  discussion 
is  limited  to  three  plastic  operations,  viz. : removal  of  scars,  cystocele 
and  perineal  injuries.  The  statement  is  made  that  it  is  bad  surgery 
to  leave  any  wound  of  the  vagina  and  perinseum,  whether  it  occurs 
during  parturition  or  from  other  causes,  to  heal  by  granulation  ; that 
it  is  the  imperative  duty  of  the  accoucheur  to  make  a critical  exami- 
nation of  the  genitalia  after  every  labor,  and  if  he  finds  any  form  of 
rupture,  it  should  be  repaired  before  he  leaves  his  patient. 

I grant  that  a thorough  examination  of  the  patient’s  genital  organs 
should  be  made  immediately  after  each  labor,  but  I do  not  believe 
that  a surgical  operation  must  necessarily  follow  labor  immediately 
in  a case  of  laceration  of  the  cervix,  vagina  or  perinseum,  one  or  all. 
In  the  mnjority  of  cases  I hold  that  it  is  bad  surgery  to  operate  on 
distended  and  ecchymosed  tissues  which  must  undergo  physiological 
involution  ; that  in  a case  of  extensive  laceration  of  the  perinseum, 
the  soft  parts  have  been  traumatized  and  predisposed  to  infection 
which  a surgical  operation  does  not  hinder  but  rather  invites ; that 
the  superficial  and  not  the  deep  structures  of  the  perineal  body  are 
united  by  immediate  perineorrhaphy,  provided  that  union  of  the  parts 
takes  place  at  all ; and  that,  as  a rule,  the  delayed  operation  in  a case 
of  laceration  of  the  cervix  or  perinseum  requiring  surgical  interference 
affords  the  best  results. 

I have  examined  a good  many  women,  from  one  month  to  several 
years  after  they  had  undergone  the  immediate  operation,  by  different* 
obstetricians  for  lacerations  of  the  perinseum  extending  down  to  or 
through  the  sphincter-ani  muscle,  and  I must  acknowledge  that  I 
have  not  met  with  a perfectly  restored  perinseum  in  the  entire  num- 
ber. I am  convinced  that  the  obstetrician  who  invariably  resorts  to 
immediate  perineorrhaphy  not  only  deceives  himself  but  misleads  his 
patient  into  the  belief  that  she  has  a good  perineal  body. 

Let  nature  and  good  treatment  do  what  they  may  towards  restor- 
ing tears  of  the  vagina  and  perinseum,  and  wait  until  after  the  eighth 
week  from  labor  to  make  a thorough  operation  on  the  lacerated  part 
under  aseptic  and  favorable  conditions.  Removal  of  scars  at  that 
time  will  be  a trivial  matter  in  comparison  to  the  long  list  of  evils 
following  the  delusion  of  a restored  perineal  body  by  immediate  peri- 
neorrhaphy. 

Deep  ruptures  of  the  cervix,  with  complicating  metritis,  accom- 
pany ruptures  of  the  perinseum  as  a usual  thing,  and  under  these 
circumstances  the  vagina  remains  in  a state  of  subinvolution,. and 
cystocele  and  uterine  prolapse  are  frequently  observed..  The  anterior 
vaginal  wall  is  more  easily  displaced  than  the  posterior..  In  multi- 
parse, a small  cystocele  is  often  seen,  especially  when  the  bladder  is 
lull.  It  is  not  a pathological  phenomenon,  but  is  due  to  the  subin- 
voluted and  thickened  vaginal  wall.  When  the  perinseum  is  defi- 

34 


530 


world’s  homoeopathic  congress. 


cient  in  tone,  a vesical  hernia  is  liable  to  occur,  as  the  posterior  wall 
of  the  bladder  is  adherent  to  the  anterior  wall  of  the  vagina  and  is 
carried  down  with  it.  The  posterior  wall  of  the  vagina  is  only 
loosely  connected  to  the  intestinal  wall,  and  therefore  rectocele  occurs 
less  frequently  than  cystocele.  The  uterus  is  soon  affected  by  the 
constant  dragging  of  a prolapsed  vagina  upon  its  attachments,  and 
thus  occurs  uterine  prolapse  and  hypertrophic  elongation  of  the  cer- 
vix. I commend  the  operation  for  cystocele  which  Dr.  Green  has 
described. 

Stolz  makes  a somewhat  different  suture  in  anterior  colporrhaphy. 
“ After  freshening  an  oval  surface  to  correspond  with  the  cystocele, 
two  curved  needles  are  threaded  on  a silk  suture,  one  needle  at  each 
end,  and  beginning  near  the  cervix,  the  suture  is  passed  in  and  out 
of  the  whole  circumference  of  the  wound  about  half  an  inch  from  the 
edge,  something  like  the  drawstrings  of  a tobacco  pouch.  The  de- 
nuded surface  is  pushed  inward  toward  the  bladder,  and  the  ends  of 
the  silk  closely  drawn  and  tied.” 

However,  I prefer  the  continuous  suture  in  layers.  I agree  with 
Dr.  Green  that  operations  about  the  cervix  or  vagina  should  be 
performed  with  the  knife  or  the  scissors  and  not  with  either  the 
ecraseur  or  galvano-cautery,  and  that  denuded  surfaces  should  be 
covered  with  mucous  membrane.  I approve  of  Dr.  Green’s  method 
of  operating  for  incomplete  laceration  of  the  perinseum.  I would 
advise  that  the  rectum  be  first  tamponed  with  cotton,  sponge  or  iodo- 
form gauze  covered  with  vaseline  and  furnished  with  a thread ; the 
posterior  vaginal  wall  is  pushed  forward  by  the  tampon  and  displayed 
to  a better  advantage. 

This  operation  for  incomplete  laceration  of  the  perinaeum  is  a 
modification  of  Tait’s  method,  which  is  much  employed.  Martin 
recommends  juniper  catgut  and  a continuous  suture  on  superposed 
planes  instead  of  silver  sutures  at  separate  points.  The  removal 
with  the  scissors  of  u a pear-shaped  piece  ” from  the  flaps,  as  recom- 
mended by  Dr.  Green,  takes  out  the  slack  and  cicatricial  tissue  from 
the  mucous  membrane  and  prevents  a puckered  and  pocketed  vagi- 
nal lining  in  the  completed  operation.  In  this  respect  the  operation 
is  similar  to  Emmet’s,  which  leaves  but  little  scar  tissue.  The  ope- 
ration described  can  be  done  more  quickly  than  the  tedious  operation 
of  Emmet,  and  when  well  done  accomplishes  the  same  purpose. 

Many  procedures  have  been  brought  forward  for  complete  lacera- 
tion of  the  perinaeum,  but  I am  convinced  that  the  operation  described 
by  Dr.  Green  is  the  best  of  all.  Good  results  have  been  obtained 
by  the  Simon-Hegar,  the  Freund,  the  Hildebrandt,  the  Martin,  the 
Emmet,  the  Tait,  the  Simpson,  and  other  methods,  but  the  great 
objection  to  each  of  these  operations  is  that  the  women  whose  perinei 
have  been  operated  upon  by  these  methods  and  have  the  appearance 
of  being  perfectly  restored,  are  very  liable  to  complain  that  they  have 


PLASTIC  SURGERY  OF  THE  VAGINA. 


531 


no  power  of  retaining  the  gaseous  and  liquid  contents  of  the  intes- 
tine. Whenever  this  complaint  is  made  the  operator  will  know  that 
he  failed  to  get  a good  union  of  the  deep  muscular  planes  and  the 
divided  ends  of  the  sphincter-ani  muscle.  Again,  the  union  may  be 
complete  superficially,  but  “a  cavity  may  be  left  more  deeply,  with 
a resulting  recto-vaginal  fistula.”  Since  more  care  has  been  taken 
to  pass  the  sutures  through  the  perinaeum  entirely,  so  as  to  bring 
the  deeper  parts  in  apposition,  the  recto-vaginal  fistula  has  not  been 
so  frequent,  but  in  the  modified  operation  of  Dr.  Green  this  accident 
is  guarded  against  in  a very  successful  way. 

According  to  his  method,  “ the  ends  of  the  torn  sphincter  are  loos- 
ened up  and  secured  with  medium-sized  catgut  and  two  or  three 
heavy  silk  approximating  ligatures,  taking  a good  hold  on  either 
side  to  relieve  the  tension  on  the  parts.”  This  procedure,  combined 
with  the  American  operation,  more  nearly  meets  the  objections  that 
I have  mentioned  than  is  done  by  any  other  operation,  and  is  the 
most  simple.  The  danger  of  sepsis  is  reduced  to  the  minimum,  as 
the  admission  of  any  discharge  from  either  the  vagina  or  rectum  is 
prevented  by  the  closed  incision. 

Even  in  the  cases  that  involve  a laceration  extending  up  the  recto- 
vaginal septum  more  than  an  inch  and  a half,  the  American  opera- 
tion goes  far  toward  simplifying  the  perineorrhaphy  and  rendering 
the  result  more  successful. 

L.  C.  Grosvenor,  M.D. : In  one  point  the  paper  and  the  first 
disputant  upon  the  paper  take  diametrically  opposite  positions,  the 
one  arguing  for  immediate  repair  of  the  perinseum  and  the  other 
criticizing  that  operation  and  stating  his  reason  therefor.  I have 
but  few  thoughts  to  give  you  after  considerable  experience  in  this 
matter.  The  first  is  to  call  your  attention  to  the  irritable  and  hurt- 
ful results  of  cicatrices  which  heal,  in  which  there  are  hard  tissues 
and  fibres,  and  the  immediate  operation  prevents  all  cicatrices  if  the 
operation  is  successful. 

The  other  thought  I wish  to  call  your  attention  to  is  this:  that 
raw  surfaces  are  points  of  sepsis,  and  when  a torn  perinseum  is  im- 
mediately coapted,  and  well  coapted  and  well  cared  for  after  the 
operation,  there  is  removed  from  the  case  a danger  of  sepsis. 

T.  L.  McDonald,  M.D.  : I want  to  add  just  a word  in  commen- 
dation of  the  paper  by  Dr.  Green,  and  not  altogether  in  condemna- 
tion of  the  statements  of  Dr.  Runnels.  I want  to  commend  the  in- 
genuity of  a man  who  can  devise  such  a plan  of  operation  as  Dr. 
Green  has.  I know  it  is  excellent,  and  it  is  the  best  one  I know  of. 
I have  tried  it.  There  are,  however,  some  cases  in  which,  like  all 
good  operations,  it  will  not  apply.  All  of  us  who  do  any  work  on 
the  bowels,  and  most  of  us  do,  find  occasionally  bowels  where  there 
have  been  excessive  and  extensive  syphilitic  ulcers.  In  such  cases 
the  bowel,  perhaps  for  inches,  has  been  destroyed,  and  you  have,  in- 


532 


world’s  HOMOEOPATHIC  CONGEE'S. 


stead  of  a healthy  tube,  such  a condition  that  it  is  impossible  to  bring 
down  the  bowel.  In  such  cases  as  that  X do  not  think  even  Dr. 
Green  himself  would  apply  this  operation.  I have  tried  it,  however, 
in  the  better  class  of  cases,  and  I know  it  works  well. 

I would  differ  from  Dr.  Green  just  a little  with  respect  to  his  first 
division  or  classification  of  tears  in  the  perinseum.  It  may  not  be 
any  improvement.  I scarcely  think  it  is.  Instead  of  cutting  out 
the  mucous  membrane  in  the  smaller  form  of  tear,  I would  do  Tait’s 
perinseum  operation  ; that  is,  slitting  it  up  and  converting  a trans- 
verse incision  into  a longitudinal  and  leaving  the  mucous  membrane 
right  open  ; not  cutting  it  out,  but  leaving  it  there.  You  are  bound 
to  have  union  by  first  intention,  as  far  as  my  experience  goes,  be- 
cause you  have  no  possibility  of  secretion  falling  into  it. 

While  here  I want  to  add  a word  in  favor  of  the  primary  opera- 
tion for  laceration  of  the  perinseum.  You  know  the  rule  is  here,  as 
everywhere  else  in  surgery,  to  close  the  wound,  if  possible,  and  obtain 
primary  union.  The  reasons  have  well  been  given  already.  If 
done  promptly,  the  results  are  justifiable.  I know  there  are  men 
here  who  have  operated  a hundred  times  to  my  one,  and  are  com- 
petent to  operate  much  better;  but  so  far  as  I am  concerned,  I have 
never  seen  a failure  after  the  primary  operation.  I saw  one  partial 
failure  where  I was  not  able  to  take  the  after-treatment  myself,  and 
it  might  have  happened  if  I had  been. 

Martha  G.  Ripley,  M.D. : I only  wish  to  say  that  having 
spoken  against  operations,  I do  not  wish  to  be  thought  entirely  op- 
posed to  them.  I believe  in  the  primary  operation,  and  with  a large 
obstetrical  practice,  I must  have  some  cases  that  need  operation.  The 
primary  operation  is  the  best  one,  in  my  opinion,  and  I am  surprised 
to  hear  that  somebody’s  opinion  is  there  was  never  a successful  case 
seen  vet.  If  my  patients  were  here,  I think  there  would  be  success- 
ful cases  seen. 

As  to  the  new  idea  that  has  recently  been  promulgated  in  the  med- 
ical magazines  in  regard  to  primary  operations  upon  the  cervix,  I 
should  not  feel  justified  in  performing  one  with  my  present  knowl- 
edge, with  the  parts  in  the  condition  that  they  must  be  after  partu- 
rition. I hardly  believe  it  would  be  the  thing.  But  the  primary 
perineal  operation  is  the  one  that  I have  done,  and  done  immedi- 
ately. 

J.  W.  Streeter,  M.D.,  of  Chicago  : I would  not'  say  a word  this 
afternoon  on  this  subject  or  any  other,  were  it  not  that  I believe  that 
it  is  quite  an  important  one,  and  that,  so  far  as  it  is  possible  for  us, 
we  should  settle  it  in  our  own  minds  and  be  consistent  at  least.  It 
seems  to  me  that  we  are  too  far  advanced  in  surgical  knowledge,  in 
pathological  knowledge,  in  our  ideas  of  sepsis  and  antisepsis,  to 
revert  to  the  old  method  of  allowing  nature  to  do  the  work  which 
art  can  do  a great  deal  better.  The  perinseum  should  be  sewn  at 
once  when  it  is  torn.  There  is  hardly  an  exception. 


PLASTIC  SURGERY  OF  THE  VAGINA. 


533 


I once  used  a common  needle  and  linen  thread  when  I was  too 
far  away  from  silk  and  suitable  instruments,  and  it  was  not  a suc- 
cess. In  every  other  instance  in  my  experience — which  has  not  been 
a very  limited  one — the  primary  operation  has  been  successful.  If 
successful,  why  not  do  it  every  time  ? 

The  laceration  of  the  cervix,  the  primary  repair  of  which  is  done 
in  some  of  the  German  hospitals,  is  a surgical  exploit,  and  that  is 
all  there  is  of  it.  Nine-tenths  of  lacerations  of  the  cervix  will 
repair  themselves  so  that  the  gynaecologists  will  never  find  them.  I 
can  imagine  a case  now  and  then  where  it  would  be  wise  to  take  a 
few  stitches;  but  ordinarily,  as  I said  before,  it  is  a surgical  exploit 
which  will  never  become  general  in  private  practice. 

J.  C.  Wood,  M.D.,  of  Ann  Arbor:  As  to  a perineal  operation  or 
an  operation  on  the  pelvic  floor,  I experimented  for  some  time  with 
the  flap-split  operation,  and  was  delighted  with  it  so  far  as  restoring 
the  perinseum  was  concerned.  I found  out,  however,  by  experience, 
that  in  those  cases  where  there  was  decided  relaxation  of  the  pelvic 
floor,  with  rectocele,  that  it  did  not  fulfil  the  indications,  so  that  by 
degrees  I simply  extended  the  flap-split  until  I separated  the  tis- 
sues to  the  crest  of  the  rectocele,  even  if  the  crest  was  near  the  cer- 
vix uteri.  Then,  instead  of  dissecting  out  the  tissue,  I found,  by 
experiment,  that  if  the  tissues  were  brought  together  underneath  the 
superior  flap,  that  it  accomplished  the  desired  end,  that  it  gave  us  a 
posterior  pillar,  which,  instead  of  being  in  the  way,  was  a most  val- 
uable supporting  medium.  If  the  perinaeum  is  to  be  restored,  I 
make  my  outside  incisions  exactly  as  in  the  Tait  flap-split  method. 
If  it  is  simply  to  overcome  the  relaxation  of  the  pelvic  floor,  I make 
my  incision  high  up,  simply  underneath  the  vaginal  mucous  mem- 
brane, make  my  dissection  with  the  finger,  and  the  whole  thing  can 
be  done  in  two  or  three  minutes,  and  bring  the  underlying  surfaces 
together  with  a continuous  catgut  suture  passed  through  the  vaginal 
mucous  membrane,  the  sutures  being  entirely  passed  through  the 
vagina.  The  result,  I think,  will  be  surprising  to  those  of  you  who 
will  experiment  with  this  operation. 

Dr.  Green  closed  the  discussion  as  follows  : 

There  has  been  so  much  said  upon  the  subject  of  immediate  repair 
of  laceration,  that  it  is  hardly  worth  while  for  me  to  reply  ; but,  it 
is  a subject  to  which  we  cannot  give  too  much  emphasis,  and  it  is 
useless  for  a man  to  put  his  theories  against  another’s  experience; 
and  when  I hear  a man  condemning  the  immediate  repair  of  a lacer- 
ated perinseum,  I have  but  one  thought  in  my  mind,  and  that  is,  that 
he  is  theoretical  and  not  practical.  When  a man  says  he  has  re- 
peatedly examined  cases  that  have  been  operated  upon  and  were 
faulty  in  their  results,  I must  say  it  has  not  been  properly  done.  I 
have  seldom  seen  a failure,  and  I have  been  doing  this  ever  since  I 
commenced  the  practice  of  medicine.  In  my  earlier  operations  it 


534 


world’s  homoeopathic  congress. 


was  not  well  done,  and  I failed,  probably,  in  40  per  cent,  of  ray 
cases ; but,  after  studying  over  the  causes  of  these  failures,  they  dis- 
appeared. 

In  regard  to  the  rupture  of  the  cervix,  I believe  the  writer  states 
that  a rupture  of  the  cervix  often  occurs  at  the  same  time,  and  why 
not  repair  it  a^  well  ? I say,  why  not  repair  it  as  well  ? I do  repair 
it  as  well.  Whenever  I am  called  upon  to  operate  upon  a lacerated 
perinseum,  I always  examine  the  cervix,  and  if  the  cervix  has  been 
lacerated  I draw  it  down  and  repair  it  at  the  same  time.  We  can- 
not neglect  any  of  those  things  that  will  benefit  a patient  who  is 
under  our  care. 

In  regard  to  the  draw-string  operation,  I have  operated  a number 
of  times  with  that.  It  is  imperfect,  does  not  give  good  results,  and 
the  reason  is,  principally,  that  it  shortens  the  anterior  vaginal  wall 
and  destroys  the  parts  that  we  attempt  to  restore. 

I have  also  performed  Tait’s  operation  a number  of  times,  and  I 
find  that  faulty.  The  fault  is  in  not  removing  the  flap.  A portion 
of  the  flap  protruding  into  the  vagina  causes  more  or  less  deformity, 
and  I have  found  better  results  by  removing  the  flap  than  when  I 
left  it.  Why  should  not  the  flap  be  removed?  You  have  got  to 
dissect  these  structures  down  to  the  muscular  tissue.  If  you  simply 
denude  a part,  you  will  not  get  strong  union.  That  structure  is  cica- 
tricial. It  is  devoid  of  circulation,  and  why  not  remove  it?  How 
do  you  know  that  a nerve  fibre  may  not  be  pinched  in  that  scar? 
If  you  know  anything  about  orificial  surgery,  you  know  it  may,  and 
you  know  it  is  bad  surgery  to  leave  a scar  tissue  anywhere. 

In  respect  to  the  subinvolution  of  the  vagina,  etc.,  the  Doctor  is 
wrong  in  his  anatomy.  The  parts  have  been  over-distended.  The 
bloodvessels  have  lost  their  support.  There  has  been  exudation  of 
matter  there  that  has  become  organized,  the  parts  are  thickened,  and 
the  whole  thing  is  the  result  of  the  want  of  support  which  has  been 
taken  from  the  vagina. 

In  regard  to  the  suggestion  made  by  Dr.  McDonald  I accept  that. 

The  following  question  was  asked  of  Dr.  Green  : 

“ Plow  many  hours  may  elapse  before  it  is  too  late  to  sew  up  the 
perinseum  after  labor?” 

Dr.  Green:  That  depends  very  much  upon  the  acoucheur.  If 
the  man  is  one  who  is  given  to  antiseptic  methods,  the  operation  may 
be  delayed  for  several  hours;  but,  ordinarily,  if  it  is  not  done  at 
once,  if  several  hours  elapse,  the  tissues  become  swollen,  and  prob- 
ably have  become  infected,  and  it  will  not  do  to  sew  the  perinseum 
up  after  the  lapse  of  ten  or  twelve  hours,  as  he  is  liable  to  have 
failure. 

The  Chairman  : There  is  a little  confusion  in  regard  to  the  pri- 
mary operation  upon  the  cervix.  Do  you  wish  the  Congress  to  un- 
derstand that  you  operate  upon  a torn  cervix  at  the  time,  or,  were 


PLASTIC  SURGERY  OF  THE  VAGINA. 


535 


you  referring  to  a secondary  operation  ? Do  you  repair  the  perinseum 
and  also  the  cervix  at  the  time  of  the  accident? 

Dr.  Green:  When  I am  called  upon  to  repair  a lacerated  peri- 
nseum,  an  immediate  repair  I mean,  I always  examine  the  cervix, 
and  if  I find  a lacerated  cervix  and  it  is  my  judgment  that  that  can 
be  mended  at  the  time,  it  is  my  habit  to  sew  it  there  and  then.  Some- 
times it  will  not  unite,  but  often  it  does.  Where  the  labor  has  been 
perfected,  and  where  the  parts  are  greatly  bruised  and  ecchymosed,  it 
is  probably  not  necessary  to  do  it,  as  it  will  not  unite;  but,  in  my 
experience,  a reasonable  number  of  cases  will  unite,  and  save  the 
patient  a secondary  operation  for  laceration  of  the  cervix. 


536 


world’s  homoeopathic  congress. 


CJESAEIAN  SECTION. 

By  H.  F.  Biggar,  M.D.,  Cleveland,  O. 


Historical  and  Statistical. 

Leishman  says  that  Caesarian  section  with  its  perfection  in  detail 
of  operation  and  splendid  results  is  of  modern  date.  It  is  true  that 
it  has  a history  dating  back  to  Numa  Pompelius  who  “ forbade  the 
burial  of  pregnant  women  in  whom  the  operation  had  not  lleen  per- 
formed.” We  have  no  early  authentic  statement  that  Caesarian  sec- 
tion was  performed  upon  living  women.  Though  no  mentiou  is 
made  of  it  by  the  old  writers,  such  as  Hippocrates  and  others,  yet  its 
great  antiquity  is  admitted.  The  first  mention  of  Caesarian  section 
is  in  the  Chirurgia  Guidonis  de  CauliacOj  published  in  the  middle  of 
the  fourteenth  century,  and  here  only  after  the  death  of  the  mother. 
It  was  performed  the  first  time  on  a living  woman  in  1500  by  Jacques 
Nufu  on  his  own  wife.  At  first  no  attempt  was  made  to  close  the 
uterine  wound,  for  all  of  the  attention  seems  to  have  been  given  to  the 
manner  of  closing  that  of  the  abdomen.  In  1769,  Libas  was  the  first 
to  close  the  uterus  with  sutures  after  the  operation,  but  this  proceed- 
ing was  lost  sight  of  until  1828,  when  it  was  carried  out  by  Dr. 
Frank  E.  Pollen,  who  first  used  the  silver  wire  suture  for  the  uterine 
wound. 

Sir  F.  Gould,  in  1742,  is  the  first  British  author  who  notices  the 
operation  and  says  it  may  be  performed  “ either  while  the  mother  is 
living  or  after  her  death.” 

The  Caesarian  operation  meant  one  of  three  different  proceedings, 
viz. : 

First. — Cutting  the  os  when  hard  fibrinous  deposits  are  found 
around  it,  or  when  other  conditions  exist  which  necessitate  its  open- 
ing and  enlargement;  this  is  vaginal  Csesarian  section. 

Second. — Abdominal  Caesarian  section  for  the  removal  of  the  foetus 
from  the  abdominal  cavity,  or  ectopic  gestation. 


CiESARIAN  SECTION. 


537 


Third . — Caesarian  section  where  the  incision  is  made  through  the 
abdominal  and  uterine  walls  for  the  extraction  of  the  foetus. 

In  abdominal  section  there  are  three  conditions  which  indicate  the 
operation,  viz. : 

First. — When  the  foetus  is  alive  and  the  mother  died  in  labor,  or 
in  the  last  two  or  three  months  of  pregnancy. 

Second. — Where  the  foetus  is  dead  but  cannot  be  delivered  in  the 
usual  way  on  account  of  the  deformity  of  the  mother  or  the  dispro- 
portionate size  of  the  child. 

Third. — When  both  the^nother  and  child  are  living,  but  delivery 
cannot  take  place  from  the  same  cause  as  in  the  second  example. 

History  records  the  bitter  opposition  to  the  operation  as  well  as  the 
strenuous  efforts  made  to  support  it  during  the  seventeenth  and  nine- 
teenth centuries.  To-day  it  is  an  accepted  operation  under  existing 
conditions  with  results  favorable. 

The  conditions  which  warrant  the  operation  are  largely  disputed. 
In  Germany  it  is  asserted  that  where  the  conjugate  diameter  of  the 
brim  is  only  2J  inches.  Americans  say  that  craniotomy  can  be  per- 
formed where  the  diameter  is  only  1J  inches,  but  the  conjugate  is  not 
the  test. 

Cazeau  thinks  the  operation  is  indicated  when  the  pelvic  contrac- 
tion measures  five  centimetres  (two  inches),  and  Tarnier  is  of  the 
same  opinion.  JDePaul  prefers  the  Caesarian  section  when  the  pelvic 
contraction  is  only  six  centimetres  and  the  child  is  alive. 

Scanzoni  would  even  prefer  the  operation  for  a living  child  if  the 
contraction  was  only  eight  centimetres.  This  diameter  may  be  from 
1 J to  2J  inches  and  other  conditions  exist  which  demand  the  pro- 
cedure. These  conditions  may  be  a shelving  brim,  an  exostosis,  a 
fibroma,  pelvic  haematocele,  cellulitis,  malignant  neoplasms,  fracture 
of  the  pelvic  bones,  spondylolisthesis,  placenta  praevia,  the  kyphotic 
pelvis,  the  scolio-rachitic  pelvis,  the  Roberts  pelvis,  the  osteo-malacia 
pelvis,  or  the  ruptured  uterus.  Moreover,  the  operation  is  indicated 
in  cases  in  which  the  mother  prefers  the  operation  rather  than  to  sac- 
rifice the  life  of  the  child  ; also  in  cases  of  death  of  the  mother  while 
the  child  is  viable. 

The  following  statistics  by  Schroeder  up  to  1874  gives  the  per- 
centage of  deaths  at  54  per  cent.  Dr.  Robert  P.  Harris  gives  the 
following  statistics  of  operations  : In  North  America,  135  cases  with 
60  cures ; in  England,  141  cases,  25  cures. 


538 


world’s  homceopathic  congress. 

He  farther  states  that  in  120  operations  in  this  country  the  per- 
centage of  cures  in  the  country  was  62J  per  cent. ; in  the  small  towns, 
34  per  cent.,  and  in  the  cities  33  per  cent.  The  same  authority,  in 
a report  dated  September,  1886,  gives  the  results  of  Caesarean  sec- 
tion performed  when  the  condition  was  favorable,  viz.:  saved,  75 
per  cent,  of  the  mothers  in  this  country  and  80  per  cent,  of  the 
children.  It  further  gives  a statistical  report  as  follows : 


Caesarean  operations  of  the  United  States, 144 

Women  saved,  37J  per  cent., 54 

Children  living  when  delivered, 64 

First  50  operations  saved,  54  per  cent., 27 

Last  50  “ “ 24  per  cent., 12 

Operations  for  decade  ending  Dec.  31,  1855,  . . . .25 

Women  saved,  48  per  cent., 12 

Children  living, 13 

Operations  for  decade  ending  Dec.  31,  1865,  . . . .24 

Women  saved,  45|  per  cent., 11 

Children  living, 10 

Operations  for  decade  ending  Dec.  31,  1875,  . . . . 36 

Women  saved,  27|  per  cent., 10 

Children  living, 11 

Operations  for  10J  years,  ending  Aug.  1,  1886,  . . . . 37 

Women  saved,  21§f  per  cent 8 

Children  living, .16 

Late  operations,  nearly  84  per  cent,  of  this  division,  . . .31 


The  late  Dr.  S.  S.  Lungren,  of  Toledo,  O.,  collected  reports  of  all 
cases  on  the  same  woman.  On  48  women  the  operation  was  per- 
formed 119  times;  8 mothers  only  have  died  and  40  have  been 
saved. 

“ The  time  most  favorable  for  the  operation  is  that  which  just  pre- 
cedes or  immediately  follows  the  rupture  of  the  membranes;  for  at 
this  time  the  os  is  well  dilated  and  the  uterine  contractions,  which 
have  already  existed  for  some  time,  acquire  a more  regular  and  in- 
tense character.  If  one  operates  much  earlier  than  this,  the  uterine 
contractions  after  the  operation  are  apt  to  be  insufficient,  and  if  much 
later,  the  danger  to  the  child  is  considerably  increased.” 

Statistics  vary  ; one  report  gives  the  advantages  of  an  operation 
during  or  before  the  close  of  the  first  day  of  labor  to  be  73  per  cent, 
of  women  and  86  per  cent,  of  children,  while  Lusk  says  only  81  per 
cent,  of  women  are  saved. 

Dr.  Harris  gives  statistics  as  follows : 


CiESARIAN  SECTION. 


539 


24  hours  before  labor  had  commenced, 
« u <( 

34  “ after  “ “ 


Operations.  Cures. 
. 7 7 

. 7 4 

. 10  1 


Radfoot  gives  statistics  of  100  cases  as  follows : 


Operations.  Cures. 

24  hours  before  labor,  ......  24  7 

24  “ after  “ ......  76  9 


Kayser’s  statistics  in  relation  to  the  rupture  of  the  membranes  is 


as  follows  : 

Before  or  6 hours  after,  . 
7 to  24 

More  than  24  “ 


Mothers.  Children. 


Cases. 

Cures. 

Cases. 

Cures. 

39 

20 

39 

34 

35 

24 

32 

25 

38 

13 

37 

19 

Of  Porro’s  operation  the  results  for  the  first  few  years  were  very 
unfavorable.  'It  is  reported  that  the  mortality  of  mothers  was  58 
per  cent.  For  the  period  of  five  years  to  the  close  of  1889,  from  all 
countries — the  general  result  is  of  158  operations — there  were  47 
deaths — a mortality  of  29  per  cent.  Italy,  who  gave  us  the  Porro 
operation,  and  has  thus  far  led  all  countries  in  the  number  of  her 
Porro-Csesarean  exsections,  has  made  the  least  satisfactory  progress 
in  reducing  the  percentage  of  deaths. 


Caesarean  operations  in  the  United  States  where  the  obstruction 

was  due  to  uterine  fibroids, 

Caesarean  operations  in  the  United  States  where  the  obstruction 

was  due  to  pelvic  fibrous  tumors, 

Caesarean  operations  in  the  United  States  where  the  obstruction 
was  due  to  pelvic  exostosis,  . 

Women  recovered  in  uterine  fibroid  cases, 

“ “ pelvic  “ 

<(  “ “ exostosis,  . 

Children  living  in  uterine  fibroid  cases, 

“ “ pelvic  “ 

“ “ “ exostosis, 

Time  in  labor  in  uterine  fibroid  cases,  42  hours  to  15  days, 

Time  in  saved  cases:  9J  hours,  14  hours,  3 days,  4 days,  respect 

ively, 

Time  not  stated,  but  labor  prolonged, 

Time  in  labor  in  pelvic  exostosis  cases,  24  hours  to  3 days,  . 

Time  in  saved  cases:  ‘‘a  few  hours  12  hours,  24  hours  and  38 
hours,  respectively,  .........  4 

Uterine  fibroids,  cases  saved,  ....  30y|  per  cent 

Pelvic  exostosis,  cases  saved, 50  “ 


13 


540 


world’s  homoeopathic  congress. 


Modifications  of  the  Operation. 

1.  Porro’s  Caesarean  section;  ovaro-hysterectomy ; amputation  of 
the  uterus  and  ovaries  immediately  after  the  performance  of  Caesarean 
section,  the  stump  being  fastened  at  the  lower  angle  of  the  abdomi- 
nal wound. 

2.  Thomas’s  operation  ; laparo-elytrotomy. 

3.  Porro-Miiller  operation.  In  this  the  uterus  is  brought  out  of 
the  abdominal  incision,  an  elastic  ligature  is  applied  around  the  cer- 
vix at  the  level  of  the  internal  os,  and  the  uterus  is  then  incised  and 
the  foetus  extracted. 

4.  Porro-Veit  operation.  Modification  of  Porro’s  operation  by 
dropping  the  stump  into  the  pelvis. 

5.  Sanger’s  operation,  sero-serous. 

6.  Pubeotomy. 

Necessary  Steps  in  the  Operation. 

First. — Care  for  the  patient  in  every  particular,  as  in  coeliotomy. 

Second. — The  abdominal  incision  should  be  sufficiently  long  to 
permit  the  lifting  of  the  womb  out  of  the  abdominal  cavity. 

Third — Protect  the  exposed  uterus  with  hot  cloths. 

Fourth. — Have  a heavy  rubber  tubing  passed  around  the  cervix 
uteri,  and  tie  in  a single  knot  loosely;  it  may  be  useful  in  case  of 
haemorrhage. 

Fifth. — Surround  the  lower  part  of  the  uterus  with  sterilized  or 
medicated  gauze,  thus  pre renting  soiling  the  abdomen. 

Sixth. — Open  the  uterus  and  remove  the  child  and  placenta. 

Seventh. — If  severe  haemorrhage  occurs,  seize  the  uterus  with  the 
hands  and,  gently  or  otherwise,  contract  it.  Ergot  may  be  necessary ; 
or,  tighten  the  rubber  tubing. 

Eighth. — After  cleaning  the  cavity  of  the  uterus,  close  the  uterine 
incision  with  sutures.  Silver,  silk,  or  catgut  may  be  used,  adopting 
one  of  two  ways,  viz. : 

1.  The  deep  suture,  avoiding  the  mucosa,  with  superficial  inter- 
vening suture.  2.  The  sym-peritoneal  suture,  or  the  sero-serous  of 
Sanger. 

Ninth. — Close  the  abdominal  wound  with  silkworm -gut  suture, 
after  the  manner  of  coeliotomy,  and  the  usual  antiseptic  dressings. 


CAESARIAN  SECTION. 


541 


Clinical  Cases. 

Case  I. — Caesarian  section.  Mother  and  child  saved. 

Mrs.  A.  Salter,  a German,  of  Salineville,  O.,  set.  28,  weight  65 
pounds,  height  4 feet ; husband’s  height,  4 feet  9 inches.  This  is 
her  fourth  impregnation  ; in  the  three  previous  gestations  the  lives 
of  the  children  were  sacrificed  at  full  term  by  craniotomy. 

The  parents  were  desirous  of  having  a living  child,  and  the  mother 
was  willing  to  assume  the  risk  of  a Csesarian  section. 

Two  weeks  before  the  time  of  the  completion  of  term  Mrs.  S. 
came  to  the  Huron  Street  Hospital,  in  Cleveland,  O.  At  the  com- 
pletion of  her  gestation,  at  7 a.m.,  December  15,  1886,  labor  pains 
began  and  continued  till  9 o’clock  in  the  evening  of  the  same  day. 
Prof.  J.  C.  Sanders  was  in  constant  consultation  during  the  day  and 
up  to  the  time  of  the  completion  of  the  operation.  Prof.  Sanders, 
after  his  first  careful  examination  of  the  patient,  believed  that  by 
turning  the  foetus  in  utero  a living  child  could  be  born.  At  9 at 
night,  when  the  os  was  dilated  to  the  size  of  a silver  dollar,  and  be- 
fore the  membranes  had  ruptured,  the  doctor  decided  that  it  would 
be  impossible  to  deliver  the  child  alive  per  vias  naturales — a wall  of 
bone,  the  shelving  brim  of  the  pelvis,  obstructing  the  passage,  and 
the  conjugate  diameter  being  less  than  two  inches.  Anticipating 
his  decision,  every  preparation  was  ready  for  the  operation.  The 
babe  was  living,  and  the  heart-beats  were  135  per  minute.  The 
London  mixture  was  used,  and  in  fifteen  minutes  after  beginning  the 
operation  a living  girl  babe  was  extracted  from  the  womb  through 
the  abdominal  and  uterine  walls.  The  operation  was  performed  in 
the  operation-room  of  the  hospital,  before  the  senior  class  of  the 
Homoeopathic  Hospital  College  and  other  physicians. 

The  Method  of  Operating. 

The  patient,  assistants,  nurses,  instruments,  dressings,  room  and 
furniture  were  all  carefully  prepared  for  the  operation.  None  were 
admitted  who  had  been  dissecting  or  were  in  attendance  on  any  con- 
tagious or  suspicious  cases  within  forty-eight  hours.  The  usual  eoe- 
liotomy  incision  was  made,  beginning  two  inches  above  the  symphy- 
sis pubis  and  extending  to  a point  beyond  the  umbilicus,  and  in 
depth  down  to  the  peritonaeum.  When  the  bleeding  wa^  stopped 
the  peritonaeum  was  opened,  exposing  the  uterus.  An  assistant  held 
the  uttrus  in  position  by  placing  the  hands  on  either  side  of  the 


542 


world’s  homoeopathic  congress. 


womb.  The  sides  of  the  peritonaeum,  coming  in  contact  with  the 
uterus,  were  packed  with  sterilized  gauze,  thus  protecting  the  perito- 
neal cavity  from  the  entrance  of  fluids.  The  uterus  was  entered  by 
an  incision,  eight  inches  in  length,  in  the  medium  line  on  the  inte- 
rior surface.  Fortunately,  the  “ placental  site”  was  not  in  danger  of 
being  encroached  upon  by  the  knife,  which  brought  to  view  the  trans- 
lucent membranes  enclosing  the  fluids  which  cushion  the  babe  in  its 
casket  like  a bird  in  the  egg.  A natural  contraction  of  the  uterus, 
observable  by  all,  ruptured  the  membranes;  the  fluid  escaped  when 
the  infant,  doubled  upon  itself,  was  exposed  to  view  and  the  closest 
approach  to  the  great  mystery  of  life — the  marvel  of  maternity — it 
is  possible  to  have  enjoyed  was  seen  by  those  who  reverently  wit- 
nessed the  operation.  Some  strong  men  actually  wept  in  witness  of 
the  depth  of  emotion  caused  by  what  so  few  have  ever  seen  and  what 
no  man  could  see  without  being  profoundly  moved — a sight  as  pow- 
erful to  move  the  heart  as  the  view  that  Moses  had  of  Deity.  Every 
other  feeling  was  completely  subordinated  to  that  sentiment  of  rev- 
erence and  wonder  which  would  be  natural  on  being  permitted  to  see 
what  is  transpiring  on  another  of  the  inhabited  planets.  The  pre- 
sentation was  natural.  The  feet  were  seized  and  the  babe  lifted 
from  the  womb  and  given  to  Prof.  J.  C.  Sanders  and  Dr.  L.  W. 
Sapp  to  care  for.  A gasp  and  a lusty  squall,  assuring  us  all  of  the 
safety  of  the  babe,  elicited  a round  of  genuine  but  subdued  applause 
and  an  exclamation  of  delight  from  the  father.  The  cord  was 
secured,  after-birth  and  membranes  were  carefully  removed,  the 
uterus  was  grasped  and  made  to  contract.  The  patulous  coellum 
uteri  did  not  need  a drainage-tube.  The  cavum  uteri  was  gently 
cleaned  and  the  uterus  closed  with  animal  ligatures,  after  Sanger’s 
method.  The  abdominal  cavity  was  cleaned,  the  abdominal  incision 
closed  with  silk  sutures,  the  toilet  of  the  abdomen  completed,  and 
the  mother  put  to  bed.  After  a few  moments  she  recovered  con- 
sciousness and  found  by  her  side  a living  girl  babe.  With  motherly 
instinct  she  drew  her  child  closely  to  her  heart  and  greeted  her  dar- 
ling with  the  exclamation,  “ Mein  babe,”  a salutation  that  could  but 
feebly  express  the  depth  of  her  mother’s  love  and  devotion  to  those 
who  did  not  know  the  risk  she  had  run  to  save  the  babe’s  life.  The 
mother  and  babe  were  the  recipients  of  devoted  and  sympathetic 
attention  by  the  nurses  of  the  hospital,  and  both  returned  toSalineville 
after  the  usual  uneventful  convalescence  of  a coeliotomy. 


CJESARIAN  SECTION. 


543 


Case  II. — Caesarian  section. 

Mrs.  R.  T.,  American,  set.  34,  mother  of  two  living  children.  From 
the  beginning  of  her  labor  was  assisted  by  a midwife  for  sixty  hours. 
At  this  time  Drs.  J.  C.  and  J.  Y.  Winans,  of  Madison,  O.,  were 
called,  and  the  midwife  retired  from  the  case.  The  condition  of  the 
patient  was  so  alarming  that  Dr.  Winans  immediately  summoned 
Drs.  A.  L.  Gardner  and  L.  H.  Tillotson,  of  Painesville,  O.  It  was 
supposed  that  large  doses  of  Ergot  had  been  given  by  the  midwife. 
I was  summoned  by  telegraph  and  arrived  at  two  in  the  morning, 
and  found  the  patient  in  a state  of  collapse  with  suspected  symptoms 
of  a ruptured  uterus  and  a non-viable  child.  Sectio  Csesaria  was 
determined  upon  and  performed  by  the  light  of  a kerosene  lamp. 
The  uterus  was  found  longitudinally  ruptured  at  the  lower  third  an- 
teriorly, the  amniotic  fluid  escaping  into  the  abdominal  cavity,  but 
the  membranes,  placenta,  and  child  were  in  utero.  Perhaps  from 
the  weakened  condition  of  the  patient  at  the  time  of  the  rupture  and 
the  syncope  following  the  escape  of  fluid  into  the  abdominal  cavity, 
all  uterine  contractions  had  ceased.  No  doubt,  if  the  labor  pains 
had  been  severe  the  contents  of  the  uterus,  or  the  greater  part,  would 
have  been  found  in  the  abdominal  cavity. 

The  operation  was,  in  every  way,  similar  to  Case  I.,  with  this  differ- 
ence, that  the  rupture  which  was  slightly  to  the  right  of  the  median 
uterine  line,  was  enlarged;  the  torn  edges  were  trimmed,  and  the 
uterus  closed  by  two  sets  of  animal  sutures,  the  deep  going  to  the 
mucosa,  and  the  superficial  approximating  the  peritoneal  borders. 
The  surroundings  were  unfavorable  for  successful  operation — the 
woman  was  moribund,  the  13-pound  foetus  dead,  and  the  nursing 
incompetent.  The  patient  lived  but  a few  hours. 

Case  III. — Pon-o’s  Operation. — Mrs.  W.  N.  K.,  a German,  set. 
43,  living  in  Akron,  O.,  and  mother  of  two  living  children.  Dr. 
O.  D.  Childs  had  attended  her  in  previous  labors.  No  uterine  ex- 
amination had  been  made  by  Dr.  Childs  since  the  birth  of  her  last 
child  till  the  beginning  of  the  third  labor. 

Upon  examination,  he  found  a very  large  intra-mural  fibroma, 
situated  at  the  junction  of  the  neck  with  the  body  of  the  womb. 
Consultants  were  called,  and  every  effort  made  to  deliver  by  forceps, 
or  by  turning  the  child,  or  by  changing  the  position  of  the  woman, 
but  no  advancement  was  made.  The  membranes  had  ruptured  18 
hours  after  labor  set  in.  I was  summoned  by  telegraph,  and  arrived 


544 


world’s  homoeopathic  congress. 


forty-eight  hours  after  labor  began.  Dr,  Childs  Says  the  child  had 
been  dead  three  days.  The  condition  of  the  woman  was  not  very 
good.  I made  every  reasonable  effort  to  deliver  and  failed.  Could 
not  get  even  an  entrance  to  the  womb,  owing  to  the  displacement 
of  the  os  upwards  and  behind  the  symphysis  tubes,  as  well  as  from 
the  undilatable  os  from  the  fibrinous  deposit.  Porro’s  operation  was 
performed,  in  all  respects  similar  to  Case  I.,  with  this  difference, 
that  after  the  babe  and  placenta  were  extracted,  the  neck  of  the 
womb  was  clamped  with  Keith’s  clamps,  the  uterus  with  the  fibroma 
and  adnexa  were  removed  and  the  stump  dressed,  extra-peritoneal. 
The  fibroma  weighed  11 J pounds  and  the  child  11  pounds. 

On  the  tenth  day  after  the  operation  there  was  profuse  haemor- 
rhage of  the  stump,  and  before  the  physician  arrived  the  woman 
was  in  a state  of  collapse  and  shortly  died.  If  the  patient  had  been 
in  the  hospital,  the  haemorrhage  might  have  been  stopped.  If  the 
rubber  ligature,  since  introduced,  had  then  been  used,  the  result 
might  have  been  different. 

Case  IV. — Ectopic  gestation,  in  many  respects  similar  to  Sectio 
Caesaria.  Miss  H.,  an  American  sewing  girl,  set.  22,  a patient  of 
Dr.  I.  F.  Baughman,  of  Akron,  O.,  after  a railroad  accident,  first 
noticed  a lump  in  the  right  ovarian  region.  Action  was  brought 
against  the  railroad  company,  who  settled  the  claim  without  litiga- 
tion. The  tumor  continued  to  grow.  Fifteen  months  after  the  rail- 
road accident,  and  seventeen  months  after  the  cessation  of  the  menses, 
with  the  assistance  of  Drs.  Baughman,  O.  I).  Childs,  J.  W.  Bock- 
well,  Wm.  Murdock,  and  R.  B.  Carter,  coeliotomy  was  performed  at 
the  rooms  of  the  patient.  She  refused  to  go  to  a hospital.  The  tu- 
mor, which  filled  the  abdominal  cavity,  was  adhered  to  the  parietal 
peritonaeum  and  abdominal  viscera.  The  incision  was  in  the  median 
line  of  the  abdomen.  It  required  very  careful  dissection  to  avoid 
the  intestines,  which  were  closely  adherent  to  the  entire  circumfer- 
ence of  the  uterus;  the  walls  of  the  sac  were  thick  and  resembled 
uterine  tissue.  Within  the  cavity  was  a dead  foetus,  which  was  re- 
moved from  its  placental  nidus.  The  extensive  adhesions  of  the 
cyst  were  not  disturbed,  but  the  edges  were  stitched  to  the  abdom- 
inal opening;  glass  drainage-tubes  were  placed  both  in  the  abdom- 
inal and  placental  cavities.  The  child,  a boy,  weighed  18  pounds; 
the  nails  were  so  long  that  they  curled  around  the  fingers  and  toes. 
Its  conception  was  seventeen  months  previous  to  the  time  of  the 


CiESARIAN  SECTION. 


545 


operation.  The  child  was  in  a good  state  of  preservation,  but  we 
were  not  able  to  elicit  any  information  from  the  mother  as  to  the 
exact  time  of  the  death  of  the  child.  The  room,  bedding,  furniture, 
and  surroundings,  were  very  uninviting,  in  fact  everything  indicated 
a picture  of  squalor;  notwithstanding  all  these  conditions,  the  pa- 
tient slowly  recovered  and  subsequently  married. 

Case  V. — Sectio  Csesaria  repeated  on  same  woman.  Mother  and 
two  children  living.  Mrs.  A.  Salter,  same  woman  as  reported  in 
Case  I.,  from  Salineville,  O.,  set.  34,  six  years  after  the  first  Caesarian 
section  became  pregnant,  making  in  all  her  fifth  impregnation.  At 
the  seventh  month  of  gestation  she  came  to  Cleveland  for  consulta- 
tion. With  Professor  J.  C.  Sanders  as  consultant,  she  was  advised 
to  return  to  her  home,  and  in  two  weeks  before  the  completion  of 
the  gestative  period  she  was  to  enter  the  hospital  and  be  prepared 
for  the  Caesarian  section.  On  February  16,  1893,  at  3 p.m.,  two  or 
three  weeks  before  the  expected  time,  while  at  her  home  at  Saline- 
ville, labor  began,  and  at  3 a.m.,  December  17th,  they  took  a train 
for  Cleveland.  They  came  in  a day-car,  75  miles,  the  pains  lasting 
until  her  arrival  at  7 a.m.  By  a mistake,  I did  not  learn  of  her  ar- 
rival on  the  morning  train,  and  the  consultation  preceding  operative 
measures  occurred  at  4.30  p.m.  ; at  5 P.M.,  twenty -six  hours  after  the 
rupture  of  the  membrane,  I began  the  operation  before  the  medical 
class  of  the  college.  The  method  was  the  same  as  the  first  Sectio 
Csesaria,  following  the  old  line  of  incision.  The  old  operation  had 
resulted  in  the  adhesion  of  the  entire  uterine  length  to  the  abdom- 
inal  wall.  The  method  of  suturing  the  uterus  was  different  owing 
to  adhesions  of  the  uterus  to  the  parietal  peritonaeum  ; the  deep  su- 
tures around  the  tissues  included  the  abdominal  and  uterine  walls 
down  to  the  mucosa,  and  the  superficial  sutures  merely  the  abdominal 
walls  down  to  the  peritonaeum. 

The  length  of  time  occupied  was  twenty-five  minutes  ; the  birth 
was  “dry  ” in  this  case  on  account  of  the  early  rupture  of  the  waters. 
The  child  weighed  eight  and  one-quarter  pounds.  At  the  first  ope- 
ration the  father  positively  objected  to  the  removal  of  the  ovaries. 
It  was  thought  best  not  to  do  so  at  this  time,  not  only  on  account  of 
most  intimate  adhesions  of  the  abdominal  parietes  to  the  uterus,  but 
from  the  enfeebled  condition  of  the  mother  resulting  from  labor  hav- 
ing continued  for  thirty  hours,  and  the  uncomfortable  journey  to  the 
hospital  during  a severe  winter  night.  Prof.  J.  C.  Sanders  deter- 

35 


543 


world’s  homoeopathic  congress. 


mined  the  foetal  heart-beat  as  128,  prognosticating  a boy.  The  case 
made  a good  recovery,  despite  some  bronchitic  and  erysipelatous 
symptoms,  and  returned  home  in  the  usual  state  of  bodily  vigor. 
The  boy  was  christened  as  a point  of  remembrance  of  the  method  by 
which  rescued,  Caesar,  and  was  a thrifty,  well-nourished  child. 

The  doctors  present,  besides  the  college  seniors,  were  Drs.  J.  C. 
Sanders,  H.  Pomeroy,  J.  K.  Sanders,  Martha  A.  Canfield,  G.  W. 
Meredith,  H.  D.  Bishop,  G.  B.  Haggart  and  Emily  Barnes. 

Suggestions. 

Antiseptic  thoroughness  is  essential  in  every  detail,  including  the 
care  of  the  abdomen  and  vagina. 

Chloroform  is  preferable,  especially  with  Junker’s  improved  appa- 
ratus. 

Ether  in  certain  conditions  may  be  safer.  If  possible,  prevent 
vomiting,  as  it  might  open  the  uterine  sutures.  To  prevent  vomit- 
ing after  an  anaesthetic,  have  a good  movement  of  the  bowels. 

Trendelenburg’s  position  is  not  very  desirable  in  sectio  Csesaria. 

If  the  operation  is  at  the  election  of  the  surgeon,  the  most  suitable 
time  is  before  the  membranes  are  ruptured  and  when  the  os  has  di- 
lated in  size  equal  to  a silver  dollar. 

Tait’s  method  with  a rubber  cord  around  the  cervix  uteri  to  stop 
the  hsemorrhage,  and  lifting  the  uterus  outside  of  the  abdomen  to 
extract  the  child,  are  of  great  advantage. 

If  rubber  cord  is  used,  beware  of  secondary  haemorrhage.  The  in- 
cisions should  be  six  or  eight  inches  in  length,  beginning  three  inches 
above  the  pubes,  and  extending  above  the  umbilicus. 

In  cutting  through  the  abdominal  wall,  secure  all  bleeding  vessels 
before  incising  the  uterus. 

If  the  uterus  is  not  lifted  out  of  the  abdomen  let  the  assistant  press 
the  abdominal  walls  on  each  side  of  the  incision  down  against  the 
uterus,  thus  retracting  the  wound  edges  and  pressing  the  uterus  still 
prominently  into  the  wound  opening. 

Before  lifting  the  uterus  out,  insert  three  or  four  long  sutures  of 
silk  through  the  upper  part  of  the  incision,  so  that  the  abdomen  may 
be  temporarily  closed  before  extracting  the  child. 

Let  the  incision  into  the  uterus  correspond  with  the  abdominal 
opening,  but  shorter. 

Avoid  entering  the  uterus  through  the  placental  site.  If  the  pla- 


CJESARIAN  SECTION. 


547 


centa  should  lie  in  the  line  of  the  incision  (placenta  praevia  Caesareana) 
run  the  fingers  between  it  and  the  uterine  wall,  find  its  margin  and 
break  through  the  membranes  there  and  grasp  the  feet  and  extract, 
as  before. 

Do  not  out  the  placental  tissue,  thus  bleeding  the  child  in  placenta 
praevia  Caesareana. 

Deliver  by  the  feet. 

If  the  uterus  is  not  lifted  out  of  the  abdomen  before  delivery  of 
the  child,  it  may  be  done  afterwards  for  the  purpose  of  inserting  the 
stitches. 

There  are  three  dangers — shock,  haemorrrhage  and  sepsis.  Haem- 
orrhage may  be  controlled  by  manual  compression  of  the  uterus  or 
cervix  uteri. 

Sutures  should  be  thoroughly  antiseptie. 

Don't  use  a continuous  suture  in  the  uterus. 

If  the  contents  of  the  uterus  are  septic,  turn  the  uterus  out  of  the 
abdomen  before  the  delivery  of  the  child. 

The  reason  the  uterus  was  not  sutured  in  the  early  times  was  largely 
due  to  the  persistent  existing  superstition  with  regard  to  the  alternat- 
ing contractions  and  relaxations  of  the  uterus  which  forbade  the  em- 
ployment of  the  uterine  sutures.  Even  Porro  at  one  time  considered 
that  the  contraction  of  the  uterus  necessitated  its  entire  removal. 
Now  his  operation  has  been  restricted  to  within  narrow  limits. 

Suturing  the  uterus  largely  adds  to  the  good  results. 

Caesarian  section  should  be  always,  if  possible,  elective,  not  the 
dernier  ressort.  Per  via  naturales  may  not  always  be  the  best  way. 
In  mismanaged  cases  Porro’s  operation  is  preferable.  Foetal  mor- 
tality is  greater  in  this  country,  the  hospital  weight  of  infants  being 
about  seven  and  a half  pounds  ; in  private  rooms  in  Europe  the 
average  is  six  ponnds. 

Thanks  to  the  great  discovery  of  the  source  of  the  sepsis  and  of 
its  preventive  means,  this  “ Opprobrium  Chirugae”  has  to-day  as- 
sumed and  is  destined  forever  to  maintain  its  place  as  one  of  the 
benign  and  most  serviceable  resources  of  art. 

Caesarean  section  will  yield  as  good  results  as  those  now  given 
by  coeliotomies. 

May  we  not  consider  this  operation  in  placenta  praevia  totalis  or 
even  partialis  ? In  placenta  praevia  vaginalis,  if  the  os  is  rigid  from 
fibrosis,  the  haemorrhage  profuse,  the  presentation  lateral,  the  cord 


548 


world’s  homoeopathic  congress. 


prolapsed  and  not  reducible,  or  the  foetus  evidently  suffering,  imme- 
diate recourse  to  the  Caesarean  section  should  be  had. 

If  the  cord  was  prolapsed,  and,  after  reposition,  still  descended, 
the  os  being  partly  dilated  and  not  dilatable — dangerous  haemor- 
rhage continuing  meanwhile — the  Caesarean  section  would  be  un- 
questionably indicated  for  the  safety  of  both  mother  and  child. 

The  perforation  of  the  living  child  is  not  longer  justifiable. 

Where  there  is  a viable  child,  is  not  Caesarian  section  'preferable  to 
craniotomy  f 

Craniotomy  and  embryotomy  are  performed  too  often.  It  soon 
may  become  a lost  art,  or  it  will  be  relegated  to  its  proper  place  as 
an  operation  on  the  dead  foetus  to  save  the  mother,  and  not  to  de- 
stroy the  child. 

Craniotomy  is  a more  difficult  operation  than  Caesarean  section. 

Dr.  Osborn,  in  the  celebrated  case  of  Elizabeth  Sherwood,  ex- 
tracted a child  through  a pelvis  measuring  f of  an  inch  in  the  nar- 
rowest portion. 

The  precise  limit  at  which  the  dangers  of  delivery  through  the 
pelvis  rise  to  the  level  or  exceed  those  from  Caesarean  section  is  not 
easy  to  determine.  It  depends  partly  upon  the  size  and  ossification 
of  the  child’s  head,  and  largely  upon  the  experience  and  dexterity 
of  the  operator. 

The  indications  of  premature  labor  in  pelvic  deformities  may 
make  the  operation  justifiable. 

Michaelis  extracted  a small  child  through  a pelvis  measuring  but 
1J  inches  in  the  conjugate  diameter. 

From  1777  to  1849,  65  pubiotomies  are  recorded,  saving  44 
mothers  (32.4  per  cent,  mortality)  and  24  children  (64  per  cent, 
mortality).  From  1868  to  1880,  50  operations,  by  three  operators, 
saved  40  mothers  and  41  children — a mortality  of  20  per  cent,  and 
18  per  cent,  respectively.  From  1880  to  1886,  Morisana  had,  out 
of  18  cases,  only  10  recoveries.  But  with  a perfected  technique, 
and  by  practicing  strict  antisepsis,  better  results  were  obtained,  and 
the  last  report  by  Caruso  showed  in  22  operations  22  recoveries  and 
20  living  children. 

From  a late  report  of  pubiotomy,  in  44  cases  all  the  mothers  re- 
covered but  one,  with  a loss  of  5 children. 

Pubiotomy  is  on  trial.  The  opinions  of  eminent  specialists  differ. 
Some  cases  have  not  resulted  well.  Schroeder,  Fritsch,  A.  Martin 


CJESARIAN  SECTION. 


549 


and  Runge  treat  it  with  silent  contempt.  Kehrer,  Zweifel  and 
Winckel  condemn.  Kehrer  writes  that  it  always  results  in  perma- 
nent invalidism. 

Winckel  says:  “The  good  results  expected  from  this  operation 
have  not  been  obtained,  but  lacerations  of  the  bladder,  injuries  to 
the  sacro-iliac  joints  and  necrosis  of  the  pubic  bones  have  been 
plentiful.” 

Pubiotomy  not  admissible  in  Roberts’s  or  Nagle  pelvis. 

The  so-called  Sanger’s  stitch  is  the  best,  but  be  it  knowm  to  all 
men  that  our  own  Lungren  even  folded  in  the  peritonaeum  so  a6  to 
keep  the  peritoneal  surfaces  in  contact.  He  not  only  did  this,  but 
described  it  in  print  several  years  before  Sanger,  so  that  everybody 
could  read  how  he  did  it. 

The  Galbiatis  knife  for  pubiotomy. 

A ruptured  uterus  occurs  once  in  4000  cases.  Hugenburger  esti- 
mates the  mortality  from  ruptured  uterus  at  95  per  cent.;  Carl 
Braun  at  86  per  cent. 

Spaeth,  writing  before  the  conservative  operation  of  Sanger  had 
changed  the  results  of  practice,  said  that  there  had  not  been  a single 
case  in  the  lying-in  hospital  in  Vienna  during  the  century  in  which 
the  mother  had  survived. 

Baudon,  writing  in  1883,  said : “ In  Paris  there  has  been  one 
successful  case  in  eighty  years,  though  in  the  present  century  the 
operation  has  been  performed  on  as  many  as  fifty  women.” 

Leopold  says : “ The  danger  to  the  mother  increases  directly  as 
the  time  since  the  rupture,  and  the  forces  used  in  attempting  deliv- 
ery, those  factors  leading  to  exhaustion  from  haemorrhage  or  infec- 
tion. The  child  dies  very  soon  after  the  rupture.  The  mother  may 
show  considerable  shock  within  a very  short  time,  but  quick  assist- 
ance and  successful  control  of  the  haemorrhage  can  save  the  woman, 
and  allow  a favorable  prognosis  in  the  most  severe  tears,  where  the 
woman  is  seen  at  once. 

Rupture  of  the  uterus  anteriorly  at  the  vesico- uterine  fold  is  more 
frequent  than  has  been  generally  supposed.  A rupture  at  this  point 
does  not  necessarily  produce  severe  haemorrhage. 

Dr.  R.  P.  Harris  reports  nine  women  whose  wombs  had  been 
ripped  in  advanced  pregnancy  by  the  horns  of  infuriated  cattle,  with 
the  survival  of  four  women  and  four  children. 

In  another  report  of  six  cases  of  self-inflicted  Caesarian  section, 
five  of  the  women  recovered. 


550 


world’s  homoeopathic  congress. 


In  repeated  operations,  shall  the  incision  be  through  the  first? 
Not  unless  there  are  no  adhesions. 

If  the  urine  must  be  drawn,  have  the  vulva,  particularly  the  vesti- 
bule and  orifice  of  the  urethra,  antiseptic. 

After  Caesarian  section,  would  it  not  be  well  to  ligate  the  Fallopian 
tubes  for  the  future  safety  of  the  woman,  and  thus  have  no  repetition 
of  Caesarian  section? 

To  avoid  post-partum  uterine  relaxation,  operate  early. 

Vaginal  drainage  is  not  always  necessary. 

Consider  well  before  operating  upon  a dead  child. 

The  Jews,  from  very  ancient  times,  practiced  hysterotomy,  now 
called  Sectio  Caesaria. 

The  Greeks  were  acquainted  with  the  operation  of  removing  the 
child  while  the  mother  was  alive,  and  named  it  hysterotomia. 

The  first  case  recorded  with  anything  like  circumstantial  minuteness 
is  that  done  by  a sow  gelder  (Chatneur  of  Seigerheusen),  who  oper- 
ated on  his  own  wife. 

Kehrer  recommends  that  the  uterus  be  opened  at  the  level  of  the  in- 
ternal os  by  a transverse  incision,  thus  avoiding  the  placenta  and  a 
gaping  uterus. 

Cohnstein  recommended  that  the  whole  uterus  should  be  turned 
out  of  the  abdominal  wound,  and  that  the  opening  should  be  made 
on  its  posterior  aspect  while  the  aorta  is  being  compressed.  He  says 
the  uterine  tissue  is  thickest  behind,  and  therefore  less  likely  to 
gape. 

Do  not  use  the  utero-parietal  suture. 

Let  an  abdominal  bandage  be  worn  for  months  after  coeliotomy. 

Let  the  operation  be  thoroughly  and  quickly  done. 

To  secure  union  or  healing  without  pus  is  the  highest  attainment  of 
a surgeon,  and  counts  for  more  than  the  brilliant  operation. 

The  operation  may  be  brilliant  and  skilful,  but  success  depends  on 
the  proper  preparatory  and  subsequent  care. 

Caesarian  section  is  an  easy  operation. 

Bibliography. 

Cooper’s  Medical  Dictionary. 

Leishman’s  System  of  Midwifery. 

Reference  Hand-Book  of  the  Medical  Sciences. 

Lusk’s  Science  and  Art  of  Midwifery. 


CiESARIAN  SECTION. 


551 


The  American  Journal  of  Obstetrics  and  Diseases  of  Women  and 
Children. 

The  British  Gynaecological  Journal. 

Gynaecological  Transactions. 

Sanger — The  Caesarian  in  Cases  of  Uterine  Fibromata  ; Criti- 
cisms,  Studies,  and  Propositions  for  the  Improvement  of  the  Caesa- 
rian Section. 

Rousset — Traite  Mouveau  de  Chysterotomotakie,  ou  Enfantement 
Cesarienne. 

Medical  Record. 

North  American  Journal  of  Homoeopathy. 

Homoeopathic  Journal  of  Obstetrics,  Gynaecology  and  Paedology. 

Billings’s  National  Medical  Dictionary. 

The  Lancet. 

The  British  Medical  Journal. 

Arehiv.  fur  Gynak. 

Centralbl.  fur  Gynak. 

J.  Greig  Smith — Abdominal  Surgery. 

Herodotus. 

Josephus. 

Annual  of  the  Universal  Medical  Sciences. 

International  Clinics. 

The  International  Medical  Annual. 

Discussion. 

The  Chairman:  The  gentleman  who  was  appointed  to  lead  in 
the  discussion  of  this  paper  is  not  present.  The  paper,  therefore, 
will  be  in  the  hands  of  the  Congress  at  once,  and  I hope  we  may 
have  it  discussed.  I have  the  pleasure  of  introducing  to  you  Dr. 
Streeter,  who  will  open  the  discussion. 

J.  W.  Streeter,  M.D. : I don’t  mean  this  discussion  to  go  by 
default.  It  is  to  me  a very  interesting  paper.  I was  not  prepared 
to  discuss  it  secundum  artem , but  there  are  some  points  I desire  to 
emphasize.  I am  delighted  with  the  record  made  by  our  friend,  and 
I think  we  all  have  a right  to  be  proud  of  him.  I was  also  glad  to 
hear  that  my  old  friend  from  Toledo  had  done  such  good  work  in 
this  direction.  It  seems  to  me  that  the  Caesarean  section  is  grow- 
ing, that  the  demand  for  it  is  growing,  and  the  advisability  of  it  is 
growing,  and  just  in  proportion  as  the  doctors  and  the  people 
become  educated  to  what  seems  to  be  the  wisest  plan  for  women 
in  extremis,  just  so  soon  will  they  submit  to  an  early  operation, 


552 


world’s  homoeopathic  congress. 


and  it  seems  to  me  it  is  the  early  operation  that  is  bound  to  be  suc- 
cessful. Most  of  these  cases  which  the  doctor  narrated  were  upon 
women  in  extremis ; two  of  them  were  premeditated  cases.  I be- 
lieve, as  he  says  at  the  end  of  his  remarks,  Caesarean  section  is  an 
easy  operation.  It  is  an  easy  operation,  but  in  a majority  of  cases 
it  is  done  when  the  woman  is  so  far  exhausted,  so  extreme  in  her 
debility,  that  her  chances  are  not  at  all  good.  The  trouble  is  not 
in  the  operation,  but  in  deferring  to  a time  when  the  woman  does  not 
have  a reasonable  chance  for  her  life.  If  we  can  educate  ourselves 
and  our  patients  to  a belief  that  there  is  surgical  aid  in  these  ex- 
treme cases  of  pelvic  deformity,  that  it  is  a reasonably  safe  remedy, 
just  so  soon  have  we  done  them  and  ourselves  a very  great  service. 
It  is  only  a few  years  since,  if  a case  of  Caesarean  section  was  per- 
formed in  Europe,  it  was  heralded  all  over  the  world;  and  if  it  was 
done  in  this  country,  Europe  knew  it  by  telegraph.  Now  it  is  done 
throughout  the  country  and  in  the  backwoods,  and  successfully  done. 
It  is  a wonder,  too,  that  it  is  done  so  successfully,  because,  as  I said 
before,  most  of  the  women  are  half  moribund  before  the  operation 
is  commenced.  You  would  not  by  preference  operate  in  that  way. 
Discover  these  deformities,  if  you  can,  in  time,  and  set  the  time  to 
operate,  and  make  it  a premeditated  case.  Make  every  preparation 
for  it,  and  it  will  be  as  simple  and  as  satisfactory  in  its  results  as 
laparotomy.  I am  very  much  obliged  to  Dr.  Biggar  for  his  careful 
paper. 

The  Chairman  : While  waiting  for  another,  I might  interject  a 
word  with  regard  to  a double  Caesarean  section.  This  was  performed 
on  a woman,  and  she  recovered.  A silver  suture  was  used  in  the 
uterus.  The  doctor  told  me  all  about  this,  so  that  I speak  advi- 
sedly. He  used  the  silver  wire  in  the  uterine  wall,  twisting  it  down 
and  leaving  it;  and  when  he  came  to  do  his  second  operation  on  the 
same  woman,  three  or  four  years  later,  he  found  the  silver  sutures 
there  in  a perfect  state,  bright  and  clean.  The  uterus  had  gone  on 
in  its  expansion  and  the  silver  wire  had  not  caused  any  trouble.  He 
had  to  perform  this  second  operation  at  the  peril  of  his  life — a 
drunken  husband  threatening  to  kill  him  if  she  died,  and  he  deter- 
mined then  and  there  that  he  would  never  perform  it  on  her  again ; 
so  he  did  what  was  unknown  at  that  time,  and  I haven’t  heard  of 
it  having  been  done  anywhere  since;  he  ligated  the  Fallopian  tubes, 
and  so  stopped  the  business. 

E.  H.  Pratt,  M.D. : It  has  been  a long  time  since  I have  deliv- 
ered babies,  but  at  one  time  I was  doing  it  at  quite  a rapid  rate.  I 
never  killed  a child  to  save  a mother.  I have  been  called  upon  to 
deliver  them  after  they  have  been  killed — been  called  in  counsel. 

The  valuable  part  of  this  paper  to  me  lies  in  the  suggestion  of 
preventing  craniotomy.  It  is  very  rare  that  we  will  ever  come 
across  that  ; that  there  ever  occurs  a case  of  rupture  of  the  uterus 


CJE3ARIAN  SECTION. 


553 


into  the  peritoneal  cavity  at  confinement.  I have  never  encoun- 
tered one  in  my  personal  experience,  nor  have  I ever  come  in  contact 
with  a medical  gentleman  that  has  reported  such  a case  to  me.  They 
are  in  the  books,  and  Dr.  Biggar  very  kindly  furnished  us  with  illus- 
trations of  that  class  of  cases,  but  they  are  so  rare,  and  when  they  do- 
occur  the  collapse  is  so  extreme,  that  Caesarean  section  simply  offers 
a forlorn  hope  that  is  doomed  before  you  touch  it;  and  it  is  so  rare 
that  the  report  is  of  no  avail  to  us.  But  it  is  so  frequent  that  chil- 
dren are  too  large  to  be  born  in  the  natural  way,  and  they  have  to 
be  killed  or  die  from  very  prolonged  labor,  that  the  practical  sug- 
gestion of  doing  Caesarean  section  to  save  the  life  not  only  of  the 
mother  but  also  of  the  child  is  a very  valuable  part  of  the  paper. 

This  is  the  age,  I think,  of  abdominal  section  ; it  is  the  age  of 
going  into  the  abdominal  cavity  with  impunity.  I would  like  to 
relate  one  experience  which  I think  would  have  saved  not  only  the 
life  of  the  child  but  also  of  the  mother,  if  the  doctors  had  acted  upon 
the  knowledge  which  this  paper  makes  common  to  us. 

I was  called  to  a neighboring  town,  in  my  earlier  surgical  career, 
wdien  I was  not  as  old  or  as  brave  or  ^ competent  in  any  particular 
as  I am  present.  A woman  had  been  in  labor.  It  was  among  the 
poorer  classes,  it  was  the  very  centre  of  squalor.  They  were  an  un- 
happy, quarrelsome  family,  as  well  as  a half-starved,  half-clothed, 
and  halt-frozen  family.  It  was  cold  weather,  and  yet  they  had  no 
fire  in  the  house.  The  woman  had  been  in  labor  for  a week.  She 
was  a hunchback,  and  also  had  a distorted  pelvis,  so  much  so  that 
it  was  impossible  to  even  get  three  fingers  as  far  as  the  uterus.  It 
happened  to  be  a leg  presentation ; the  feet  came  down  first,  and 
the  doctors  pulled  the  child  away  piece-meal.  They  got  away  one 
leg,  and  then  the  other  leg,  and  then  the  body,  and  finally  the  arms, 
and  left  in  the  womb  nothing  but  the  head  itself.  The  woman  had 
been  trying  to  deliver  that  head  when  I saw  her  for  one  week,  and 
they  asked  me  to  come  and  perform  Caesarian  section.  I went  out 
there  prepared  for  Caesarian  section,  at  the  same  time  having  confi- 
dence that,  by  hook  or  crook,  I could  get  the  remains  of  that  child 
out  of  the  pelvic  cavity.  I went  with  all  the  instruments  at  my 
command,  but  was  unable  to  strike  the  head  by  any  instrument  with 
me,  and  so  I was  compelled  to  do  Caesarian  section.  I performed  it 
in  the  midst  of  that  dirt  and  squalor  and  the  uncomfortable  sur- 
roundings, to  the  best  of  my  ability.  It  was  not  an  antiseptic  opera- 
tion. The  conditions  were  not  favorable  to  it.  What  surprised  me 
at  that  time,  was  the  thickness  of  the  walls  of  the  uterus.  I ex- 
pected to  find  a tissue-paper  wall,  thin  and  wasted  away.  Instead  of 
that,  the  walls  of  the  uterine  cavity  were  fully  two  inches  thick. 

I opened  the  walls  and  removed  the  head  and  after-birth,  and  the 
blood  which  gushed  very  rapidly  at  first  as  I went  through  the  uterine 
walls,  stopped  itself  under  the  uterine  contractions.  I had  no  diffi- 


554 


WORLD  S HOMOEOPATHIC  CONGRESS. 


cully  in  checking  the  hsemorrhage.  I stitched  the  uterus  and  the 
abdomen,  and  left  the  patient  in  the  care  of  an  exceedingly  incom- 
petent nurse.  I am  satisfied  now,  if  I had  taken  the  precaution  to 
take  a nurse  with  me  I would  have  saved  the  woman.  She  lived  one 
week  without  fever  or  chills,  or  any  trouble  whatsoever,  but  at  the 
end  of  the  week  there  occurred  a family  row,  and  she  got  out  of  bed 
to  take  a hand  in  the  row.  The  result  was,  she  died  in  forty-eight 
hours. 

Dr.  Biggar:  Perhaps  some  of  the  gentlemen  in  the  audience 
have  also  performed  successfully,  or  otherwise,  Caesarian  section,  or 
knew  of  the  skill  of  Dr.  Lungren,  and  what  he  did. 

We  have  a late  case  in  this  city  by  Professor  Ludlam,  and  we  have 
a new  case  by  our  good  friend  and  Institute-President,  Dr.  McClel- 
land. I do  not  see  Dr.  Ludlam,  nor  do  I see  Dr.  McClelland,  but, 
perhaps,  if  their  names  are  called,  they  will  spontaneously  appear. 

The  Chairman  : Ladies  and  gentlemen,  Dr.  Ludlam  is  here. 

R.  Ludlam,  M.D. : Concerning  the  case  which  I reported  a little 
while  ago,  I suppose  that  everybody  reads  the  Clinique , and  if  they 
do,  intelligently,  they  must  be  familiar  with  the  case  which  I had 
the  honor  to  conduct.  The  Chairman  of  the  bureau  has  requested 
me  to  give  the  details  of  the  case,  and  therefore  I will  repeat  myself 
with  your  permission. 

I might  say,  by  way  of  premise,  that  so  far  as  I know,  my  case  is 
the  only  one  that  has  ever  been  made  in  this  country  because  of 
uterine  fibroid. 

Briefly,  the  case  was  one  of  pelvic  obstruction  by  a fibroid  which 
laid  below  the  child,  and  which  twisted  the  cervix  out  of  place  so 
it  never  came  down  and  was  not  accessible  in  any  way,  shape  or 
manner  from  below.  Another  peculiarity  of  the  case  was,  as  soon 
as  we  discovered  the  fibroid  within  the  pelvis  we  also  discovered,  or 
had  evidence  to  believe,  that  the  patient  was  pregnant  and  at  about  the 
fourth  month.  The  diagnosis,  however,  could  not  be  absolute.  I re- 
commended, under  the  circumstances,  the  making  of  an  exploratory 
incision  so  that  the  complicated  conditions  might  be  plain,  and  it 
might  appear  then  as  to  what  would  be  best,  whether  to  remove  the 
foetus,  to  remove  the  uterus — I mean  by  way  of  Paen’s  operation — 
taking  the  tumor  along  with  it  or  not,  or  to  leave  it  until  term.  So 
at  the  fourth  month,  as  I recollect,  we  made  an  exploratory  incision 
through  the  abdomen,  as  usual,  and  came  down  to  the  pregnant 
uterus  lying  off  to  the  right  side.  The  appearance  of  the  uterus,  the 
thickness  of  the  wall,  made  us  feel,  though  we  did  not  touch  it  much 
I assure  you,  that  the  patient  was  pregnant.  The  fibroid  could  be 
felt  below  the  brim  of  the  pelvis.  It  was  therefore  deemed  practi- 
cally impossible  or  impracticable  that  the  labor  should  be  consum- 
mated under  the  circumstances,  but  I said  with  plenty  of  space  for 
this  uterus  to  develop,  with'a  good  position  of  the  organ,  with  the 


CESARIAN  SECTION. 


555 


fact  that  this  tumor  does  not  involve  its  capacity  at  all,  why  not  let 
it  go  on  to  term. 

A reason,  and  very  weighty,  too,  under  the  circumstances,  was  that 
the  parents  were  said  to  be  very  desirous  to  have  a child.  The 
father  and  mother  prospectively  were  happy  with  the  idea  of  having 
a child,  and  I determined  if  any  means  could  secure  that  end,  those 
were  the  means  they  desired.  So  with  this  backing,  with  the  under- 
standing that  the  incision  was  exploratory,  the  wound  was  closed, 
and  we  decided  to  await  events.  I am  sure  that  during  the  next  to 
the  last  half  of  the  period  of  gestation  we  were  all  quite  anxious  as 
to  the  outcome  of  this  case.  We  recommended  exercise  in  the  open 
air,  plenty  of  good  food,  and  all  that  sort  of  thing,  and  in  the  most 
natural  way  she  rode  about  the  country  and  had  a good  time  until 
term,  and  then  we  were  to  be  notified  directly  there  was  any  appear- 
ance of  the  signs  of  labor. 

I remember  very  well  one  evening  coming  home  from  one  of  my 
lectures  with  my  assistant  and  found  a call  to  go  forty  miles  in  the 
country  by  the  very  first  train.  We  had  less  than  an  hour’s  time  to 
pack  up  our  duds  and  get  to  the  train.  We  reached  the  place  about 
one  o’clock  in  the  morning  and  went  to  this  little  private  hospital 
and  got  ready  to  look  the  case  over.  The  waters  had  been  discharged  ; 
the  cervix  could  not  be  felt  or  found  at  all  ; the  pain  had  subsided 
with  the  discharge  of  the  water.  We  had  a consultation  with  Dr. 
Clark,  who  was  looking  after  the  patient  and  was  to  assist  us  in  this 
matter,  and  did,  very  kindly.  We  resolved,  at  my  suggestion,  that 
we  would  not  wait  until  daylight  lest  the  pains  should  come  on  and 
constitute  an  obstacle. 

We  made  a window  in  that  uterus  and  got  the  little  rascal  out  of 
that  window  safely  for  himself — or  herself,  as  it  turned  out — and  the 
mother.  We  went  at  it  at  2 o’clock  in  the  morning  under  gaslight, 
and  I should  like  to  have  had  a photograph  of  the  scene.  Not  for 
any  advertising  purposes — God  forbid — but  as  a sort  of  reminiscence 
of  the  way  the  thing  was  done. 

We  made  an  incision  of  twelve  inches  over  the  abdomen,  and  an 
eight-inch  incision  through  the  uterus;  came  down  through  the  mem- 
branes, went  through  them  very  gently  and  quickly,  for  there  was  no 
time  to  waste  nor  time  to  discuss,  and  no  talk.  I had  instructed  my 
assistant,  Dr.  Stetler,  who  was  on  hand,  and  in  a lively  way,  too,  I 
assure  you,  to  tie  that  chord,  if  they  ever  got  at  it  and  the  youngster 
was  alive,  as  quickly  as  possible.  The  chord  was  tied  after  a man- 
ner that  I recommend  in  emergencies  and  haste  when  you  want 
delivery.  He  snapped  two  forceps  across  the  chord.  They  were 
gauged  forceps.  He  snapped  one  here  and  one  there,  and  a pair  of 
scissors  went  between,  and  a great  deal  more  quickly  than  I can  tell 
it,  the  baby  was  off  to  be  resuscitated.  When  the  baby  cried,  which 
was  while  we  were  delivering  the  after-birth,  we  heard  the  sound 


556 


world’s  homoeopathic  congress. 


which  was  music  to  us  and  to  the  new  mother.  The  short  of  this  is, 
that  the  mother  made  a prompt  and  excellent  recovery.  The  child 
weighed  eight  pounds,  and  I suppose  she  is  going  to  Sunday-school, 
now. 

H.  F.  Biggar,  M.D.  : In  regard  to  the  previous  report,  I would 
say  : in  a ruptured  uterus  it  was  the  first  I knew  anything  about, 
and  the  suspicion  of  it  was  the  syncope.  Some  writer  has  said 
— and  it  is  embodied  in  the  paper — that  a ruptured  uterus  occurs 
once  in  four  thousand  times.  This  is  from  the  Vienna  report.  I 
do  not  know  that  it  is  found  as  often  as  that.  It  is  merely  a statistic 
that  is  given  ; but  another  writer  says  that  a rupture  of  the  uterus 
occurs,  with  a proper  delivery  of  the  child,  more  frequenlly  than  is 
known  by  the  obstetrician.  What  data  he  may  have  for  saying  so  I 
do  not  know,  but  it  is  so  asserted. 

In  reference  to  the  fibroma,  with  which  Professor  Ludlam  has 
kindly  given  us  his  interesting  case,  I will  state  here,  as  he  did  not, 
that  one  of  the  five  Caesarian  sections  was  for  a fibroma,  in  which 
the  child  had  been  been  dead  three  days,  and  in  which  the 
mother  had  been  in  labor  some  thirty-six  or  forty  hours,  and 
it  was  thought  that  it  was  possible  to  deliver  her;  but  they  could 
not  do  so  on  account  of  the  fibrous  condition  of  the  os,  it  being 
crowded  way  up  behind  the  symphysis  pubis,  so  that  we  could 
not  reach  it,  and  we  performed  the  operation  ; that  the  weight  of 
the  tumor  and  uterus  was  eleven  and  a-half  pounds,  and  the  weight 
of  the  child  was  ten  pounds;  and  the  woman  went  ten  days  before 
death,  and  death  occurred  from  haemorrhage  of  the  womb.  We  had 
to  use  clamps.  The  ligature-clamps  had  not  been  introduced  by 
Keith,  and  even  if  Keith’s  clamps  had  been  in  use  at  the  hospital, 
she  was  at  her  home  when  the  haemorrhage  began,  and  they  sent 
for  her  physician,  but  he  could  not  get  there  in  time. 

I may  state,  in  conclusion,  that  Akron,  Ohio,  has  afforded  two 
of  these  cases.  It  nearly  afforded  a third  case;  if  I had  received 
the  telegram  in  time  to  catch  the  train  the  woman  might  possibly 
have  been  saved  ; but  I got  there  six  hours  after  on  the  next  train, 
and  when  I was  going  to  the  house,  which  was  three  miles  out  of 
Akron,  and  some  little  distance  from  the  road — for  they  were  poor 
German  people — the  two  doctors  came  to  meet  me  in  a carriage,  and 
told  me  about  the  case,  and  said  that  we  would  have  to  perform 
Caesarian  section  on  account  of  some  obstruction.  As  I stated  in 
the  paper,  the  conjugate  diameter  is  not  the  test  whether  you  shall 
operate  or  not.  There  are  other  conditions  existing,  which  you 
must  look  to.  When  we  were  leisurely  walking  up  to  the  house, 
expecting  to  perform  the  Caesarian  section,  the  husband  came  out 
and  told  us  to  hasten,  and  when  we  got  to  the  door  we  heard  the 
cry  of  the  child.  The  child  was  born.  The  midwife  had  turned 
the  woman  in  a different  position,  or  rather  put  her  in  a knee-elbow 
position,  which  enabled  the  child  to  be  born. 


CAESARIAN  SECTION. 


557 


This  was  a case  of  uterine-fibroma,  the  size  of  a cocoanut,  situa- 
ted at  the  junction  of  the  cervix  with  the  body,  and  the  Doctors 
could  not,  under  any  circumstances,  get  inside  of  the  womb  (so 
they  said) ; but  by  the  change  of  position  the  woman  was  able  to 
deliver — but  at  the  cost  of  her  life.  She  died  from  septicaemia, 
some  seven  or  eight  days  afterwards.  I think  by  Pean’s  opera- 
tion, or  Caesarian  section,  if  we  had  been  able  to  reach  there  six 
hours  earlier,  we  would  have  saved  the  mother. 


558 


world’s  homceopathic  congress. 


UTERINE  FIBROIDS . 

By  John  W.  Streeter,  M.D.,  Chicago,  III. 


The  non-malignant  neoplasms  of  the  uterus  are  classed  under  the 
general  name  of  fibro-myoma.  This  compound  word  covers,  at  least? 
two  distinct  classes — the  fibroid  or  connective-tissue  tumor,  and  the 
myoma  or  muscular-tissue  tumor.  They  differ  in  gross  and  in  mi- 
nute anatomy.  The  connective-tissue  tumor  is  in  the  uterus  but  not 
of  the  uterus.  It  has  a well  defined,  though  loose,  capsule,  from 
which  it  can  be  shelled  out  without  serious  deformity  to  the  organ 
in  which  it  is  found.  It  is  slow  of  growth  ; never  appears  before 
puberty,  or  after  the  menopause ; rarely  increases  after  the  meno- 
pause; causes  haemorrhage,  at  times,  and  pressure-symptoms,  but 
does  not  often  give  constitutional  symptoms,  and  is  seldom  the  im- 
mediate cause  of  death. 

The  myoma  is  chiefly  hypertrophied  muscular  tissue.  It  is  in  the 
womb  and  of  the  womb.  It  has  no  capsule  of  any  kind,  but  grad- 
ually shades  off  into  healthy  tissue.  It  is  usually  found  at  the  fun- 
dus, but  it  often  involves  a large  portion  of  the  organ.  It  cannot  be 
removed  without  seriously  mutilating  the  uterus.  It  growTs  rap- 
idly,  gives  constitutional  symptoms,  as  well  as  haemorrhages,  and  it 
is  frequently  the  subject  of  degenerative  changes,  either  cystic  or 
myxomatous. 

The  fibroid  is  much  more  common  than  the  myoma,  and  it  alone 
is  taken  as  the  subject  of  this  paper.  As  the  chief  interest  in  all 
morbid  growths  hinges  on  the  treatment,  I shall  have  but  little  to 
say  in  regard  to  its  pathology,  aetiology,  or  symptomatology. 

All  fibroids  of  the  uterus  begin  their  lives  within  the  muscular 
wall  of  this  organ.  They  remain  interstitial  or  intramural,  or  they 
grow  in  the  direction  of  least  resistance,  and  finally  become  either 
sub-peritoneal  or  sub-mucous.  This  accidental  development  gives 
rise  to  the  three  varieties  under  which  these  tumors  are  classed.  But 
whether  interstitial,  sub-peritoneal,  or  sub-mucous,  the  tumor  always 


UTERINE  FIBROIDS. 


559 


presents  the  same  general  characteristics.  It  is  a connective-tissue 
tumor,  firm,  hard,  somewhat  elastic,  pale  in  color,  cuts  like  carti- 
lage, and  its  cut  surface  shows  concentric  layers  of  connective  tissue 
arranged  around  one  or  more  centres.  It  grows  after  the  manner 
of  exogenous  plants  by  appropriating  layer  after  layer  of  the  loose 
connective-tissue  bark,  which  we  call  its  capsule.  It  receives  its 
blood-supply  from  the  large  vessels  which  ramify  in  this  capsule. 
Few  vessels  and  no  nerves  penetrate  the  substance  of  the  tumor. 
More  than  90  per  cent,  of  these  tumors  show  themselves  between  the 
ages  of  25  and  45.  In  clinical  interest  these  tumors  increase  in 
importance  from  without  inwards,  the  sub-peritoneal  ones  being  of 
least  importance.  Situated  under  the  covering  membrane  of  the 
uterus,  they  have  a strong  tendency  to  become  pedunculated,  and 
retain  but  a slender  hold  upon  that  organ.  They  do  not,  as  a rule, 
greatly  increase  the  size  of  that  organ,  do  not  often  cause  an  increase 
of  the  menstrual  discharge,  and  are  only  troublesome  on  account  of 
pressure  symptoms.  Indeed,  they  sometimes  sever  connection  with 
the  parent  organ  and  form  other  attachments,  or  remain  free  in  the 
abdomen;  nature,  in  these  cases,  giving  the  hint  to  the  surgeon  as 
to  the  best  method  of  treating  pedunculated  sub-peritoneal  tumors,  if 
they  become  burdensome.  This  variety  seems  to  be  but  little  affected 
by  either  medical  or  galvanic  treatment.  If  the  patient  cannot 
tolerate  the  growth,  there  is  but  one  remedy  and  that  the  knife. 

The  intra-mural  tumor  gives  more  marked  symptoms.  The  uterus 
is  enlarged  in  exact  ratio  with  the  size  of  the  tumor ; the  mucous 
lining  is  increased  in  area,  thickened,  softened,  and  made  more  vas- 
cular. This  gives  rise  to  the  menorrhagia  which  is  such  a frequent 
symptom.  These  cases  do  not  often  give  sudden  and  profuse  haem- 
orrhages, as  do  the  sub-mucous  ones ; but  the  bloody  discharge  is  so 
continuous  as  to  be  a serious  drain  upon  the  woman.  Add  to  this, 
the  pressure  upon  rectum  or  bladder,  or  both,  and  we  find  a com- 
bination which  is  distressing.  Medicinal  treatment  and  galvanism 
promise  more  in  these  cases  than  in  the  former,  but  still  they  do  not 
show  very  satisfactory  results.  It  is  the  sub-mucous  tumor  which 
gives  rise  to  the  most  distressing  and  serious  symptoms,  and  it  is, 
therefore,  of  the  greatest  clinical  interest.  Fortunately,  this  variety 
gives  us  the  widest  latitude  in  means  of  relief,  and,  in  most  respects, 
the  most  satisfactory  results. 

We  will,  for  a moment,  consider  the  cause  of  the  symptoms  which 


560 


world’s  homoeopathic  congress. 


the  sub-mucous  tumor  produces.  The  symptoms  of  sub-mucous 
fibroids  are  such  as  would  be  caused  by  a foreign  body  in  the  uter- 
ine cavity.  Nature’s  efforts  to  force  this  body,  first  into  the  cavity 
of  the  womb  and  then  expel  it  entirely,  gives  rise  to  pain  from  un- 
conscious contractions,  irregular  discharges  of  mucous  and  blood 
from  the  whole  lining  membrane,  and  occasional  profuse  haemor- 
rhages from  ruptured  vessels  or  sinuses  in  the  capsule.  The  effort 
of  nature  to  pedunculate  these  growths  and  then  expel  them,  gives 
the  surgeon  a useful  hint  as  to  treatment.  A moderate  percentage 
of  these  tumors  would  be  disposed  of  by  unaided  nature  if  it  were 
safe  to  wait.  Pedunculation,  with  gradual  wasting  of  the  pedicle, 
ulceration  of  mucous  covering  and  capsule,  with  enucleation  in  toto , 
or  the  breaking  down  of  the  tumor  and  its  discharge  in  offensive 
fragments,  are  not  uncommon,  and  some  women  pass  through  the 
ordeal  in  safety.  But  the  dangers  from  hemorrhage,  and  especially 
from  sepsis,  make  the  careful  surgeon  unwilling  to  trust  to  unaided 
nature,  and  they  force  him  to  do  in  an  aseptic  and  rapid  manner 
much  the  same  things  that  nature  is  trying  to  do  in  her  slow  and 
poisonous  way. 

Now  as  to  treatment.  First,  What  medicines  may  be  expected  to 
act  upon  those  neoplasms,  either  directly  or  by  diminishing  the  blood 
supply  to  the  capsule?  Almost  every  remedy  in  our  Materia  Med- 
ica  may  be  called  upon  to  cover  direct  or  intercurrent  symptoms,  but 
very  few  have  any  control  over  the  tumor  itself.  The  medicines 
which  have  been  the  most  used  are,  First,  the  Bromides,  which  are 
fast  going  out  of  use.  They  were  used  long  and  indiscriminately, 
but  with  little  effect.  Second,  the  Iodide  of  lime  in  material  doses, 
in  the  hope  that  the  deposit  of  the  lime  in  the  capsule  would  cut 
off  the  blood  supply  and  change  the  growing  tumor  into  the  quies- 
cent “ womb-stone.”  There  are  a few  cases  in  which  this  remedy 
seems  to  have  done  some  good.  Third.  Hydrastis  can.  is  coming 
into  rather  frequent  use  to  moderate  the  haemorrhages  and  for  a sup- 
posed specific  action  upon  the  tumor.  Fourth,  Ergot.  This  remedy 
has  had  many  advocates,  and  is  still  in  frequent  use.  It  acts  in  two 
ways  : First,  through  its  influence  on  the  muscular  coats  of  the  arte- 
ries, it  diminishes  their  calibre;  and  second,  by  exciting  muscular 
contraction  in  the  uterus,  it  cuts  off  the  blood  supply  or  favors  ex- 
pulsion of  the  tumor.  In  well-selected  cases  Ergot  will  prove  a 
useful  adjuvant,  but  it  should  not  be  depended  upon  in  any  case,  and 


UTERINE  FIBROIDS. 


561 


is  absolutely  useless  in  most.  In  the  sub-peritoneal  variety  it  is 
worse  than  useless;  in  the  interstitial  it  is  of  doubtful  benefit;  but 
in  the  sub-mucous  tumor  it  may,  if  wisely  used,  aid  in  the  enuclea- 
tion or  the  pedunculation  of  the  growth.  Thus  much  for  the  spe- 
cific medication  of  fibroids.  It  is  not  to  be  relied  upon.  I will  not 
speak  of  the  symptomatic  medicinal  treatment,  for  that  would  in- 
volve the  naming  of  half  of  our  Materia  Medica.  W ell-selected 
remedies  will  relieve  the  urgent  symptoms,  but  they  rarely,  if  ever, 
cure  the  fibroid. 

Electricity  holds  a prominent  place  in  the  treatment  of  these 
growths.  So  prominent  has  it  become  since  Apostoli  formulated 
and  published  his  methods  that,  in  the  opinion  of  many  gynaecolo- 
gists,  no  case  should  be  operated  upon  until  it  has  first  been  thor- 
oughly treated  by  the  galvanic  current.  My  investigation  and  ob- 
servation teach  me  that  at  least  50  per  cent,  of  sub-peritoneal  and 
intramural  tumors  are  benefited  by  galvanism,  and  some  of  them  are 
cured.  The  common  result  in  favorable  cases  is  moderate  shrinking  of 
the  tumor  and  a marked  diminution  in  the  symptoms,  due  to  pressure 
or  congestion.  In  the  sub-mucous  tumor  the  chances  of  permanent 
improvement  are  not  so  good.  The  positive  pole  will  check  the 
haemorrhage  for  the  time,  but  it  is  apt  to  return.  In  some  cases  it 
is  the  best  treatment  short  of  enucleation.  The  only  great  change 
which  has  come  since  Apostoli  formulated  his  views  is  the  disuse  of 
the  needle  and  actual  puncture.  Equally  good  results  are  obtained 
with  the  intra-uterine  electrode,  without  the  dangers  which  must 
attend  puncture.  The  almost  universal  rule  is  to  use  the  large 
abdominal  pad  with  the  positive  pole  and  a small  intra-uterine  elec- 
trode attached  to  the  negative  pole  in  all  cases  not  complicated  by 
haemorrhage.  In  the  bleeding  cases  the  poles  are  reversed.  A ser- 
viceable current  is  from  75  to  250  milliamperes  continued  from  four 
to  twelve  minutes,  and  repeated  from  two  to  six  times  per  week,  as 
the  case  can  bear  it.  Treatment  should  be  followed  three  weeks  in 
each  month  for  three  or  four  months. 

The  surgical  measures  for  the  palliation  of  symptoms  are:  first, 
ligation  of  uterine  arteries  through  the  lateral  fornices  ; second,  the 
removal  of  the  ovaries  and  tubes.  These  measures  are  warranted  in 
haemorrhagic  cases,  in  which,  for  various  reasons,  radical  measures 
are  contra-indicated.  Ligation  of  the  uterine  arteries  is  simple, 
easily  done,  and  unattended  by  danger.  As  the  chief  blood-supply 

36 


562 


world’s  homoeopathic  congress. 


is  through  these  vessels,  we  have  reason  to  expect  a marked  decrease 
in  the  haemorrhages.  The  removal  of  the  appendages  operates  in 
two  ways.  It  diminishes  the  blood-supply  (by  the  ligation  of  the 
ovarian  arteries),  and  it  produces  an  artificial  menopause  and  re- 
lieves the  woman  from  the  periodical  congestion  which  attends  her 
menstrual  life.  The  production  of  this  artificial  menopause  has 
given  excellent  results,  as  a rule.  The  tumors  cease  from  troubling, 
and  often  decrease  in  size.  A combination  of  the  two  methods 
ought  to  be  safe  and  very  successful.  First,  ligate  the  uterine  ar- 
teries, and  two  weeks  later  remove  the  ovaries  and  tubes.  The 
blood-supply  would  then  be  practically  inhibited,  and  the  tumor 
must  grow  less.  I have  done  these  operations,  in  one  case  with  the 
most  gratifying  result.  The  tumor  was  reduced  at  least  fifty  per  cent, 
in  one  year,  and  the  woman  lost  all  consciousness  of  it. 

In  speaking  of  radical  surgical  treatment  of  uterine  fibroids,  we 
must  divide  the  subject  into  two  classes — those  in  which  the  tumor 
can  be  removed  per  vaginam,  and  those  in  which  it  is  necessary  to 
open  the  abdomen.  The  first  class  should  include  only  'pedunculated 
sub-mucous  tumors.  The  exception  to  this  rule  would  be  an  occa- 
sional broad-based  or  sessile  sub-mucous  tumor.  The  enucleation  of 
Intramural  fibroids  per  vaginam  is  a more  serious  operation  than 
abdominal  extirpation  of  the  uterus,  and  should  not  be  attempted 
unless  under  very  exceptional  conditions.  The  pedunculated  fibroid 
‘is  nothing  more  than  a fibrous  polypus,  and  it  can  be  treated  as  such. 
The  cervix  is  to  be  widely  dilated,  the  tumor  seized  with  a strong 
volsellum  and  dragged  down  through  the  dilated  cervix  until  its 
pedicle  can  be  reached.  The  mucous  covering  of  the  pedicle  should 
now  be  cut  through  and  the  pedicle  “ shelled  ” away  from  the 
uterine  wall  by  the  finger-nail  or  some  blunt  instrument.  This 
insures  the  total  extirpation  of  the  growth.  Little  after-treatment 
is  required.  In  the  case  of  a sessile  tumor,  wide  dilatation  of  the 
cervix  is  to  be  followed  by  a longitudinal  incision  through  the  mu- 
cous covering  and  the  loose  capsule  of  the  growth.  The  membrane 
and  capsule  are  to  be  stripped  back,  right  and  left,  until  the  lower 
portion  of  the  hard  mass  can  be  grasped  by  strong  volsellum  forceps. 
Now  steady  and  persistent  traction  is  to  be  made  by  an  assistant, 
while  the  operator,  with  fingers,  blunt  scissors  or  such  other  blunt 
instruments  as  he  may  find  useful,  strives  to  loosen  the  tumor  from  its 
capsular  bed.  There  will  be  some  smart  spurts  of  blood,  but  these 


UTERINE  FIBROIDS. 


563 


will  not  last  long,  for  the  uterus  is  thrown  into  contractions  by  the 
traction  on  the  tumor,  and  we  now  have  a vis-a-tergo  to  help  expel 
this  foreign  body.  The  operation  is  a protracted  one,  and  the  patient 
need  not  be  kept  profoundly  anaesthetized.  She  should  be  watched 
carefully,  stimulated  if  necessary,  and  occasionally  the  operation  will 
have  to  be  suspended  for  twenty-four  hours  to  give  her  time  to  pick 
up.  If  this  is  the  case,  the  vagina  and  uterine  cavity  should  be  left 
in  an  absolutely  aseptic  condition,  and  thoroughly  packed  with  iodo- 
form gauze.  Usually  one  long  sitting  will  suffice,  and  the  tumor 
will  gradually  yield  to  traction  and  enucleation.  No  one  should 
undertake  the  enucleation  of  a broad-based  fibroid  without  being 
prepared  to  do  total  extirpation  if,  by  failure  or  by  accident,  this 
should  become  necessary. 

The  second  class  includes  all  interstitial  and  sub-peritoneal  cases 
which  require  surgical  interference.  During  the  past  few  years  “ Fi- 
bromectomy  ” (or,  as  the  Germans  say,  “ Myomectomy  ”)  has  been 
by  experiment  and  improved  technique  put  upon  a comparatively 
safe  footing.  The  great  mortality  which  followed  it,  even  in  the 
most  skillful  hands,  has  been  so  reduced  that  it  now  compares  favor- 
ably with  abdominal  section  for  other  causes.  In  most  eases  where 
fibromectomy  is  indicated,  it  is  impossible  to  determine  what  the 
exact  operation  shall  be  until  the  abdomen  is  opened.  The  variety, 
size,  position  and  relations  of  the  tumor  have  to  be  considered,  and 
also  the  age  and  the  social  and  domestic  condition  of  the  patient. 
In  some  cases  it  is  of  the  utmost  importance  to  leave  the  uterus  un- 
mutilated, that  the  woman  may  possibly  bear  children in  other 
cases  this  is  a matter  of  no  consequence,  and  the  easiest  and  safest 
way  may  be  adopted.  If  the  tumor  is  a subserous  one,  and  dis- 
tinctly pedunculated,  the  pedicle  may  be  ligated  after  the  manner  of 
an  ovarian  cyst-pedicle.  The  stump  should  be  cut  V-shaped  and 
carefully  sutured.  If  the  tumor  is  interstitial  and  small,  the  uterus 
may  be  split  wide  open  antro-posteriorly,  and  the  tumor  shelled  out, 
the  uterine  walls  being  drawn  again  together  by  layer  after  layer  of 
buried  catgut  sutures,  strengthened  on  the  peritoneal  surface  by  a 
few  deep  silk  ones.  Sessile,  sub-peritoneal,  and  interstitial  tumors, 
when  large,  can  only  be  removed  by  hysterectomy,  either  supra- 
vaginal or  total.  It  is  not  necessary  to  go  into  the  details  of  the 
various  methods  in  which  this  operation  has  been  done.  All  have 
had  their  advocates,  and  most  of  them  some  merit.  The  problem 


564 


world’s  homoeopathic  congress. 


of  the  pedicle  has  been  the  hard  one  to  solve.  Whether  it  should 
be  treated  extra-peritoneally  or  dropped  back  like  the  stump  of  an 
ovarian-cyst,  was  the  point  of  contention  between  abdominal  sur- 
geons. There  is  little  doubt  but  that  the  extra-peritoneal  advocates 
could  show  the  best  results,  even  when  their  only  method  was  to 
fix  the  stump  in  the  lower  angle  of  the  wound,  either  with  a clamp 
or  elastic  ligatures  and  skewers.  Martin’s  method  of  total  extirpa- 
tion settled  the  question  of  stump  so  far  as  his  cases  are  concerned, 
and  it  gives  good  drainage ; but  it  increases  the  mutilation,  the 
vagina  being  often  impaired.  Two  new  methods  for  the  extra-peri- 
toneal management  of  the  stump  have  been  presented  within  the 
last  three  years  : one  by  Dr.  Henry  P.  Byford,  of  Chicago,  and  the 
other  by  B.  F.  Baer,  of  Philadelphia.  Byford’s  plan  is  to  cut  and 
tear  through  the  anterior  vaginal  wall,  in  an  ingenious  way,  an 
opening  large  enough  to  admit  the  stump,  which  is  to  be  bent  for- 
ward and  forced  through  it.  The  stump  is  now  clamped  from 
within  the  vagina  and  allowed  to  slough.  This  is  unquestionably 
a great  improvement  over  the  old  methods,  but  it  lacks  in  sim- 
plicity. It  has  proved  very  successful  in  the  skilled  hands  of  its 
author.  The  method  of  Dr.  B.  F.  Baer,  of  Philadelphia,  is  sim- 
plicity itself,  and  it  commends  itself  for  several  reasons:  it  is  easily 
done,  the  stump  is  not  ligated,  and  therefore  will  not  slough ; it 
is  left  extra-peritoneal,  there  is  no  traction  upon  it,  and  there  is  no 
mutilation  of  the  vagina. 

The  peculiarities  of  Barr’s  operation  are  ligation  of  ovarian  arte- 
ries, cutting  loose  the  upper  part  of  the  broad  ligament,  stripping 
down  the  peritonaeum  from  a little  above  the  os  internum  in  front 
and  behind,  the  ligation  of  the  uterine  arteries,  either  through  the 
ligament  or  within  its  folds,  the  amputation  of  the  neck  so  as  to  re- 
move the  entire  supra-vaginal  portion,  the  stump  dropping  deeply 
into  the  pelvis  and  being  completely  hidden  by  the  raw  flaps  of 
peritonaeum,  and  the  stitching  together  of  these  flaps  by  Lembert 
sutures.  The  cervix  is  now  in  its  normal  position  as  regards  the 
vagina,  and  is  entirely  extra-peritoneal.  It  has  no  ligature  or  suture 
in  its  tissue,  and  it  is  covered  by  raw  peritonaeum,  which  will  imme- 
diately adhere  to  it.  If,  in  addition,  the  cervical  canal  is  widely 
dilated  before  it  is  dropped,  it  will  furnish  complete  self-drainage  in 
the  event  of  an  extra-peritoneal  abscess,  as  was  the  fact  in  one  of  my 
cases.  It  seems  to  me  that  this  is  the  simplest  method  of  abdominal 


UTERINE  FIBROIDS. 


565 


hysterectomy  and  the  one  which  promises  the  best  results.  It  treats 
the  stump  extra-peritoneally  without  tension  and  without  slough, 
and  it  leaves  the  vagina  unmutilated.  It  is  not  necessary  to  add, 
that  in  all  these  surgical  methods  the  most  perfect  aseptic  precautions 
are  of  the  utmost  importance. 

Discussion. 

H.  W.  Robey,  M.D.,  of  Kansas:  The  paper  of  Dr.  Streeter  has 
covered  the  field  of  fibroids  so  thoroughly  that  it  would  be  difficult 
for  me  to  add  anything  of  special  interest  to  the  subject,  and  I think 
the  best  that  I can  do  will  be  to  narrate  to  you  a very  few  experi- 
ences in  the  management  of  some  of  these  growths. 

Medicines,  as  a rule,  prove  inefficient  and  practically  worthless  so 
far  as  the  removal  of  these  neoplasms  is  concerned.  At  best,  I 
believe  they  can  only  serve  the  purpose  of  mitigating  or  palliating 
some  of  the  collateral  symptoms  that  go  along  in  the  case  with  the 
development  of  the  tumor.  We  see  in  the  medical  journals  occa- 
sionally, it  is  true,  reports  of  some  of  these  cases  being  cured  by  the  use 
of  remedies,  but  I think  the  fact  is,  that  the  actual  experiences  of  cures 
are  very  few.  Since  Lungren  promulgated  the  plan  of  cutting  off  the 
nutrition  of  these  growths,  cutting  off  the  blood  supplies  from  the 
uterus,  a good  deal  has  been  done  in  the  way  of  progress  in  the  man- 
agement of  these  cases.  You  know  that  Dr.  Boothby  has  achieved  a 
great  deal  of  reputation  in  the  treatment  of  these  cases  bv  simply  cut- 
ting off  the  blood  supply  and  removing,  in  many  cases,  the  entire 
ovaries  and  tubes,  and  in  ligating  the  uterine  arteries.  I have  found 
success  attending  a number  of  cases,  and  where  I have  tried  it  I have 
had  no  failures  in  what  I might  call  the  Pratt  treatment,  which  con- 
sists simply  in  treating  the  rectum  and  the  uterine  cavity  by  the 
methods  taught  us  by  Professor  Pratt.  Where  there  are  disorders  of 
nutrition,  where  there  are  hsemorrhoidal  conditions,  where  there  are 
conditions  of  false  growth,  false  membrane,  and  spongy  conditions  of 
the  endometrium,  a disordered  condition  of  the  blood  supply  and 
nutriment  of  the  uterine  structure,  I have  found  that  by  dilating  the 
rectum  and  clearing  up  the  haemorrhoids,  clearing  the  cavity  and 
clearing  out  the  debris , and  setting  the  circulation  going  in  a normal 
condition,  in  a number  of  cases  these  growths,  especially  the  intra- 
mural growths,  have  disappeared  in  the  course  of  two  or  three 
months,  or  had  very  much  diminished. 

I have  in  my  mind  one  case  where  I was  telegraphed  to  go  one 
hundred  miles  to  see  a patient  who  was  bleeding  to  death  from  inter- 
nal tumor.  When  I arrived  the  patient  was  exhausted  and  scarcely 
able  to  lift  a finger  or  to  speak  above  a whisper.  I found  there  was 
a growth  of  a very  large  size  protruding.  I immediately  removed 
it.  The  lady  made  a good  recovery,  but  in  a little  while  another 


566 


world’s  homoeopathic  congress. 


developed.  She  then  came  to  Chicago  and  submitted  herself  to  a 
prominent  surgeon  in  this  city,  and  he  removed  the  growth.  She 
went  home  to  Kansas,  and  in  a short  time  another  developed.  She 
came  back  to  Chicago,  and  for  some  reason  or  other,  I know  not 
what,  the  surgeon  to  whom  she  had  applied  at  first  here,  who  had 
removed  one  tumor  for  her,  declined  to  operate  again,  and  sent  her 
home.  She  came  to  me  again,  and  I anaesthetized  her  and  made  my 
preparations  for  removal.  But  after  I had  given  her  an  anaesthetic 
and  dilated  the  rectum  sufficiently  so  I could  pass  my  hand  and  make 
a more  thorough  exploration,  I saw  the  tumor  was  intramural,  in- 
volving at  least  one-half  or  two-thirds  of  the  uterine  wall,  and  I 
thought  I knew  enough  to  back  out  of  the  undertaking.  I did  back 
out.  When  she  recovered  from  the  anaesthetic  I said  to  her  that  I 
believed  that  the  Apostoli  treatment  was  the  right  one  for  the  case. 
I gave  her  galvanic  treatments  for  three  months,  every  day  for  three 
weeks  of  that  time,  and  then,  when  the  period  passed,  the  haemorrhage 
being  comparatively  insignificant,  I applied  it  every -other  day  for 
another  three  weeks.  When  the  next  period  recurred  the  haemorrhage 
was  almost  entirely  abated,  and  after  that  I gave  another  month’s 
treatment.  The  patient  went  to  California,  and  I had  a letter  from 
her  a few  weeks  ago,  saying,  that  so  far  as  she  could  discover,  the 
tumor  had  entirely  disappeared.  In  that  case  I supposed,  as  nearly 
as  I could  ascertain,  that  the  tumor  was  as  large  as  a moderate-sized 
cocoanut,  but  by  giving  the  galvanic  treatment  it  has  entirely  disap- 
peared. 

I find  that  that  treatment  is  very  serviceable  in  a goodly  number 
of  these  cases.  I remember  a case  that  occurred  in  roy  city,  where 
the  patient  had  a very  large  growth  of  that  kind.  She  had  the 
treatment  of  a number  of  physicians,  and  finally  she  wanted  to  go 
back  to  Scotland  (of  which  country  she  was  a native)  before  dy- 
ing, and  I gave  her  a letter  of  introduction  to  Mr.  Keith,  who  was 
at  that  time  perhaps  second  to  Apostoli,  the  great  apostle  of  the 
galvanic  treatment.  He  gave  her  the  treatment  three  months,  and 
told  her  he  could  do  nothing  for  her.  He  had  arrested  apparently 
the  growth  and  caused  a diminution  of  probably  one- half  the  size 
of  the  growth.  It  was  intramural.  She  came  back  to  me,  and  I 
took  up  the  treatment  again  myself,  and  followed  it  about  three 
months  longer,  in  which  time  the  tumor  had  almost  entirely  disap- 
peared, and  she  is  now  in  good  health,  vigorous  and  active,  doing 
her  own  work  about  the  house,  and  seems  to  have  very  little  or  no 
inconvenience  whatever  from  that  cause. 

In  the  great  American  desert  we  raise  a good  many  things.  We 
raise  cane  sometimes  ; we  raise  wheat  and  corn,  and  we  raise  some 
large  tumors.  You  remember,  a few  years  ago,  perhaps,  that  Mr. 
Nast,  in  making  an  illustration  of  the  Kansas  calamity  of  grasshop- 
pers, pictured  a field  of  wheat  and  a rail  fence,  and  on  the  other  side 


UTERINE  FIBROIDS. 


567 


a very  large  grasshopper  with  the  motto  “ In  this  wheat  bv  and 
by.”  Now,  in  that  country  where  we  raised  two  hundred  millions 
of  corn  and  a hundred  and  fifty  millions  of  wheat  in  a year,  we 
sometimes  raise  large  tumors.  I have,  bottled  in  my  office,  and  I 
meant  to  have  brought  some  photographs  of  it  (but  forgot  them),  a 
fibroid  that  weighs  thirty-six  pounds  avoirdupois.  It  was  sub- 
peritoneal.  It  required  the  making  of  a large  abdominal  section, 
a large  incision  and  a long  one,  and  the  tumor,  when  turned  out 
of  its  bed  and  severed  from  its  attachment,  filled  a good  foot-pan 
almost  level  full.  I took  it  to  the  undertaker  to  see  what  he  could 
do  in  the  way  of  preserving  it,  and  he  embalmed  it  for  me.  He 
passed  his  trocar  and  his  aspirator  in  the  tumor  at  least  in  fifty  or 
more  places,  and  could  find  no  sac  or  cavity  or  any  liquid  of  any 
kind — the  growth  being  entirely  and  absolutely  solid,  through  and 
through.  I am  very  sorry  I cannot  produce  it  and  show  it  to  you, 
because  it  is  really  to  my  mind  a rare  sight.  It  was  a bloody  piece 
of  business,  but  I was  fortunate  in  getting  it  out  safely. 

Geo.  Royal,  M.H  : I would  like  to  relate  just  one  case,  because 
of  the  statement  that  has  been  made  by  two  of  the  speakers  upon 
this  subject,  and  I agree  with  the  speakers : and  that  is  in  the  inef- 
fectual use  of  remedies  as  a cure.  Eight  years  ago  there  came  under 
my  care  a lady  who  had  been  married  five  years,  suffering  from  all 
the  symptoms  of  a fibroid.  She  went  to  New  York  and  was  exam- 
ined by  Thomas.  A diagnosis  was  made  of  interstitial  fibroid,  and 
she  was  put  upon  Ergot  by  hypodermic  injection.  The  result  was 
not  satisfactory.  The  tumor  increased,  and  she  went  back  for  a re- 
examination, taking  a sister  with  her  who  was  suffering  from  the 
same  condition,  and  who  was  to  be  operated  upon  also.  The  sister 
died  in  the  operation.  The  woman  returned  home,  having  firmly 
made  up  her  mind  that  she  would  live  as  long  as  she  could,  and 
refusing  to  have  the  operation  performed.  I did  all  I could  to 
encourage  her  and  to  have  her  submit  to  an  operation,  but  she  ob- 
jected. Then  I thought  there  was  just  one  thing  to  do,  and  that 
was  to  ameliorate  the  symptoms  as  much  as  possible.  She  was  obliged 
to  be  in  bed  about  eighteen  of  the  twenty-eight  days.  I put  her 
upon  Trillium  the  second  day,  simply  to  control  haemorrhage.  The 
result  was  slow,  but  I could  see  improvement.  More  than  that, 
after  about  one  year’s  treatment,  and  she  took  this  Trillium  fourteen 
out  of  the  twenty-eight  days,  I could  notice  a perceptible  difference 
in  the  tumor,  and  she  became  pregnant.  She  miscarried,  during  the 
five  years  under  treatment,  three  times  ; but  after  being  treated  about 
five  years  and  two  months,  and,  I should  say,  taking  Trillium  about 
two-fifths  of  that  time,  she  gave  birth  to  a child  at  term  ; and  at 
that  time  I should  think  the  tumor,  which  before  had  been  larger 
than  a good-sized  orange,  was  hardly  perceptible.  The  child  is  now 
about  three  years  old,  and  I have  examined  her  twice  and  am  unable 


568 


WORLD  S HOMOEOPATHIC  CONGRESS. 


to  find  any  trace  whatever  of  the  tumor,  and  the  woman  is  perfectly 
healthy.  Whether  the  remedy  had  anything  to  do  with  it  or  not  I 
cannot  say,  but  I am  inclined  to  attribute  a little  benefit  to  the 
medicine. 

E.  B.  Finney,  M.D. : I had  one  case  come  to  me  last  fall  which 
I saw  once  before  I operated  upon  it.  There  was,  in  the  city,  an 
identical  case  operated  upon  by  our  best  surgeon  in  the  Old  School. 
My  patient  was  fifty-two  years  of  age,  and  his  thirty;  my  growth 
was  of  fourteen  years’  duration,  while  his  growth  was  only  of  about 
five.  My  patient  was  exhausted,  and  could  not  sleep  at  night  any 
longer  than  one  hour  at  a time  before  she  would  have  to  change  her 
position. 

In  his  case,  it  was  an  interstitial  fibroid,  and  he  cut  into  the  tumor 
through  the  vagina,  first  dilating  the  cervix.  He  found  it  would  be 
a very  tedious  job  to  remove  the  tumor  per  vaginam,  so  he  then  per- 
formed laparotomy,  removed  the  ovaries,  and  turned  his  patient  loose 
to  get  well. 

I cut  into  the  tumor;  and  my  patient  wanted  a child,  if  she  could 
possibly  have  it,  and  she  says,  “ Doctor,  I have  faith  in  Homoeop- 
athy, but  if’you  can  save  my  ovaries  do  it  above  all  things;  make 
it  the  last  resort.”  I found  it  a tedious  job;  but  I introduced  my 
knife  and  made  a long  incision  through  the  mucous  membrane  to  the 
tumor.  I then  grabbed  it  with  a pair  of  forceps  ordered  specially 
from  Philadelphia,  and  with  a long  pair  of  shears  I removed  it 
piecemeal,  and  the  largest  piece  was  no  larger  than  that  (indicating), 
and  the  last  piece  was  about  the  size  of  ray  fist ; it  weighed  three 
pounds  and  a half. 

I believe  that  we,  as  Homoeopathic  surgeons  especially,  scattered 
through  the  West,  are  afraid  of  the  criticism  that  may  reflect  upon 
our  school  if  a case  results  disastrously  ; and  again,  I have  a horror 
of  removing  an  ovary  if  there  is  any  way  of  preventing  it,  and  I 
believe  if  we  will  only  use  care,  and  take  these  cases  and  instruct 
our  patients  that  an  early  operation  will  prevent  failure,  and  may-be 
give  conception,  it  is  our  duty  as  surgeons  to  do  it. 

H.  F.  B*ggar,  M.D.  : First,  let  me  congratulate  Dr.  Streeter  on 
his  valuable  paper,  which  I have  enjoyed  very  much.  I did  not 
understand  that  Dr.  Streeter  mentioned  the  diameters  of  the  fibroid. 
If  he  did,  it  escaped  me. 

In  the  use  of  electricity,  I have  found  that  it  is  of  no  use  in  those 
tumors  at  all.  Where  you  get  the  fibro  cystic  or  soft  tumor,  you 
get  a condition  of  septicaemia  which  you  must  avoid  ; the  advantage 
of  electricity  is  in  the  smooth,  round  tumor.  Is  it  not  so,  Dr. 
Streeter?  If  it  is  nodulated  in  any  way  whatever,  you  do  not  get 
the  natural  contraction  you  would  wish  from  the  electricity. 

One  other  point,  which  is  a clinical  experience  with  myself.  There 
are  two  remedies  very  valuable.  One  is  the  Ergot,  and  the  other  is 


UTERUS E FIBROIDS. 


569 


the  Ustilago.  But  there  are  two  conditions  in  which  one  is  good 
and  the  other  bad,  and  vice  versa.  If  you  have  the  hard  fibroma, 
you  get  a good  action  from  the  Ergot,  but  if  it  is  soft,  you  get  a good 
action  from  the  Ustilago. 

One  word  more  and  I am  done.  In  whatever  condition  you  may 
find  a uterine  fibroma,  in  all  the  different  varieties,  do  not  hesitate 
to  look  well  to  the  diet,  because  it  is  true  that  this  neoplasm  is  caused 
from  connective  tissue,  and  connective  tissue  is  fed  by  starch  or  sugar. 
Put  your  patient  on  the  roast  beef  or  red-meat  diet,  and  exclude  all 
starches,  and  give  them  nothing  but  good  green  vegetables,  and  you 
will  find  great  relief  from  these  growths. 

Dr.  Wilcox:  I would  like  to  enter  my  endorsement  of  the  state- 
ment about  galvanism  in  these  fibroid  tumors.  I have  had  many 
cases  of  fibroid  tumors,  and  I am  sure  that  galvanism  has  served  me 
well.  All  growths  are  relieved  by  galvanism.  Six  years  ago,  I 
reported  a case  of  fibroid  tumor  at  Saratoga  which  I had  relieved, 
which  measured  forty-six  inches,  and  which  I,  in  a few  months  re- 
duced to  twenty-six.  I heard  from  the  patient  not  a year  ago,  and 
there  has  been  no  additional  growth — she  has  remained  well.  I am 
sure  it  was  galvanism  that  removed  the  growth  and  cured  her ; and 
I believe  that  the  day  has  come  when  galvanism  and  electricity  will 
be  a boon  for  women  in  many  of  their  diseases. 


570 


world’s  homceopatiiic  congress. 


VAGINAL  HYSTERECTOMY. 

By  J.  M.  Lee,  M.D.,  Rochester,  N.  Y. 


This  operation  was  introduced  as  a cure  for  carcinoma  uteri,  but 
it  may  frequently  be  called  for  in  non-malignant  diseases,  as  pro- 
lapsus, intractable  inversion,  neurasthenia,  accumulation  of  pus  about 
the  uterus  (which  cannot  safely  be  reached  by  abdominal  section), 
extensive  laceration,  and  myoma  with  protracted  haemorrhage,  or 
pain,  not  amenable  to  other  treatment.  Such  well-known  surgeons 
as  Billroth,  Schede,  Schroeder,  Martin,  Olshausen,  Fritsche,  Kalten- 
bach,  Gusserow,  Leopold  and  others  have  placed  on  record  several 
hundred  operations,  with  a combined  mortality  of  about  fifteen  per 
cent. ; and  a half-dozen  individual  operators,  with  series  of  cases 
varying  in  number  from  thirty-five  to  eighty,  have  reduced  the  mor- 
tality to  five  per  cent.  This  brings  the  percentage  of  recoveries 
down  to  that  of  ovariotomy,  and  is  a marvellous  record.  But  we 
must  bear  in  mind  that  the  primary  results  are  not  the  most  satis- 
factory or  important ; the  operation  is  of  too  serious  a nature  to  be 
adopted  as  a palliative — it  should  be  employed  as  a curative  measure 
only.  Olshausen,  Shanta,  and  Fritsche*  have  each  had  47.5 
(per  cent.  ?)  of  their  patients  perfectly  free  from  recurrence  after 
the  lapse  of  two  years.  Martinf  had,  out  of 'fifty-eight  patients, 
thirty-four  free  from  recurrence  after  more  than  three  years ; out  of 
fifty-two  patients,  twenty-five  free  from  recurrence  after  four  years; 
out  of  thirty  cases,  eighteen  after  five  years;  out  of  nine,  six  after 
six  years ; out  of  two,  two  after  seven  years.  This  is  a combined 
average  of  seventy  and  three- tenths  per  cent,  of  his  patients  who 
were  perfectly  well  after  the  lapse  of  five  years.  In  order  to  secure 
these  results,  the  patients  must  be  selected  with  great  care.  If  the 
disease  has  involved  the  bladder,  vagina,  rectum,  or  broad  ligaments 
to  such  an  extent  that  the  uterus  is  not  movable  on  account  of  car- 


* Annals  of  Gynecology  for  November,  1892,  p.  78. 
f American  Journal  of  Obstetrics  for  October,  1892,  p.  535. 


VAGINAL  HYSTERECTOMY. 


571 


cinomatous  deposit  or  adhesions,  or  so  that  every  particle  of  the 
disease  cannot  be  extirpated,  this  operation  should  not  be  considered. 
However,  fixation  from  inflammatory  adhesions  is  not  a contra-indi- 
cation for  vaginal  hysterectomy.  Unfortunately  for  humanity,  these 
indications  render  unfit  for  operation  at  least  three-fourths  of  the 
patients  who  present  themselves  for  treatment.  This  is  due  to  the 
absence  of  symptoms  in  the  beginning  of  the  disease,  the  obstacles 
to  an  early  diagnosis,  and  faulty  teaching. 

There  are  four  symptoms  which  were  laid  down  by  the  older  au- 
thors, and  regarded  as  pathognomonic  of  carcinoma  uteri,  i.e.,  pain, 
foetid  discharge,  haemorrhage,  and  cachexia.  Now  these  are  extreme 
“ danger  signals  when  they  are  present,  it  would  be  a miracle  if 
a single  patient  could  be  cured,  and  to  wait  for  them  is  mur- 
derous. As  every  physician  knows,  the  cervix  uteri  is  not  very 
sensitive,  and  pain  does  not  develop  sufficiently  to  attract  attention 
until  the  internal  os  is  reached  and  the  greater  portion  of  the  cervix 
destroyed.  Then  the  uterine  nerves  and  vessels  are  involved  by 
carcinomatous  proliferation  ; there  is  haemorrhage ; the  discharge 
decomposes,  and  is  foetid  of  course  : ichor  is  absorbed  ; there  is  sep- 
ticaemia— all  of  which  develop  the  cancerous  cachexia.  The  laity, 
even,  readily  diagnose  the  disease  when  these  symptoms  are  present, 
and  many  physicians  wait  for  them,  although  modern  surgeons 
everywhere  oppose  such  practice.  This  careless,  negligent  and  un- 
scientific treatment,  or  lack  of  treatment,  must  be  given  up,  and 
with  it  that  other  untruthful  and  inhuman  doctrine,  that  nothing 
can  be  done  to  save  these  patient,  heroic  and  trustful  women.  In 
proportion  as  we  do  this,  will  we  increase  the  number  of  operable 
and  curable  cases,  and  corrpspondingly  lessen  the  great  majority 
whose  disease  has  been  allowed  to  reach  a point  where  we  can  only 
scrape  out  the  sloughing  tissue  and  disinfect  the  parts.  At  present 
three-quarters  of  the  patients  come  to  us  at  this  advanced  stage  of 
the  disease,  and  I believe  the  fact  is  largely  due  to  the  above  faulty 
teaching,  which  still  lingers  with  the  profession. 

The  symptoms  of  corporeal  carcinoma  in  the  beginning,  like 
those  present  when  it  is  in  the  cervix,  are  not  numerous  or  marked, 
and  the  inability  to  see  or  feel  the  disease  augments  the  difficulty  of 
diagnosis.  It  appears  to  be  more  frequent  in  the  nulliparae,  or 
women  who  have  borne  few  children,  and  have  not  sustained  cervical 
laceration.  The  attention  of  the  patient  or  physician  is  usually 


572 


world’s  homceopathic  congress. 


attracted,  as  in  disease  of  the  cervix,  by  occurrence  of  haemorrhage 
or  discharge,  which,  unlike  carcinoma  of  the^portio,  may  be  attended 
by  colicky  pains.  Bimanual  examination  does  not  afford  much,  if 
any,  information  until  the  disease  is  far  advanced  ; but  the  true  nature 
of  the  malady  may  be  made  out  by  dilatation  of  the  cervix  and  the 
removal  of  tissue  from  the  mucosa  for  microscopical  examination, 
the  same  as  in  the  diagnosis  of  cancer  of  the  cervix.  In  this  site 
the  disease  usually  develops  in  women  who  are  free  from  hereditary 
tendencies  to  carcinoma,  and  have  sustained  lacerations  of  the  cervix 
uteri  in  child-bearing.  The  rent  fails  to  heal  ; it  is  irritated  by  fre- 
quent coition,  by  parturition,  by  every  move  of  the  body,  and  finally 
epithelioma  develops  from  irritation — -just  as  on  the  lip  in  inveterate 
smokers  of  the  clay  pipe.  Now  the  most  important  feature  in  the 
treatment  of  the  disease  is  to  recognize  it  on  the  start,  when  it  is  a 
purely  local  affection,  and  amenable  to  treatment. 

Its  early  presence  may  be  discovered  by  inspection.  The  infil- 
trated portion  is  often  of  a yellowish  hue,  somewhat  elevated  and 
sharply  limited.  If  the  disease  be  carcinomatous,  bits  of  tissue  may 
easily  be  dislodged  by  the  finger-nail  ; and  where  the  growth  has 
moderately  developed,  the  information  imparted  to  the  educated 
touch  is  scarcely  inferior  to  that  of  the  microscope.  In  women 
from  thirty -five  years  of  age  upward,  every  unusual  leucorrhoea, 
watery  discharge,  spotting,  staining  of  clothing  after  coitus,  men- 
strual irregularity,  or  haemorrhage,  should  always  lead  the  physician 
to  be  on  the  alert,  lest  the  above  symptoms  be  misinterpreted,  and 
the  case  go  on  to  an  inoperable  stage  before  the  true  condition  of 
affairs  be  apprehended. 

There  is  a popular  belief  among  the  laity  and  physicians,  handed 
down  from  our  fathers,  that  it  is  not  unusual  to  have  haemorrhage, 
spotting,  or  other  irregularities,  at  the  menopause,  as  a normal  con- 
dition. This  notion  must  be  corrected.  It  is  not  true;  and  it  causes 
untold  suffering,  and  the  loss  of  scores  of  valuable  lives.  When  these 
symptoms  develop,  there  are  always  good  pathological  reasons  for 
their  appearance ; the  diagnosis  of  fibroma,  adenoma,  sarcoma,  or 
carcinoma  of  the  uterus  usually  explain  them,  and  enables  the  attend- 
ant to  apply  the  appropriate  surgical  treatment,  and  thus  escape  the 
disapprobation  which  always  follows  careless  treatment.  When  this 
has  been  done,  he  may  use  the  similimum  if  he  desires.  It  is  unpar- 
donable negligence  to  allow  carcinoma  uteri  to  advance  too  far,  and 


VAGINAL  HYSTERECTOMY. 


573 


the  poor  patient  to  be  doomed,  before  radical  treatment  is  even 
advised.  No  physician  should  attend  a patient,  especially  at  the 
menopause,  who  has  “ spotting,”  haemorrhage,  or  a watery  discharge, 
without  insisting  upon  a vaginal  examination,  the  use  of  the  sharp 
curette,  or  the  removal  of  a wedge-shaped  piece  from  the  cervix 
uteri  for  microscopical  examination,  if  necessary.  Should  the  pa- 
tient decline  these  all-important  diagnostic  methods,  or  radical  treat- 
ment, the  only  way  to  escape  condemnation  is  to  abandon  the  case. 
If  the  family  physician  does  not  take  this  course,  the  surgeon  may 
shield  him  faithfully  and  conscientiously,  yet  the  friends  will  ever 
after  censure  that  physician,  and  very  justly  so,  too. 

In  the  preparatory  treatment  most  operators  consume  from  three 
to  six  days.  This  is  not  only  unnecessary  but  positively  harmful. 
Patients  grow  very  nervous  after  they  enter  the  hospital  with  the 
expectation  of  an  operation ; and  a long  and  tedious  course  of  diet- 
ing, scrubbing,  and  douching,  unsettles  and  depresses  them.  I do 
not  favor  curetting  as  a preparatory  treatment.  It  subjects  the  pa- 
tient to  unnecessary  operations,  with  loss  of  blood  and  strength  ; it 
opens  the  vessels,  and  may  give  rise  to  sepsis  or  cancerous  affection. 
While  I know  that  the  success  <^f  every  operation  depends  upon  the 
most  careful  preparation,  yet  I believe  that  eighteen  hours  is  suffi- 
cient time  for  any  surgeon  to  place  his  patient  in  the  best  condition 
of  surgical  cleanliness  and  thorough  preparation  for  the  anaesthetic. 
My  patients  do  not  usually  go  in  the  hospital  until  the  night  before 
the  operation  is  to  be  performed ; then  they  have  a general  bath,  a 
carbolized  douche,  1 to  80,  or  a bichloride,  1 to  1000 ; a clean  bed 
and  night  clothing.  The  next  morning,  a bath  and  a copious  douche 
is  given,  and  at  7 o’clock  a cup  of  beef-tea  on4y  is  allowed.  The 
external  genitalia  are  carefully  shaved  and  scrubbed  with  soap  and 
water.  At  10  o’clock  she  is  anaesthetized,  brought  into  the  operating 
room,  placed  in  the  lithotomy  position,  and  the  parts  are  again 
scrubbed  and  washed  with  soap  and  water.  The  bichloride  or  car- 
bolic douche  is  directed  on  the  parts,  and  the  vagina  is  for  the  second 
time  thoroughly  irrigated  and  washed  out  by  the  finger. 

The  clamp  operation  is  extremely  simple : The  patient  is  brought 
down  on  the  end  of  the  table,  and  is  secured  in  position  by  any  con- 
venient gynsepod,  or  held  by  assistants.  With  a strong,  blunt  pair 
of  scissors  the  mucous  membrane  is  divided  around  the  cervix  uteri, 
taking  care  to  keep  at  least  one-half  inch  from  the  diseased  tissue, 


574 


world’s  homoeopathic  congress. 


and  not  to  enter  the  bladder  or  rectum.  The  flap  of  vaginal  tissue, 
if  it  be  found  necessary  to  go  out  so  far,  is  dissected  down  to  the 
cervix,  and  the  connective  tissue  between  the  rectum  and  bladder 
divided,  chiefly  by  the  fingers  and  thumb-nail.  In  most  cases,  after 
the  circular  incision  is  made,  cutting  instruments  are  not  used  until 
the  broad  ligaments  are  divided,  and  not  a single  vessel  requires  the 
ligature.  In  a few  instances,  however,  while  separating  the  bladder 
or  rectum,  bands  of  strong  cellular  tissue  must  be  divided  by  the 
scissors  before  the  dissection  can  progress. 

The  pelvic  cavity  is  opened  either  before  or  behind  the  cervix,  just 
as  is  convenient,  and  the  peritonaeum  torn  from  the  uterus  back  to 
the  broad  ligaments  on  both  sides. 

On  account  of  the  stretching  of  the  peritonaeum  before  the  fingers, 
I have  sometimes  found  it  necessary  to  puncture  it  with  a slender 
pair  of  uterine  dilators,  expand  the  blades,  and  thus  make  an  open- 
ing for  my  finger.  When  a good  hold  is  obtained  it  is  not  usually 
difficult  to  tear  the  peritonaeum  back  to  the  broad  ligaments  on  each 
side.  Now  the  orgafi  is  free  from  all  attachments  except  the  broad 
ligaments,  and  the  clamps  may  be  applied  without  difficulty.  If, 
however,  the  vagina  is  long  and  narrow,  and  the  uterus  above  the 
average  size,  the  case  is  very  different.  In  such  a condition  the 
soft,  cancerous  granulations  must  be  scraped  away,  the  cervix  packed 
with  gauze,  and  sewed  up  to  prevent  infection  ; then  the  uterus 
Should  be  inverted.  This  affords  a great  advantage,  as  it  brings 
the  fundus  down  where  the  ligaments  are  within  easy  reach,  so  that 
they  can  be  readily  tied  by  the  progressive  ligature,  or  clamped.  If 
these  instruments  be  applied,  the  sliding  knives  with  which  they 
are  provided  may  be  pushed  home,  and  the  uterus  cut  away.  This 
knife  attachment  is  an  important  feature  of  the  clamps,  as  in  large 
uteri  or  small  vaginae  it  is  both  difficult  and  dangerous  to  cut  the 
uterus  away  with  the  scissors. 

Another  desirable  feature  of  the  clamps,  as  modified  by  me,  is 
the  peculiar  and  simple  hook -lock.  The  female  blade  is  first  intro- 
duced under  the  ligament,  and  may  be  used  as  a blunt  hook  to  draw 
the  part  into  view  so  that  the  male  blade  of  the  clamps  can  be  ap- 
plied over  the  ligament,  by  sight.  In  some  cases  the  ligament  cannot 
be  drawn  down  sufficiently,  and  we  are  obliged  to  adjust  the  instru- 
ment by  sense  of  touch  ; if  this  be  impossible,  it  can  usually  be 
locked  without  even  this  aid.  Next,  the  bladder  is  sufficiently 


VAGINAL  HYSTERECTOMY, 


575 


distended  to  be  sure  that  the  organ  has  not  been  wounded.  The 
rectum  also  is  inspected.  If  there  are  bleeding  points,  they  are 
tied.  A strip  of  gauze  is  carried  up  between  the  clamps  to  promote 
drainage,  and  the  vagina  protected  from  pressure  by  packing  gauze 
between  the  soft  parts  and  the  clamps.  Even  when  this  precau- 
tion is  taken,  there  is  usually  superficial  sloughing  of  the  vaginal 
mucosa,  but  it  does  no  harm. 

The  after-treatment  is  conducted  in  precisely  the  same  manner  as 
after  abdominal  operations.  No  food  is  given  by  the  mouth  for 
two  full  days.  A little  liquid  may  be  used  to  moisten  the  lips  ; the 
thirst  can  be  overcome  by  the  use  of  hot  water  enemas,  of  twelve 
ounces  each,  every  four  to  six  hours. 

If  there  has  been  considerable  loss  of  blood,  forty-five  grains  of  So- 
dium chloride  and  fifteen  grains  of  Sodium  bicarbonate  are  added  to 
the  enemas.  If  shock  is  present,  an  ounce  of  brandy  may  also  be 
included.  The  patient  is  kept  on  her  back  for  the  first  two  or  three 
days,  and  gaseous  accumulations  are  relieved  by  copious  enemas  of 
soap  and  water — or,  it  may  occasionally  be  necessary  to  add  turpen- 
tine emulsion  before  the  bowels  can  be  moved.  The  urine  is  drawn 
or  conducted  away  from  the  dressings  by  means  of  an  instrument 
shaped  like  a shoe-horn.  . The  dressings  are  changed  at  the  end  of 
the  first  twenty-four  hours  or  when  necessary,  except  the  gauze 
about  the  clamps  ; this  is  removed  with  these  instruments  at  the  end 
of  forty-eight  hours.  If  an  effort  is  made  to  remove  the  clamps 
sooner,  there  is  danger  of  haemorrhage.  In  three  out  of  a dozen 
cases  in  which  I removed  them  at  the  end  of  twenty-four  or  thirty- 
six  hours,  I was  obliged  to  take  the  patients  into  the  operating  room 
to  check  the  haemorrhage,  which  nearly  caused  loss  of  their  lives. 
But  I have  never  seen  a case  of  haemorrhage  follow  removal  of  the 
clamps  after  forty-eight  hours.  Boro-glyceride  is  the  best  applica- 
tion to  use,  as  it  depletes  the  somewhat  inflamed  tissues,  and  keeps 
the  parts  supple.  It  is  smeared  over  the  external  genitalia,  and 
introduced  into  the  vagina  by  the  fingers.  If  there  is  much  dis- 
charge, or  especially  foetor,  a carbolized  douche  is  used,  and  the 
external  genitalia  washed  twice  a day,  or  often  enough  to  ensure 
cleanliness.  Patients  are  allowed  to  get  out  of  bed  on  the  sixteenth 
day,  and  to  leave  the  hospital  in  about  three  weeks. 

The  clamp  operation  is  more  quickly  performed,  is  attended  by 
much  less  shock,  and  secures  the  vessels  with  greater  certainty  than 


576 


world’s  homoeopathic  congress. 


the  ligature.  Again,  the  technique  is  more  simple;  the  instruments 
and  appliances  actually  needed  for  this  method  of  performing  vag- 
inal hysterectomy  are : irrigator,  sterilized  water,  Sim’s  speculum, 
volsella,  blunt  scissors  curved  on  the  flat,  artery  forceps  No.  25  (F), 
conical  sound,  No.  1 catgut  ligature,  dressings,  and  a catheter  with 
which  to  test  the  bladder.  This  outfit  is  sufficient  in  most  cases, 
yet  in  complicated  ones  the  surgeon  should  have  at  hand,  besides 
the  above,  different  sizes  of  catgut  and  silk,  a scalpel,  and  aneurism 
needle.  It  is  my  practice  never  to  prepare  for  a simple  case,  but 
secure  everything  that  could  possibly  be  needed  under  any  circum- 
stances. 

The  operation  by  means  of  the  progressive  ligature,  as  it  is  desig- 
nated, has  serious  objections,  the  greatest  of  which  is  the  fatal  shock 
due  to  greater  traumatism,  and  length  of  time  consumed  with  the 
complicated  technique.  If  catgut  be  employed,  except  by  those  ac- 
customed to  its  preparation  or  use,  there  is  danger  that  it  will  slip, 
or  absorb  too  quickly  and  give  rise  to  secondary  haemorrhage ; silk, 
if  cut  short,  may  remain  as  a foreign  body,  keep  up  a discharge,  and 
make  it  necessary  to  annoy  the  patient  by  a second  operation  to  ex- 
tract it.  If  this  material  be  tied  down  and  the  ends  allowed  to 
protrude  from  the  wound,  there  is  danger  of  sepsis  from  capillary  at- 
traction, and  the  silk  threads  cannot  often  be  removed  before  the  fourth 
week.  Where  the  clamps  are  employed,  they  come  off  within  the  first 
forty-eight  hours,  there  is  but  little  danger  of  haemorrhage,  and  the 
patients  are  discharged  from  the  hospital  within  three  weeks.  Then, 
the  clamps  can  be  applied  much  higher  than  ligatures,  even  if  the 
vagina  be  stretched  or  incised.  The  objection  that  the  clamp  opera- 
tion is  unsurgical,  or  not  an  ideal  operation,  goes  for  nothing,  since 
better  results  have  been  obtained  from  them  than  from  the  liga- 
tures. 

For  the  past  six  years,  I have  practiced  according  to  the  foregoing 
principles,  with  success  which  has  been  satisfactory  to  myself,  and  a 
source  of  great  benefit  to  my  patients.  During  this  time  I have 
removed  the  uterus  per  vaginam  forty-two  times.  Many  of  these 
operations  were  easy  and  required  but  a few  minutes ; others  were 
complicated,  attended  by  accidents,  and  demanded  all  the  skill  I 
could  command.  The  shortest  operation  consumed  but  eight  minutes, 
and  the  lady  was  out  of  her  bed  only  a quarter  of  an  hour.  Three 
took  from  forty-five  minutes  to  an  hour,  and  one  two  and  one-half 


VAGINAL  HYSTERECTOMY. 


577 


hours;*  the  remainder  were  easily  finished  within  thirty  minutes. 
The  complications  which  prolonged  the  operations  were : Haemato- 
cele,  extension  of  the  carcinoma  to  the  broad  ligaments,  f very  large 
uteri  or  small  vaginae,  destruction  of  the  cervix,  and  inflammatory 
adhesions. 

The  operations  were  for  the  following  diseases:  Two  for  prolapsus 
uteri  (one  of  which  was  complicated  by  carcinoma  of  the  portio) ; 
two  for  neurasthenia;  one  for  a complete  unilateral  laceration  of  the 
uterus,  with  an  incurable  purulent  discharge ; one  for  malignant  ad- 
enoma ; two,  each,  for  sarcoma  and  carcinoma  of  the  fundus  uteri. 
In  the  remainder,  thirty-two  cases,  the  cancerous  disease  started  in 
the  portio  or  cervical  canal. 

Two  patients  died,  and  the  causes  of  their  deaths  were  deter- 
mnied  by  post-mortem  examinations.  The  first  was  sent  by  Dr.  D. 
McPherson,  of  Palmyra,  N.  Y.  Death  was  from  septic  peritonitis 
caused  by  a cancerous  nodule  (three-quarters  of  an  inch  in  diameter) 
which  was  detached  during  the  operation,  and  lodged  in  the  pelvis 
near  the  origin  of  the  left  broad  ligament.  The  uterus  was  five 
inches  long,  and  correspondingly  thickened.  The  operation  was  ex- 
ceedingly difficult.  The  second  death  was  a patient  from  Dr.  W. 
M.  Follet,  of  Seneca  Falls,  N.  Y.,and  was  caused  by  ileus.  I opened 
the  abdomen  and  broke  up  the  adhesions  which  obstructed  the  in- 
testines, but  she  did  not  have  sufficient  strength  to  undergo  the  sec- 
ond operation,  and  died  on  the  seventh  day.  Her  uterus  was  four 
and  one-half  inches  long,  and  the  operation  was  also  very  difficult. 

Forty-two  cases,  with  two  deaths,  make  my  mortality  in  vaginal 
hysterectomy  4.76  per  cent.,  a little  lower  than  the  average  in  ovari- 
otomy. 

Discussion. 

R.  Ludlam,  M.D.  : I am  very  glad  whenever  I can  offer  a word 
to  those  who  are  willing  to  hear  it,  that  may  add  to  the  experience 
of  those  who  are  practicing  in  so  serious  a department  of  gynaeco- 
logical work  as  that  to  which  this  paper  has  been  devoted.  Vaginal 
hysterectomy  is  one  of  the  grandest  expedients  that  has  been  devel- 
oped by  modern  times.  Its  resources  are  almost  limitless,  so  far  as 
it  can  be  applied  to  the  removal  of  the  uterus  and  diseased  conditions 
connected  therewith.  Nothing  more  marvellous,  more  wonderful,  or 


* Recovered  without  complications, 
f One  case. 


37 


578 


world’s  homceopathic  congress. 


satisfactory  has  been  done  in  any  department  of  surgery  than  this 
particular  operation.  I have  made  it  a good  many  times,  and 
every  time  have  been  more  and  more  satisfied  of  its  efficiency  and 
of  its  wide  range  of  application.  This  paper  does  not  go  into 
detail  with  reference  to  anything  except  vaginal  hysterectomy  for 
cancer,  and  the  technique  given  and  the  remarks  made  I most  hear- 
tily approve.  Especially  is  it  impossible  to  emphasize  what  the 
essayist  has  so  well  put  forth  as  to  the  importance  of  an  early  diag- 
nosis, and  of  an  early  operation  when  it  is  necessary  at  all.  This 
should  be  emphasized  in  the  presence  of  general  practitioners,  be- 
cause such  cases  are  put  off  until  the  evil  day  has  come,  and  the 
disease  has  progressed  so  far  that  even  this  recourse  will  be  of  little 
avail.  As  to  the  Doctor’s  idea  that  curetting  had  better  be  left  out 
as  part  of  this  operation,  I believe  he  is  perfectly  right.  As  to 
the  desirability  of  operating  upon  these  patients  early,  when  an 
operation  is  determined  upon,  and  not  allow  them  to  worry  or  reflect 
about  it  for  days  and  weeks  beforehand,  and  not  to  bring  them  into 
a hospital  until  you  are  about  ready  to  go  to  work,  I think  is  an 
excellent  one.  It  avoids  a mental  shock  beforehand,  and  it  puts  the 
patient  in  the  best  condition  for  operation,  for  she  doesn’t  stop  to 
think  much  about  it. 

I want  to  call  your  attention  to  one  fact,  however  ; and  that  is, 
that  the  French  are  far  ahead  of  the  Germans  in  this  matter,  and 
that  the  best  results  have  been  derived  by  them,  for  this  is  a French 
operation.  The  technique  which  the  Doctor  has  given  you  is  essen- 
tially Paen’s  operation,  or  Richelieu’s  operation,  neither  of  whom  are 
mentioned  in  his  paper.  As  to  the  results  derived  from  this  opera- 
tion for  vaginal  hysterectomy,  Paen  has  had  the  best  in  the  world, 
not  even  excepting  my  good  friend  Dr.  Lee,  whose  records  are  the 
best  on  this  side  of  the  water.  Dr.  Paen’s  last  report  gives  one 
hundred  and  fifty-eight  cases  of  vaginal  hysterectomy  with  one  hun- 
dred and  fifty-eight  recoveries.  I am  something  of  a Frenchman  by 
adoption,  and  do  not  want  the  French  left  out.  I do  not  believe, 
where  you  can  help  it,  in  leaving  ligatures  about  the  broad  liga- 
ments. 

It  has  been  my  good  fortune  to  see  the  operation  made  in  a number 
of  different  ways,  and  by  the  best  operator  in  the  world  (Leopold  of 
Dresden,  who  always  uses  the  ligature),  and  by  others.  The  Ger- 
mans will  not  make  the  operation  by  the  French  method  because  it 
is  French,  except  a single  man  in  Berlin,  and  he  uses  the  clamps  or 
forceps.  In  Paris,  nobody  will  use  the  ligature  because  it  is  the 
German  method,  and  the  best  way  for  us,  who  are  cosmopolitan,  is  to 
have  both,  and  use  whatever  we  like ; but  I believe,  with  Dr.  Lee, 
that  the  clamp  is  much  better  and  safer. 

I want  to  say  this  one  thing  in  favor  of  vaginal  hysterectomy  as 
over  any  form  of  abdominal  hysterectomy  that  has  been  devised  or 


VAGINAL  HYSTERECTOMY. 


579 


practiced  by  anybody  anywhere.  In  the  excellent  paper  that  we 
have  had  on  uterine  fibroid,  nothing  was  said  about  these  tumors 
being  always  almost  multiple,  and  of  their  recurrence.  They  don’t 
come  back  in  the  same  stump,  but  there  will  be  another  sprout,  like 
potatoes.  Now  so  long  as  any  of  the  uterine  muscular  tissue  is  left 
behind  by  any  operation  for  uterine  fibroids,  there  is  a possibility 
and  probability  of  recurrence.  If  you  know  your  business  you  can 
take  them  out  through  the  vagina.  I have  taken  out  by  the  vagina 
a uterus  with  twenty-three  fibroids  attached  to  it. 


580 


world’s  homoeopathic  congress. 


REMOVAL  OF  THE  ENTIRE  UTERUS , TOGETHER 
WITH  THE  APPENDAGES,  FOR  UTERINE 
FIBROIDS. 

By  Homer  I.  Ostrom,  M.D.,  New  York,  N.  Y. 


Since  sending  the  title  of  this  paper  to  our  Chairman,  I have 
been  able  to  clinically  verify  the  entire  practicability  of  an  operation 
that  I have  advocated  for  several  years,  namely,  when  we  remove 
the  ovaries  and  tubes  for  diseases  of  which  they  alone  are  the  seat, 
we  not  only  can,  but  should,  remove  the  uterus  also.  With  your 
permission,  therefore,  I will  include  the  above  proposition  in  this 
discussion,  reserving  it,  however,  for  the  close  of  the  paper. 

With  a better  understanding  of  the  principles  of  operative  surgery, 
and  the  perfecting  of  surgical  technique,  many  operations  are  justifia- 
ble and  possible  that  formerly  would  not  have  borne  the  test  that 
should  be  applied  to  all  scientific  procedures.  Thus  it  has  come  to  pass 
that  abdominal  surgery  occupies  its  present  proud  position,  for,  as  a 
rule,  knowledge  must  precede  practice  ; and  while  surgeons  for  many 
years  prior  to  the  work  of  our  countryman,  Ephraim  McDowell,  be- 
lieved that  abdominal  tumors  should  be  removed  byoperation,  it  has 
only  been  by  the  elimination  of  sources  of  failure,  the  removal  of  erro- 
neous conservatism,  and  the  perfection  of  methods,  that  we  are  able  to 
show  such  great  results  in  this  branch  of  our  art. 

Especially,  does  what  I have  said  apply  to  the  treatment  of 
uterine  tumors.  Ovariotomy  was  recognized  as  a legitimate  opera- 
tion long  before  hysterectomy  was  placed  in  the  same  position ; and, 
even  now,  in  some  quarters,  among  those  who  advocate  electrolysis, 
the  advances  of  this  branch  of  abdominal  surgery  are  steadily  re- 
sisted. But  we  cannot  discard  well-founded  theory,  or  refuse  facts 
gained  from  clinical  experience. 

There  is  nothing  in  the  operation  of  abdominal  hysterectomy, per 
sey  that  should  give  the  high  mortality  that  we  have  heretofore  been 
obliged  to  record.  With  improved  technique,  hysterectomy  for  uter- 


REMOVAL  OF  ENTIRE  UTERUS. 


581 


ine  fibroids  should  not  give  a higher  mortality  than  ovariotomy. 
The  length  of  incision  necessary  to  remove  a large  tumor  has  long 
ceased  to  be  regarded  as  influencing,  one  way  or  the  other  ; and  the 
manipulation  of  the  abdominal  organs  need  be  little  more  than  in 
ovariotomy.  Of  course,  there  is  more  manipulation  than  in  a plain- 
going ovariotomy,  but  not  more  than  in  cases  in  which  there  are 
adhesions  to  break  up  and  tie.  I think,  therefore,  we  are  justified  in 
concluding  that  the  former  mortality  of  abdominal  hysterectomy  is, 
in  a large  measure,  due  to  the  method  of  operating,  to  an  erroneous 
conception  of  pelvic  physiology,  and  to  false  conservatism. 

What,  for  example,  when  applied  to  any  other  department  of  sur- 
gery, can  be  less  in  accord  with  modern  surgery  than  to  leave  in 
position  a part  already  diseased,  or,  judging  from  its  previous  history, 
one  that  will  very  probably  become  diseased?  Or,  what  is  less  in 
accord  with  all  that  antisepsis  has  taught  us,  than  to  deliberately  in- 
vite suppuration  and  sloughing  of  tissue  as  in  the  extra-abdominal 
treatment  of  the  uterine  pedicle?  Why,  it  may  with  reason  be  asked,, 
should  we  leave  the  appendages,  or  any  part  of  the  uterus,  when  the 
major  part  of  the  latter  organ  is  taken  away?  We  have  long  since 
given  up  the  clamp  in  ovariotomy;  why  should  we  continue  its  use 
in  hysterectomy,  and  why  should  we  leave  any  pedicles  to  clamp? 
It  is  a cardinal  principle  of  all  operative  surgery,  that  the  risk  in- 
curred is  in  proportion  to  the  tissue  constricted,  and  that  the  ideal 
method  of  controlling  haemorrhage  is  by  ligating  the  artery  only ; 
in  proportion  as  we  apply  the  general  principles  of  surgery  to  ab- 
dominal work,  and  do  not  make  it  in  any  sense  an  exception,  I be- 
lieve we  will  make  it  a success.  The  abdomen  is  not  different  from 
other  parts,  save  that  it  contains  organs  essential  to  life,  and  is,  prac- 
tically, a closed  cavity;  and  if  we  work  here,  as  elsewhere,  carefully, 
expeditiously,  with  cleanliness,  removing  all  diseased  tissue,  tying 
all  arteries,  and  providing  means  for  the  escape  of  injurious  fluids, 
laparotomies  should  be  attended  with  no  more  danger  than  any  other 
major  surgical  operations. 

But  it  is  unnecessary  to  dwell  on  the  advantages  to  be  derived 
from  leaving  no  pedicles  in  abdominal  hysterectomy;  they  are  ap- 
parent, and  need  not  be  defended.  The  question  is,  how  can  this  be 
accomplished  with  a minimum  risk.  From  the  cases  that  I have  had 
during  the  past  winter,  eight  in  number,  in  which  I have  removed 
the  entire  uterus,  together  with  the  appendages  for  uterine  fibroids, 


582 


world's  homoeopathic  congress. 


I am  led  to  believe  that  this  operation  is  less  dangerous  than  under 
the  old  method  of  clamping  a uterine  pedicle.  It  is  certainly  more 
difficult ; but  this  should  not  weigh  against  the  advantages  gained. 
All  of  the  eight  cases  have  recovered  promptly,  with  but  little  suf- 
fering, and  with  really  no  constitutional  disturbance.  Indeed,  the 
usual  symptoms  of  change  of  life  so  frequently  observed  after  double 
oophorectomy,  have  not  been  well  marked.  With  increased  facility 
there  has  been  a corresponding  decrease  of  shock  attending  the  oper- 
ation, the  last  operation  having  been  completed  in  thirty  minutes. 
This  patient  walked  from  her  bed  to  her  chair  on  the  eighteenth  day, 
and  returned  to  her  home  in  four  weeks. 

My  method  of  operation  is  simple,  and  capable  of  great  rapidity, 
a matter  of  importance  to  the  patient  when  consistent  with  safety. 
After  opening  the  abdomen,  and  I make  the  incision  large  enough 
to  allow  free  manipulation,  I raise  the  tumor  by  screwing  into  it  my 
broad-flanged  corkscrew.  With  curved  needles  which  I have  had 
made  for  the  purpose  I ligate  first  the  left  ovarian  artery  as  near  its 
origin  as  possible.  I then  tear  or  cut  the  broad  ligament  down  to  the 
vaginal  vault.  This  brings  the  uterine  artery  into  the  field  of  oper- 
ating, which  is  tied  in  the  same  manner  as  the  ovarian  artery.  The 
right  side  is  then  treated  in  a similar  manner.  The  bladder  is  next 
separated  from  the  anterior  uterine  surface,  and  then  the  rectum 
from  the  posterior  surface,  when  it  will  be  found  that  the  tu- 
mor, uterus  and  appendages  can  be  lifted  out  of  the  pelvis.  But 
four  ligatures  remain  as  the  result  of  the  operation,  and  after  placing 
a drainage-tube  in  the  vagina,  the  abdominal  wound  is  closed. 

Now,  upon  drainage  I lay  great  stress,  and  consider  that  upon  its 
accomplishment  depends  much  of  the  success  of  the  operation  ; for, 
in  the  first  place,  it  is  an  indication  of  what  is  going  on  in  the  ab- 
dominal cavity  ; and  in  the  second  place,  it  acts  as  a safety-valve 
for  congestion  of  the  peritonaeum.  But  I have  found  considerable 
difficulty  in  maintaining  vaginal  drainage,  for  while  this  is  the  me- 
chanical drain  of  the  abdominal  cavity,  it  is  a fact  that  the  vagina 
tends  to  close  more  rapidly  than  is  consistent  with  perfect  and  con- 
tinued drainage.  Moreover,  the  pelvic  organs  seem  to  fall  upon  the 
drainage-tube,  and  close  the  mouth. 

I have  tried  various  methods ; the  latin-cross  drainage-tube,  the 
glass  drainage-tube,  the  iodoform  gauze — not  one  of  these  has  in 
my  hands,  so  far,  furnished  the  ideal  vaginal  drainage.  If  any 


REMOVAL  OF  ENTIRE  UTERUS. 


583 


preference  is  given,  I think  it  is  in  favor  of  a curved  glass  tube,  or 
a tampon  of  iodoform  gauze.  Either  one  of  these  keeps  the  vagina 
open  (the  latter  especially),  while  the  rubber  tube  closes,  and  the 
discharge  takes  place  outside  of  it. 

I have  come  to  look  upon  a free  discharge  during  the  first  twenty- 
four  hours  as  rather  favorable  than  otherwise.  Not  of  blood,  for 
this  should  practically  cease  in  six  or  eight  hours,  but  of  a bloody 
serum — for  this  indicates  that  the  peritonaeum  is  functionally  active, 
and  therefore  that  the  pelvic  circulation  is  not  in  any  way  interfered 
with. 

The  time  for  removing  drainage  depends  upon  several  conditions. 
A feeling  of  local  uneasiness  or  pain  in  the  rectum,  or  an  absence  of 
discharge,  will  point  to  its  removal ; for  when  these  conditions  exist 
the  tube  has  fulfilled  its  office  or  is  not  doing  its  work  well — in 
either  case  drainage  should  be  discontinued  or  readjusted. 

In  some  cases,  when  the  tumor  is  very  large  and  grows  low  down 
in  the  pelvis,  it  may  be  necessary  to  apply  the  temporary  clamp 
before  tying  the  uterine  arteries.  This  happened  in  two  of  my 
cases,  but  I think  it  must  be  exceptional,  for  after  liberating  the 
upper  border  of  the  broad  ligament,  the  principal  obstacle  to  raising 
the  uterus  is  removed. 

There  is  sometimes  rather  troublesome  bleeding  from  the  posterior 
vaginal  opening,  though  why,  I cannot  say — for  all  circulation  is 
cut  off  from  the  azygos  artery  after  tying  the  uterine  arteries,  of 
which  it  is  a branch.  Possibly  there  is  some  anomaly  of  the  circu- 
lation. It  therefore  would  probably  be  good  practice  always  to  sew 
the  serous  and  mucous  surfaces  together  with  fine  catgut  before  clos- 
ing the  abdominal  wound. 

I am  of  course  aware  that  only  very  imperfect  deductions  can  be 
drawn  from  eight  cases;  but  in  reviewing  these  they  compare  so 
favorably  with  those  operated  on  by  the  extra-abdominal-pedicle 
method,  both  as  to  mortality  and  convalescence,  that  I am  forced  to 
the  belief  that  the  principle  is  a true  one,  whatever  may  be  the 
changes  and  future  improvements  in  the  technique  of  operating.  As 
an  offset  against  the  great  suffering  and  prolonged  convalesence 
attendant  upon  the  suppurating  pedicle  and  consequent  dangers  of 
septic  infection,  of  the  older  methods — and  of  all  these  I regard  the 
elastic  ligature  and  pins  the  most  pernicious — we  have  the  minimum 
degree  of  suffering  (I  have  never  been  obliged  to  give  morphine 


584 


world’s  homoeopathic  congress. 


after  this  operation),  a convalesence  that  is  not  prolonged  over  more 
than  three  weeks,  no  suppurating  pedicle,  and  no  danger  of  septic 
infection.  I do  not  regard  this  operation  as  severe  as  the  older  one, 
nor  should  it  be  as  long,  for  usually  much  time  is  consumed  in 
making  and  securing  the  pedicle.  From  all  aspects,  therefore,  the- 
oretic, scientific,  and  practical,  I think  we  must  look  upon  the  remo- 
val of  the  entire  uterus,  together  with  the  appendages  for  uterine 
myoma,  as  an  operation  in  advance  of  the  older  one  of  leaving  a part 
of  the  uterus  to  form  an  extra-abdominal  pedicle. 

Let  me  add  a few  words  concerning  the  removal  of  the  uterus 
when  the  operation  is  undertaken  for  diseased  appendages.  For 
several  years  I have  considered  this  an  operation  that  we  must  resort 
to  if  we  would  give  our  patients  the  chances  of  recovery  that  they 
have  reason  to  expect,  from  the  scientific  attainments  of  the  day. 
The  technical  difficulties  in  the  way  of  its  accomplishment,  have, 
however,  until  recently  deterred  me  from  carrying  it  into  practice; 
but  with  a growing  disregard  of  a long  abdominal  incision,  with 
the  advantages  conferred  by  the  Trendelenburg  position,  and 
with  a confidence  acquired  from  my  success  in  total  extirpation  of 
the  uterus  for  fibroids,  I do  not  now  hesitate  to  remove  the  uterus 
with  the  appendages,  when  the  latter  alone  are  diseased.  The  five 
cases  in  which  I have  performed  this  operation  have  been  perfectly 
satisfactory.  But  one  died,  and  that  death  was  not  the  result  of 
the  operation,  but  was  due  to  the  excessive  restlessness  of  the  patient 
and  her  unruly  disposition.  These,  together,  brought  on  fatal 
secondary  haemorrhage. 

The  advantage  of  this  operation  over  the  certainly  less  severe  one 
of  double  oophorectomy  is,  that  the  cure  is  a radical  one.  I think 
any  laparotomist  of  experience  will  agree  with  me  that  cases  of  the 
removal  of  the  appendages  are  not  always  followed  by  the  expected 
brilliant  results.  Pain  continues,  frequently  more  severe  than  before 
the  operation.  The  uterus  remains  sensitive,  generally  becomes  dis- 
placed, either  backwards  or  downwards  ; in  other  words,  becomes, 
after  the  removal  of  the  ovaries  and  tubes,  a foreign  body,  and  as 
such  is  subject  to  the  laws  that  govern  such  bodies.  Again,  I repeat, 
that  with  improved  technique,  and  with  a better  understanding  of 
reproductive  physiology,  to  cure  our  patients,  when  it  becomes  nec- 
essary to  remove  the  appendages,  we  must  also  remove  the  uterus  if 
we  would  give  them  all  that  they  have  reason  to  expect  at  our  hands. 


REMOVAL  OF  ENTIRE  UTERUS. 


585 


My  method  of  operating  is  very  similar  to  that  of  removing  the 
uterus  and  appendages  for  uterine  tumors.  The  manipulation, 
however,  is  more  difficult,  for  the  reason  that  no  large  foreign  body 
has  existed  to  push  or  to  displace  the  pelvic  viscera  upwards;  but 
with  a large  incision,  and  with  the  intestines  held  out  of  the  way,  the 
operation  is  rendered  comparatively  easy. 

Discussion. 

Alonzo  Boothby, M D. : In  discussing  an  operation  like  “Total 
Extirpation  of  the  Uterus  through  the  Abdomen/’  it  is  necessary  to 
consider,  not  only  the  danger  attending  it,  and  the  results  that  may 
be  expected  from  it,  but  we  must  take  into  consideration  the  charac- 
ter of  the  disease,  whether  it  is  likely  to  produce  serious  disturbance 
or  death  in  the  near  future,  or  is  likely  to  remain  comparatively 
harmless  for  some  time. 

I think  we  may  safely  agree  with  the  paper  just  read,  that  this 
operation  has  come  to  be  recognized  as  not  only  a justifiable  one 
under  extreme  conditions,  but  one  that  should  be  frequently  made. 
Probably — in  fact,  I should  say  undoubtedly — the  danger  from  it  is 
a little  more  than  from  ovariotomy,  or  from  the  removal  of  ovaries 
and  tubes,  and  certainly  it  is  a more  difficult  one  to  make  under  or- 
dinary circumstances,  but  it  is  not  more  dangerous  than  ovariotomy 
was  a few  years  ago. 

The  question  arises — when  or  for  what  diseases  shall  this  operation 
be  done?  I should  say  that,  with  very  few  exceptions,  it  should  be 
done  for  only  two  conditions — uterine  fibromata  and  malignant  dis- 
eases of  the  uterus. 

In  the  paper  I am  to  discuss  the  claim  is  made  that  the  uterus 
should  be  removed  when  the  ovaries  and  tubes  are  removed,  whether 
it  is  diseased  or  not.  I should  most  decidedly  take  exception  to  this. 

I do  not  believe  that  it  should  be  removed  unless  it  is  the  seat  of 
a disease  that  is  not  readily  cured.  The  failure  to  obtain  favorable 
results  will  not  be  found  to  be  in  a healthy  uterus.  That  must  be 
sought  elsewhere.  It  will  frequently  be  found  in  a non-absorbable 
ligature. 

I assume  this,  because  I have  had  very  much  less  trouble  follow- 
ing my  abdominal  operations  since  using  nothing  but  catgut  liga- 
tures. Another  source  of  trouble  is  the  disturbance  to  the  bowels 
from  their  unfavorable  position,  and  from  the  adhesions  which  are 
unavoidable. 

The  method  of  operating  has  not  b6en  quite  so  clearly  put  as  it 
might  be.  True,  one  long  incision  and  raised  hips  are  essential 
steps,  but  when  we  consider  that  we  are  working  between  the  bladder 
in  front  and  the  rectum  behind,  with  the  ureters  on  each  side,  it  be- 
comes necessary  to  cut  and  sew  with  the  utmost  care.  Then,  it  is  a 


) 


586 


world’s  homceopathic  congress. 


fact  that  aside  from  the  ovarian  and  uterine  arteries,  the  parts  to  be 
severed  are  very  vascular  and  great  care  must  be  used  to  be  sure 
that  all  vessels  are  secured.  Just  here  it  may  not  be  out  of  place  to 
suggest  that  the  case  of  death  from  what  the  Doctor  calls  secondary 
haemorrhage  caused  by  the  restlessness  of  the  patient,  was  due  to  haem- 
orrhage from  small  unsecured  vessels,  and  that  the  restlessness  was 
due  to  this  haemorrhage.  I am  very  positive  in  my  position  that  we 
never  have  secondary  haemorrhage  except  from  a defect  in  securing 
the  vessels,  as  the  result  of  a septic  inflammation,  or  from  such  vio- 
lence as  would  be  impossible  from  the  movements  of  a patient. 

After  having  removed  the  ovary  in  the  ordinary  way,  I tie  the 
broad  ligament  in  sections  and  cut  it  across,  keeping  close  to  the 
uterus.  This  is  done  on  each  side;  then  an  incision  is  made  through 
the  peritonaeum,  in  front  and  back,  so  as  to  leave  flaps  that  can  be 
easily  united  later  on.  The  separation  of  the  uterus  from  the  bladder 
can  be  made  quite  rapidly  and  safely,  by  keeping  hard  against  the 
uterus,  and  the  same  is  true  from  behind.  In  case  of  a perfectly 
healthy  cervix,  the  dissection  should  be  carried  well  down  so  as  to 
leave  a comparatively  small  opening  into  the  vagina.  After  the  re- 
moval has  been  completed,  then  the  parts  should  be  brought  to- 
gether, using  at  first  buried  sutures,  and  at  the  same  time  closing  all 
the  bleeding  vessels.  This  will  bring  the  vaginal  mucous  membrane 
well  up  to  the  peritonseum,  which  is  to  be  stitched  together,  forming 
a long  seam  from  the  site  of  one  ovary  to  that  of  the  other.  In  the 
centre  a rubber  drainage-tube  may  be  carried  down  into  the  vagina; 
this  should  be  held  in  place  by  a catgut  suture,  and  should  not  pro- 
ject outside.  If  care  is  used  in  stopping  all  bleeding,  and  in  bring- 
ing the  peritoneal  surfaces  together,  there  is  scarcely  more  need  of 
a drainage-tube  than  there  is  in  making  a simple  ovariotomy. 

During  the  past  three  months  I have  removed  the  uterus  five 
times,  four  of  which  were  for  uterine  fibroids,  and  one  for  carcinoma 
of  the  uterus,  and  in  neither  case  has  there  been  any  symptoms  more 
severe  than  from  a simple  ovariotomy,  but  evidences  of  a more  pro- 
found impression  upon  the  system  have  existed,  and  it  has  required 
a longer  time  for  complete  recovery. 

I shall  not  raise  the  question  as  to  whether  every  case  of  uterine 
fibroid  should  be  removed,  and  with  it  the  uterus,  but  content  my- 
self with  the  opinion  that  this  is  the  course  to  pursue  in  a large 
number  of  cases.  In  carcinoma  extending  above  the  vaginal  cervix, 
but  not  so  far  as  to  prevent  the  removal  of  all  the  tissue  involved, 
I should  advise  total  extirpation,  and  that  through  the  abdomen. 

The  Chairman  : I think  we  can  congratulate  ourselves  on  the 
work  that  has  been  done  here.  I don’t  think  the  Institute  has  ever 
had  better  work  done  in  this  department  ; and  we  are  in  the  centre 
of  this  work  now.  If  we  had  a few  hours  left  we  could  go  on  and 
finish  up  the  work.  I know  that  many  of  you  are  ready  to  jump  to 


REMOVAL  OF  ENTIRE  UTERUS. 


587 


your  feet  with  opinions,  and  the  ball  has  just  been  opened.  Dr.  Lee 
would  like  to  respond,  so  would  others  like  to  throw  in  their  little 
mite,  and  so  swell  the  volume  of  knowledge  on  this  point.  We  can 
congratulate  ourselves,  however,  on  the  fact  that  we  have  such  a corps 
of  practitioners  able  to  handle  the  greatest  difficulties,  and  we  may 
well  take  pride  to  ourselves  when  we  find  men  coming  here  able  to 
compete  with  the  record  of  any  operators  on  earth.  We  have  them 
in  this  room  now.  The  section  now  stands  adjourned. 


REPORT 


OF  THE 

SECTION  IN  MATERIA  MEDICA. 


Chicago;  III.,  June  1,  1893. 

The  Section  in  Materia  Medica  of  the  World’s  Congress  of 
Homoeopathic  Physicians  and  Surgeons  convened  on  Thursday,  June 
1,  1893,  at  3 o’clock  P.M.,  in  the  Hall  of  Washington,  Art  Institute 
Building. 

Dr.  A.  C.  Co wperth  waite,  of  Chicago,  111.,  Chairman  of  the  Sec- 
tion, after  calling  the  meeting  to  order,  delivered  his  Inaugural 
Address,  taking  as  his  theme  “ The  Present  Condition  of  the  Ho- 
moeopathic Materia  Medica.” 

The  first  essay  read  was  by  A.  L.  Monroe,  M.D.,  of  Louisville, 
Ivy.,  entitled  “ A Study  of  Sepia,  Pathological,  Clinical,  and  Com- 
parative.” Its  discussion  was  by  Drs.  H.  C.  Allen,  of  Chicago,  111. ; 
Lizzie  Gray  Gutherz,  of  St.  Louis,  Mo.  ; T.  F.  Allen,  of  New 
York,  N.  Y.,  and  the  author  of  the  paper. 

The  next  paper  was  entitled  “ My  Bryonia  Day,”  by  Frank  Kraft, 
M.D.,  of  Cleveland,  O.  A discussion  was  had  by  Dr.  Wilson  A. 
Smith,  of  Morgan  Park,  111.,  and  Howard  Crutcher,  of  Chicago,  111. 

Dr.  Wm.  E.  Leonard,  of  Minneapolis,  Minn.,  presented  a paper 
on  “ The  Revival  of  Therapeutics.”  It  was  debated  by  Drs.  II. 
W.  Westover,  of  St.  Joseph,  Mo.,  and  J.  H.  Henry,  of  Montgom- 
ery, Ala. 

An  essay  was  read  by  Eldridge  C.  Price,  of  Baltimore,  Md.,  on 
“ Practical  Psychology  in  Its  Relation  to  Pathogenesy.”  The  dis- 
cussion was  by  Drs.  T.  S.  Hoyne,  of  Chicago,  III.,  A.  L.  Monroe, 
of  Louisville,  Ky.,  T.  F.  Allen,  of  New  York,  N.  Y.,  and  by  Dr. 
Price,  the  author  of  the  paper. 

An  essay  by  Charles  Mohr,  M.D.,  of  Philadelphia,  Pa.,  entitled 
“ Primary  and  Secondary  Symptoms  ; or  the  Opposite  Action  of 
Large  and  Small  Doses,”  was  presented  by  title. 

“ Phytolacca  Leaf,  Fruit  and  Root,”  by  Robert  Booeock,  M.D., 
of  Flatbush,  L.  I.,  N.  Y.,  was  also  presented  by  title. 

The  Section  was  then,  on  motion,  declared  adjourned. 


INAUGURAL  ADDRESS. 


589 


INAUGURAL  ADDRESS. 

By  A.  C.  Cowperthwaite,  M.D.,  Chicago,  III.,  Chairman. 


The  Present  Condition  of  the  Homoeopathic  Materia 

Medica. 

Over  a century  has  rolled  by  since  Hahnemann  laid  the  corner- 
stone to  the  foundation  of  the  Homoeopathic  Materia  Medica.  It 
would  seem  that  one  hundred  years’  experience  would  have  devel- 
oped all  of  the  faults  and  all  of  the  excellencies  of  any  system  of 
therapeutics — indeed  the  present  is  the  only  instance  where  any 
special  system  of  therapeutics  has  survived  the  lapse  of  a century. 

Systems  rise  and  shine  for  a while,  and  then  fall,  to  be  seen  and 
heard  of  no  more;  but  Hahnemann  built  upon  a more  solid  basis. 
His  mature  mind  had  seen  the  folly  of  attempting  to  build  a founda- 
tion upon  sand,  and  he  was  therefore  extremely  careful  that  the  soil 
upon  which  he  builded  should  be  of  an  enduring  character. 

As  the  years  rolled  by,  and  stone  after  stone  was  added  to  the 
structure,  it  is  not  surprising  that,  with  the  material  and  the  char- 
acter of  the  assistance  which  Hahnemann  received,  mistakes  should 
have  been  made  both  in  the  quality  and  amount  of  material  used,  and 
in  the  method  of  its  use.  So  we  find,  upon  examination  of  the  rec- 
ords of  provings  made  by  Hahnemann  and  his  immediate  disciples, 
that  errors  frequently  became  incorporated  into  the  Materia  Medica, 
sometimes  the  result  of  a mistake,  sometimes  the  result  of  an  over- 
fertile  imagination  of  an  over-zealous  worker.  Hahnemann  was 
naturally  systematic  in  all  his  methods,  but  in  spite  of  all  his  efforts 
it  was  impossible  for  him  to  insure  system  with  all  those  who  assisted 
him  in  the  work  he  was  carrying  forward.  Then,  too,  in  the  enthu- 
siasm of  the  time,  Hahnemann  allowed  to  enter  into  the  make  up 
of  his  Materia  Medica,  symptoms  which  he  did  not  claim  to  have 
obtained  by  provings,  but  which  he  had  seen  so  often  pass  away 
under  the  influence  of  the  remedy,  that  he  felt  fully  justified  in  in- 
corporating such  symptoms  in  the  Materia  Medica.  The  experience 


590 


world’s  homoeopathic  congress. 


of  one  hundred  years  has  strongly  developed  the  truth  of  many  of 
these  so-called  clinical  symptoms,  as  it  has  at  the  same  time  shown 
the  weakness  of  many  pathogenetic  symptoms  obtained  by  certain 
of  the  provers,  to  whom  reference  has  already  been  made. 

If  we  take  the  Homoeopathic  Materia  Medica  of  to-day  and  ex- 
amine it  as  a whole,  we  cannot  hel p being  appalled  at  the  magnitude 
of  its  symptomatology.  The  first  thought  that  strikes  us  is  the  ne- 
cessity of  reducing  this  vast  mass  of  symptoms  into  a smaller  compass, 
with  (if  possible)  a more  reliable  and  systematic  foundation.  To  this 
end  many  workers  in  Materia  Medica  have  been  aiming  for  the  past 
quarter  of  a century.  That  it  is  no  light  task,  is  evidenced  by  the 
fact  that  as  yet  but  little  headway  has  been  gained,  and  it  is  more 
than  probable  that  the  headway  which  has  been  gained  has  not  been 
altogether  in  the  direction  of  a better  and  purer  Materia  Medica. 

Ever  since  the  Encyclopaedia  of  Materia  Medica  was  given  us  by 
Dr.  Allen,  special  attention  has  been  called  to  the  necessity  of  weed- 
ing out  the  mistakes  that  have  been  made  in  the  accumulation  of 
that  vast  amount  of  material  necessary  to  give  us  the  Materia  Medica 
of  to-day.  How  to  accomplish  this  result  without  doing  more  injury 
than  good  has  been  a problem  that  has  not  as  yet  been  solved. 

Undoubtedly,  with  the  wheat  has  grown  up  much  chaff  that  should 
(if  possible)  be  separated  therefrom.  One  might  say  that  it  were 
better  to  let  them  grow  together  until  the  harvest ; another  might 
reply  the  harvest  time  has  already  come,  and  the  separating  of  the 
wheat  from  the  chaff  ought  not  longer  to  be  delayed. 

The  first  important  movement  in  this  direction  that  has  received 
the  official  sanction  of  the  Homoeopathic  School  of  medicine  is  em- 
braced in  that  most  admirable,  yet  greatly  abused  work,  the  Encyclo- 
paedia of  Drug  Pathogenesy. 

Therein  Dr.  Hughes  has  given  us  the  nearest  approach  to  a perfect 
pathogenetic  symptomatology  that  our  school  has  ever  possessed. 
Others  are  inclined  to  work  in  something  of  the  same  direction,  the 
great  cry  being  a reconstructed  Materia  Medica;  but  with  all  who 
undertake  a work  of  this  kind  there  seems  to  be  the  same  tendency 
to  too  freely  discard  the  entire  symptomatology  of  Hahnemann 
unless  the  same  be  established  by  such  overwhelming  proof  as  to  the 
original  source  from  which  it  was  obtained,  that  there  can  be  no  ques- 
tion whatever  as  to  its  authenticity. 

While  we  have  admitted  the  possibility  of  Hahnemann  having 


INAUGURAL  ADDRESS. 


591 


made  errors  in  the  compilation  of  his  great  work  on  Materia  Medica, 
and  while  we  are  still  more  willing  to  admit  that  errors  crept  into 
his  work  through  the  agency  of  those  who  were  acting  with  him, 
nevertheless  when  we  contemplate  the  fact  that  over  a hundred  years 
has  not  weakened  the  power  of  our  symptomatology,  we  ought  to 
realize  that  it  is  not  a very  little  thing  for  us  to  do  to  wipe  out  at  one 
stroke  of  the  pen  four-fifths  the  sum  of  all  the  symptoms  which 
have,  up  to  recent  date,  constituted  the  Homoeopathic  Materia 
Medica.  This  was  not  the  intention  of  those  who  edited  the  Ency- 
clopaedia. It  was  only  proposed  that  this  work  should  be  a basis  for 
future  experiment  in  drug  pathogenesy,  and  that  it  should  in  no  way 
abrogate  the  symptomatology  of  the  old  Materia  Medica.  At  the 
satne  time  there  are  those  to-day  who  see  the  necessity  of  doing  away 
entirely  with  many  symptoms  which  have  been  the  result  of  careful 
provings  frequently  verified. 

Careful  consideration  of  this  subject  shows  us  very  plainly  that  a 
large  majority  of  these  symptoms  which  have  been  the  sheet-anchor 
of  the  Homoeopathic  physician  for  nearly  a century  are  not  found  in 
this  much  desired  list  of  pathogenetic  symptoms.  There  is  scarcely 
a physician  living  of  the  older  school  of  Homoeopathy  that  has  not 
verified,  many  times  over,  thousands  of  symptoms  which  it  is  now 
proposed  to  entirely  emasculate  from  the  Homoeopathic  Materia 
Medica — indeed,  the  favored  symptoms,  those  which  oftenest  lead  the 
physician  to  the  prescription  of  the  drug,  are  not  to  be  found  in  the 
proposed  new  work  on  Materia  Medica. 

When  we  consider  the  wonderful  success  that  Homoeopathy  has 
achieved  during  its  existence,  and  when  we  realize  that  this  success 
has  been  entirely  due  to  the  application  of  drugs  in  accordance  with 
the  symptomatology  given  us  by  Hahnemann,  it  is  certainly  a matter 
which  we  should  approach  very  slowly  when  we  think  of  attempting 
to  throw  out  very  largely  the  very  class  of  symptoms  which  have 
made  Homoeopathy  what  it  is  to-day.  Therefore  we  hold,  that  while 
works  like  the  Cyclopaedia  of  Drug  Pathogenesy  are  of  inestimable 
value  as  forming  the  foundation  for  future  experiments  and,  if  you 
please,  the  building  of  the  reconstructed  Materia  Medica,  yet,  at  the 
same  time,  we  feel  that  the  duty  every  Homoeopathic  physician  owes 
to  the  memory  of  Hahnemann  and  the  past  success  of  Homoeopathy 
as  a distinct  system  of  practice,  is  that  he  should  not  discard  the  ex- 
periences of  the  past.  It  may  be  that  errors  have  crept  into  the 


592 


world’s  homoeopathic  congress. 


Materia  Medica  from  sources  which  we  least  expect ; it  may  be  pos- 
sible that  Allen’s  Encyclopxdia  of  Materia  Medica  is  a vast  mass  of 
rubbish  ; it  may  be  possible  that  Hering’s  Guiding  Symptoms — that 
wonderful  accumulation  of  clinical  experiences — is  worse  than  rub- 
bish ; but  these  are  what  has  made  Homoeopathy  what  it  is  to-day, 
and  we  certainly,  from  the  standpoint  of  practical  common  sense, 
cannot  afford  to  allow  them  to  be  relegated  to  the  past  in  order  to 
make  room  for  a reconstructed  Materia  Medica  upon  anew  and  more 
scientific — at  least  more  modern — basis. 

One  writer,  in  commenting  upon  the  necessity  of  reconstructing 
the  Materia  Medica,  says  : “ The  endeavor  should  be  to  study  drug- 
effects,  and  to  disentangle  from  the  pure  material  or  adventitious  de- 
tails ; to  separate  the  certain  and  probable  from  the  mere  possible, 
rejecting  the  impossible;”  and  he  concludes:  u Thus,  ultimately, 
will  be  submitted  to  the  world  of  medicine  and  Materia  Medica  the 
pure  drug-effects  and  synthetic  work  that  will  court  scientific  analysis 
and  criticism.” 

This  sounds  well,  and  if  we  can  build  up  such  a Materia  Medica 
as  this  without  in  the  least  allowing  it  to  interfere  with  the  Materia 
Medica  we  already  possess,  allowing  the  latter  to  be  our  working 
material  and  the  former  to  be  our  scientific  material,  until  such  time 
has  come  that  its  verification  clinically  shall  have  placed  it  beyond 
peradventure  of  a doubt,  then,  very  well ; but  that  produced  with 
the  Materia  Medica  of  Hahnemann,  as  now  adopted  and  in  use,  and 
which  has,  as  we  have  already  remarked,  been  the  basis  of  all  Hom- 
oeopathic practice  for  one  hundred  years,  we  contend  that  this  Mate- 
ria Medica,  while  it  may  not,  from  a modern  point  of  view,  be  able 
to  court  scientific  analysis  and  criticism,  is,  nevertheless,  the  Homoe- 
opathic Materia  Medica,  and  will  so  remain  so  long  as  time  shall 
endure. 

The  great  trouble  in  attempting  to  build  up  a new  and  recon- 
structed Materia  Medica  lies  in  the  fallibility  of  human  judgment. 

The  variations  of  opinion  as  to  the  principles  connected  with  the 
reproving  of  drugs  and  the  rearrangement  of  those  drugs  in  a Mate- 
ria Medica  that  one  might  consider  to  be  quite  wise  and  necessary 
and  reliable,  another  might  consider  useless  and  unnecessary. 

So  while  it  would  seem  that  it  may  be  best  to  reconstruct  the  Ma- 
teria Medica  upon  a pathogenetic  basis  and  give  us  a new  Materia 
Medica  that  will  be  scientific  and  possibly  practical,  we  nevertheless 


INAUGURAL  ADDRESS. 


593 


think  this  Materia  Mcdica  cannot  and  never  will  take  the  place  of 
the  Materia  Medica  already  in  existence.  We  may  question  as  much 
as  we  please,  the  fact,  however,  remains,  that  those  who  have  most 
closely  followed  the  symptomatology  as  we  now  have  it,  are  those 
who  have  been  the  most  successful  in  their  practice. 

Perhaps  it  might  prove  of  greater  benefit  were  we  to  expend  the 
same  amount  of  energy  required  for  reconstructing  the  Materia 
Medica  in  inducing  ourselves  and  others  to  more  closely  follow  that 
which  we  already  have. 

We  submit,  then,  that  the  present  condition  of  the  Homoeopathic 
Materia  Medica  is  favorable  to  the  upbuilding  of  the  Homoeopathic 
school  of  practice  if  we  will  only  be  contented  to  abide  by  it  and  not 
be  continually  looking  out  for  something  better  and  more  scientific 
in  its  character. 

I would  not  have  it  appear  that  I would  rest  satisfied  without 
ever  making  any  advancement  by  any  means.  The  work  of  reprov- 
ing, the  work  of  clinical  verification,  the  work  of  reconstruction,  if 
you  please,  should  be  going  on  continually,  but  not  in  that  wholesale 
way  that  means  the  destruction  of  all  that  has  gone  before.  Let  us 
make  the  best  of  that  which  we  already  have,  and  not  allow  our 
gre£t  desire  to  be  looked  upon  as  intensely  scientific  and  modern 
in  all  our  methods  and  plans  to  cause  us  to  entertain  the  great  mis- 
take of  proscribing  the  only  Materia  Medica  that  has  ever  proved 
its  value  at  the  bedside,  withstanding  the  crucial  tests  of  a century’s 
application. 


38 


594 


world’s  homceopathic  congress. 


A STUDY  OF  SEPIA , PATHOLOGICAL , CLINICAL 
AND  COMPARATIVE . 

By  A.  L.  Monroe,  M.D.,  Louisville,  Ky. 


The  early  history  of  Hahnemann,  which  is  coextensive  with  the 
early  history  of  Homoeopathy,  records  no  more  striking  example  of 
keen  intuition  than  that  displayed  in  the  manner  of  his  introduction 
of  Sepia — the  great  polychrest — into  our  Materia  Medica.  First, 
in  his  discovery  of  this  subtle  agent  as  the  cause  of  declining  health 
in  his  artist  friend,  and  next  in  his  thorough  proving  of  the  drug 
and  his  swift  recognition  of  its  ability  to  become  a valuable  thera- 
peutic aid. 

Provings  so  perfect  and  complete  had  he  made  single-handed  that 
the  efforts,  many  years  later,  of  an  army  of  provers,  both  male  and 
female,  kept  under  trained  observation  for  a long  time  by  the  Amer- 
ican Institute  of  Homoeopathy  not  only  did  not  add  to  or  take  from 
their  volume,  but  only  verified  them  in  their  entirety. 

All  this  considered,  I cannot  hope  to-day  to  add  materially  to  the 
knowledge  already  obtainable  by  you  of  the  drug,  but  wish  to  at- 
tempt, as  far  as  possible,  to  endow  it  with  a distinct  individuality, 
to  present  to  your  mind’s  eye  a cameo,  clear-cut  and  concise,  of  a 
therapeutic  agent  that  you  are  gratefully  using  every  day.  Not  only 
this,  but  as  the  present  method  of  imparting  Materia  Medica  is  a 
subject  of  perennial  interest  to  all  teachers  of  this  ultimatum,  this 
sine  qua  non  of  medical  science,  and  must  ever  determine  the  relative 
advance  of  Homoeopathy,  I will  inevitably  give  at  the  same  time  a 
hint  of  my  own  method  and,  perhaps,  draw  similarly  from  other 
teachers  present,  thus  inaugurating  a general  love-feast  of  giving 
and  receiving  that  may  refresh  and  improve  us  all. 

Sepia  is  a ganglionic  or  vegetative,  hence  we  natuially  expect  it  to 
prove  a deep  and  long-acting  remedy,  hence  one  exerting  a profound 
effect  upon  nutrition. 

As,  like  Apis  and  Lach.,  it  is  an  animal  poison,  we  expect  it  to 


A STUDY  OF  SEPIA. 


595 


produce  changes  in  the  blood,  affecting  not  only  its  chemical  char- 
acter, but  also  its  fluidity  and  nutritive  qualities.  In  all  these  re- 
spects we  are  not  disappointed.  With  altered  blood,  we  must  expect 
appreciative  effects  to  be  exerted  upon  the  nerve  centres,  hence  a 
condition  of  nervous  excitement  accompanied  by  weakness — a con- 
dition of  irritable  weakness  displaying  itself  in  circulatory  ebulli- 
tions and  depressed  nutrition.  Here,  again,  we  are  not  disappointed 
and  can  readily  trace  its  relationship  with  Apis  and  Lach.,  as  well 
as  with  Murex,  Moschus  and  other  drugs  of  animal  origin. 

With  this  state  of  depressed  nutrition  we  are  not  surprised  to  find 
existing  a relaxed  condition  of  all  of  the  tissues  of  the  body — an 
atonic  condition,  one  of  lassitude,  of  muscular  weakness  and  relaxa- 
tion not  only  of  the  voluntary  muscles,  but  more  palpably  in  this 
case  of  the  muscles  supplied  by  the  sympathetic  nerve,  including 
those  which  regulate  the  calibre  of  the  bloodvessels — a condition 
very  much  resembling  that  found  under  Gelsem.,  but  more  pro- 
found and  more  enduring.  Thus  Sepia  may  be  thought  of  as  the 
chronic  Gelsem.,  just  as  Sulph.  is  the  chronic  Aeon,  and  Calc.  carb. 
the  chronic  Bellad.  The  most  pronounced  evidence  of  this  tissue 
relaxation  is  shown  here  by  the  ever-present  tendency  in  the  Sepia 
patient  toward  a sagging  of  the  movable  tissues,  especially  the  depen- 
dent ones,  the  bowels,  the  rectum  and  the  womb,  giving  us  many 
of  the  most  important  characteristics  of  the  drug. 

1.  “ The  gone,  weak  feeling  in  the  epigastrium,”  due  to  the  deter- 
mination of  the  bowels  toward  the  lower  abdomen. 

2.  The  feeling  “as  though  the  womb  would  drop  out,  causing  her 
to  sit  down  and  to  cross  her  limbs  for  support/’  due  to  relaxation  of 
the  uterine  supports  as  well  as  to  the  passive  hypersemia  of  the  organ, 
increasing  its  weight. 

3.  The  prolapsus  recti  and  the  feeling  as  though  there  was  a weight 
in  the  rectum,  described  by  some  provers  as  a “round  ball.”  The  same 
atonic  tissues  give  the  Sepia  patient  the  “pot-belly,”  so  characteris- 
tic of  the  drug.  Accompanying  the  above  symptoms,  we  have  a 
sensory  hypersesthesia  characterized  by  mental  irritability,  an  intol- 
erance of  odors,  of  strong  light,  of  noise,  indicating  the  drug  in  gas- 
tric and  uterine  disorders  and  sick  headache;  also  an  intolerance  of 
contact,  often  indicating  it  in  vaginal  pruritus. 

This  hypersesthesia  is  pronounced  in  the  Nux  patient,  who  has 
the  same  intolerance  of  odors,  accompanied  here  by  the  irregular, 


596 


world’s  homoeopathic  congress. 

spasmodic  and  inefficient  performance  of  gastric  and  intestinal  func- 
tions; in  the  Lach.  patient  in  the  intolerance  of  touch  or  pressure 
displayed  in  the  desire  to  loosen  the  clothing,  especially  about  the 
neck  and  abdomen.  In  the  Phos.  patient  in  the  aggravation  from 
electrical  changes  in  the  air,  as  well  as  from  those  of  humidity.  In 
the  Silic.  patient  in  the  aggravation  from  light,  noise,  motion  and 
thermal  changes.  In  the  Arsen,  patient  in  the  irritable  weakness 
which  is  so  extreme  and  is  accompanied  by  such  great  mental  and 
physical  unrest. 

The  circulatory  irregularities  found  in  the  Sepia  patient  are  caused 
by  a paresis  of  the  vasomotor  nerve,  displaying  itself  notably  in  the 
portal  and  genito-urinary  vessels,  and  producing  a hypersemia  of  the 
most  dependent  organs  in  tbeir  distribution.  Hence  we  get  the  con- 
gested uterus,  rectum,  ovaries  and  kidneys,  producing,  in  their  turn, 
reflexes  all  over  the  body,  and  especially  are  they  responsible  for  the 
disorders  of  cerebral  circulation  and  perversion  of  gastric  digestion  so 
closely  simulating  the  disorders  of  pregnancy  and  of  the  climacteric. 

With  the  blood  altered  in  chemistry  and  specific  gravity,  we  find 
a lack  of  cohesiveness  in  its  parts,  and  an  exudation  of  coloring 
matters  into  the  skin,  producing  yellow  spots,  splotches,  and  (from 
the  same  cause)  acrid  excretions  and  scaly  eruptions  at  the  bends  of 
the  joints  where  the  sebaceous  glands  are  numerous — together  with 
catarrhs  from  all  of  the  mucous  membranes,  with  acrid  exudations, 
like  those  of  Sulphur,  Nitric  acid,  and  Kreasote.  This  condition 
reminds  us  throughout  of  Natrum  mur.,  which  is  distinguished  by 
its  inordinate  thirst,  its  extreme  emaciation,  its  dryness  of  all  sur- 
faces, mucous  and  cutaneous. 

The  two  remedies  are  also  much  alike,  as  you  know,  in  their 
mental  characteristics,  both  showing  the  uniform  depression,  aggra- 
vated by  consolation,  with  accompanying  irritability  • but,  with 
Sepia,  this  mental  state  generally  accompanies  vascular  excitement, 
depressing  emotions  or  other  nervous  impressions.  With  Nat.  Mur. 
it  is,  in  proportion  to  the  constipation,  present.  Lycop.,  too,  has 
the  mental  depression,  the  clear,  fair  skin,  mirroring  the  blood- 
vessels ; the  eruptions,  the  acrid  odoriferous  discharges,  the  passive 
hypersemia,  and  the  excessive  uric-acid  ' deposit  in  the  urine,  as 
found  under  the  other  two  ; but,  with  Lycop.,  we  find  the  full  feeling 
in  the  abdomen,  replacing  the  weak,  gone,  empty  feeling,  and  the 
patient  is  oftener  a man. 


A STUDY  OF  SEPIA. 


597 


As  to  the  modalities  of  aggravation,  Sepia,  like  Sulphur,  Lycop., 
Calc,  and  other  ganglionics,  is  aggravated  in  general  terms  by  atonic 
influences,  and*  ameliorated  by  tonic  influences,  as  would  seem 
inevitable  in  a drug  whose  grand  central  idea,  around  which 
all  others  revolve  and  are  secondary,  is  “tissue  relaxation.”  In 
conclusion,  there  is  no  better  way  of  fixing  Sepia’s  place,  clini- 
cally, than  to  compare  it  succinctly  with  Sulphur,  the  “ king- 
polychrest.” 

The  Sepia  patient  is  oftener  a female,  is  delicate,  dyspeptic,  and  de- 
pressed— the  latter  both  as  to  mind  and  viscera.  She  may  be  grace- 
ful and  beautiful,  and  if  typical,  she  is  both  ; but  she  is  abnormally 
sensitive,  not  only  as  to  her  special  senses,  but  mentally  as  well, 
and  the  slightest  emotion  will  produce  in  her  circulatory  ebullitions  ; 
in  short,  she  is  so  delicately  poised  that  her  harmony  is  easily  de- 
stroyed. 

The  Sulphur  patient  is  more  stolid  and  unimpressionable,  is  gen- 
erally red  in  the  face. 

The  Sepia  patient  is  sallow,  but  red  when  excited  or  disturbed. 
The  Sepia  congestions  involve  the  portal  and  genito-urinary  systems. 
The  Sulphur  congestions  may  involve,  as  well,  all  or  any  organs. 
Hence  the  hot  flushes  of  Sepia  begin  below  the  belt ; those  of  Sul- 
phur are  first  noticed  in  the  increased  redness  of  the  face  and  the 
dizzy  brain. 

The  difference  in  symptoms  arising  from  anomalies  of  portal  cir- 
culation, as  between  Aloe,  and  Sepia,  are  almost,  as  we  know, 
identically  those  differences  just  pointed  out  between  Sepia  and  Sul- 
phur. 

So  much  for  a great  polychrest  of  established  reputation,  about 
which,  if  I have  thrown  any  new  lights,  I have  not  taken  your 
time  in  vain. 

Discussion. 

H.  C.  Allen,  M.D. : I only  wish  to  emphasize  a few  words 
spoken  by  my  friend,  Dr.  Monroe,  in  a resume  of  the  action  of  Sepia, 
and  enlarge  upon  one  or  two  things  that  he  touched  upon  lightly. 
The  indications  of  Sepia  that  come  to  the  surface  are  paramountly 
true  of  disorders  of  menstruation  and  pregnancy.  The  peculiar 
characteristic  of  the  remedy — the  peculiar  aggravation  that  takes 
place  during  those  disorders,  for  instance,  a terrible  constipation. 
It  differs  from  many  of  the  other  remedies,  and  it  is  in  some  of 
these  differences  that  its  force  lies.  For  instance,  the  Phosphorus 


598 


world’s  homoeopathic  congress. 


patient  feels  a change,  an  hour  or  hours  or  even  days  before  it  occurs. 
This  is  particularly  true  with  some  changes  to  which  Sepia  is  so 
characteristically  adapted : as  the  change  of  snowy  weather  in  the 
spring  time,  and  in  the  autumn  when  the  first  snow  falls;  when 
the  light  snows  fall  in  March  and  April.  One  of  the  characteristics 
of  Sepia  has  helped  me  out  of  a great  many  difficult  cases,  and  per- 
haps it  will  help  some  of  you  if  you  will  study  it  carefully.  You 
have  a child,  three,  four,  or  five  years  old,  playing  in  the  snow- 
storm. The  child  is  almost  certain  to  take  cold,  or  the  cold  takes 
the  child,  I do  not  know  which.  The  result  is  a cough,  a laryngeal 
hacking.  This  is  constantly  going  on  and  becoming  more  violent, 
finally  almost  croupy,  if  not  really  so.  Many  of  us  would  think  of 
Aconite  or  Sulphur.  This  may  relieve  temporarily,  but  it  will  not 
eradicate  that  tendency  to  take  cold  every  time  the  child  is  exposed 
to  a slight  snow-storm.  If  I had  that  thing  come  up  with  me,  I 
would  give  a few  doses  of  Sepia.  Either  begin  the  case  with  Sepia 
or  follow  it  up  with  Sepia  ; and  those  of  you  who  are  not  familiar 
with  Hering’s  Guiding  Symptoms,  if  you  will  look  over  the 
given  symptoms  of  laryngeal  and  bronchial  symptoms,  you  will 
find  Sepia  there  referred  to.  That  is  one  of  the  coughs  I have  found 
very  difficult  to  manage  and  almost  impossible  to  prevent.  Sepia 
will  help  you  prevent  many  of  them.  There  is  no  use  in  giving  it 
in  second  decimal  potency  ; it  will  leave  you  in  the  lurch  every  time. 
You  will  have  to  give  some  power  in  the  drug — something  that  is 
adapted  to  the  force  of  the  disease ; something  that  is  equivalent  to 
the  onset  of  the  attack.  Exactly  how  strong  that  snow-storm  was, 
or  that  peculiar  atmospheric  influence  was — the  force  that  was  in 
it — I do  not  know  ; but  it  was  enough  to  make  the  child  sick,  and 
you  must  use  Sepia  in  sufficient  force  to  cure  your  patient — just  what 
force  I am  not  quite  certain.  I use  the  highest  I can  get  when  I 
have  hard  cases. 

One  other  point.  My  experience  is  that  Sepia  and  all  the  rest  of 
them,  Pulsatilla,  these  alternate  remedies  do  not  sometimes  give  the 
expected  results,  and  then  fault  is  found  with  the  remedy,  that 
something  is  wrong  with  Sepia,  something  wrong  with  Pulsatilla. 
But  no,  the  remedies  are  all  right.  This  is  what’s  the  matter. 

There  are  one  or  two  other  points  which  I wish  to  emphasize. 
You  know  we  have,  in  a large  number  of  remedies,  cold,  damp  feet, 
sweaty  feet.  That  is  common  to  a number  of  remedies.  Sepia  has 
it  also.  But  where  you  find  it  in  Sepia,  you  will  find  hands  and 
feet  both  perspiring. 

Dr.  Monroe:  You  mean  Silicia  has  it  also;  you  said  Sepia. 

Dr.  Allen  : Yes,  and  a dozen  others.  But  it  is  found  with  the 
feet,  head,  neck,  chest,  and  shoulders.  Now,  Sepia  has  that,  but 
Sepia  may  have  local  perspiration  over  the  chest  and  over  the  abdo- 
men, on  one  thigh  or  on  the  side  on  which  the  patient  lies.  These 


A STUDY  OF  SEPIA. 


599 


peculiar  local  perspirations — cold,  damp,  clammy— and  these  condi- 
tions, are  almost  certain  to  be  remedied  under  a proper  dose  of 
Sepia. 

Lizzie  Gray  Gutherz,  M.D. : I only  wish  to  add  my  voice  to 
those  who  endorse  this  wonderful  drug,  and  emphasize  a few  of  the 
essayist’s  ideas.  I do  not  think  Sepia  will  replace  a displaced  uterus, 
but  I do  think  it  will  do  wonderfully  good  work  in  keeping  it  in 
its  position,  and  assist  to  reduce  the  congestive  condition  of  the  uterus 
and  its  appendages,  and  it  is  certainly  very  valuable  in  all  climatic 
conditions.  In  urinary  troubles  it  fills  its  place  in  conjunction  with 
Lycopodium.  As  Dr.  Monroe  says,  the  relaxation  has  a great  deal 
to  do  with  the  condition  of  the  uterus;  it  tones  it  up. 

T.  F.  Allen,  M.D.  : ] want  to  say  one  word  in  relation  to  the 
“ comparisons,”  which  have  been  made  this  afternoon,  of  Sepia.  I 
have  been  very  much  interested  during  the  last  few  years  in  looking 
up  the  relationship  of  Sepia,  and  in  order  to  do  that  I have  found  it 
necessary  to  inquire  into  the  nature  of  Sepia.  Sepia,  as  you  know, 
is  an  animal  product;  Sepia  is  not  a poison.  The  animal  throws 
out  the  circular  part  which  gives  the  sepian  mass  in  the  water,  which 
we  gather  as  Sepia,  in  order  to  hide  from  its  enemies  in  the  water 
when  attacked.  It  instantly  makes  the  water  inky  black,  and  so 
enables  the  animal  to  escape.  But  this  is  not  a poison;  it  is  pure 
and  simple  carbon  ; nothing  in  the  world  but  coal ; absolutely  inert 
as  far  as  its  crude  condition  is  concerned.  Hahnemann  had  supposed 
that  the  artist  who  used  India  ink  made  of  Sepia  became  poisoned 
from  contact  with  it,  and  that  very  likely  led  to  this  observation.  I 
cannot  compare  Sepia  with  any  animal  poison,  but  I have  confirmed 
Sepia  as  a vegetable  and  class  it  with  other  carbons,  pure  and  simple 
carbons,  which  by  their  trituration  develop  different  properties.  This 
is  something  to  think  about  in  making  comparisons.  I have  been 
very  much  interested  lately  in  the  chemical  history  of  Lycopodium, 
and  it  has  had  a great  influence  upon  me.  Lycopodium  is  the  only 
vegetable  known  in  the  whole  world  which  takes  up  aluminum.  I 
would  suggest  a comparison  of  Sepia  with  the  carbon. 

Dr.  Monroe  closed  the  discussion  of  his  paper  as  follows  : In 
regard  to  my  comparison  of  Sepia  with  the  other  animal  poisons,  of 
course  Dr.  Allen  and  the  rest  of  you  understand  I should  not  have 
attempted  to  make  any  such  comparison  upon  any  toxicological 
basis,  but  simply  upon  a clinical  basis.  I find  I do  not  care  how 
slow  Sepia  is  or  how  long  it  takes  to  produce  its  effects  or  how  mild 
they  are,  it  gets  there  just  the  same  eventually.  I brought  these 
comparisons  in  not  so  much  to  show  the  similarities  but  to  suggest 
the  differences.  The  paper  was  intended  simply  to  be  suggestive.  If 
I should  have  followed  the  different  avenues  that  suggested  them- 
selves to  my  mind,  I would  have  read  on  until  you  would  all  have 
left  the  hall.  And  then,  as  to  the  Selenium,  I think  that  should 


600 


world’s  homceopathic  congress. 


have  been  brought  in  the  comparison.  I always  think  of  that  as 
exaggerated  Sulphur.  I cannot  see  any  very  marked  differences  in 
the  drug,  except  that  Selenium  is  Sulphur  and  more  so,  with  an  ab- 
ject despair,  uncompromising  melancholy,  that  we  find  in  no  other 
drug  in  the  Materia  Medica,  with  an  increased  tendency  to  chronic 
troubles  and  a decreased  tendency  to  convalescence. 


MY  BRYONIA  DAY. 


601 


MY  BRYONIA  DAY. 

By  Frank  Kraft,  M.D.,  Cleveland,  Ohio. 


It  is  a matter  of  experience  with  every  closely-observing  house- 
holder that  certain  domestic  events  happen  at  stated  intervals,  and 
with  such  a degree  of  regularity  that,  given  one  series,  the  observer 
is  prepared  to  predict  the  succeeding  series.  Thus,  when  the  clouds 
hang  low  and  threatening,  he  is  reasonably  sure  that  ere  long  some 
itinerant  artisan  will  thumb  the  electric  bell  in  order  to  learn  if  there 
be  any  umbrellas  to  mend.  If  the  amateur  baseball  nine  shivers  a 
pane  of  glass  in  the  kitchen  window,  although  at  the  moment  of 
happening  a glazier  was  not  remembered  to  have  been  seen  in  that 
neighborhood  for  weeks  or  months  preceding,  yet,  in  a little  while 
he  will  be  on  the  scene  with  his  sing-song  of  “ Glass  to  put  in  !”  This 
is  true  of  snow-shovels  and  lawn-mowers;  of  the  seedy  individual 
who  begs  to  put  in  the  coal  in  the  fall  season,  and  of  Uncle  Remus 
with  h is  fin-de- siecle  cart  and  horse,  who  comes  in  the  gentle  spring 
to  haul  away  the  ashes.  The  church  strawberry  festival,  the  mid- 
summer rainy-day  picnic,  and  the  oyster-supper,  all  come  with  the 
regularity  of  time  itself — the  one  event  treading  sharply  on  the  heels 
of  its  predecessor,  and  being  in  turn  trodden  on.  If  he  be  a coun- 
try medical  man,  this  observer,  and  the  weather  is  too  bad  to  put  out 
a dog,  raining  and  cold,  mud  shoe-mouth  deep,  he  knows  that  some- 
where, a half-dozen  miles  or  more  away,  in  some  unsavory  or  non- 
paying neighborhood,  some  poor  woman  is  getting  ready  to  have 
him  called  out  about  two  o’clock  in  the  morning — verifying  that 
Napoleonic  aphorism  of  the  two-o’clbck-in-the-morniug  courage — 
because  it  takes  much  courage  to  avoid  objurgating  the  weather,  the 
profession  of  medicine,  and  perhaps,  also,  the  unfortunate  woman. 

This  medical  man,  if  a Homoeopath,  has,  in  the  course  of  a few 
years  discovered  that  he  gives  his  remedies  very  often  in  the  same 
general  way — on  a scale  of  precedent  and  consequent ; that  if  the 
first  patient  of  the  day  required  Bryonia,  Bryonia  will  be  very  apt 


602 


world’s  homceopathic  congress. 


to  lead  all  day — that  is  to  say,  it  will  be  in  some  form  the  trump 
card.  If  he  has  one  case  of  confinement,  so  says  one  medical  friend 
of  mine,  he  will  have  another  very  shortly  thereafter ; in  other  words, 
his  obstetric  practice  usually  comes  in  pairs.  When  he  awakes  of  a 
morning  and  hears  the  rain-drops  patter  on  the  roof,  he  says  to  him- 
self: “This  will  be  my  Rhus  day.”  If  the  day  be  bright  and  cold, 
with  the  wind  blowing  a gale,  he  looks  to  his  Aconite.  And  so  in- 
tuitively, or  as  an  impressionist,  as  our  eminent  teacher  and  author, 
Timothy  Field  Allen,  has  called  him,  this  doctor  finds  his  fingers 
fingering  the  cork  of  a certain  one  or  two  bottles  of  his  pocket  and 
office  case,  dependent  either  on  the  weather  or  some  other  circum- 
stance— a concomitance  not  set  down  in  the  books  or  taught  from  the 
college  platform. 

I have  found  myself  doing  this  unscientific  thing,  when  no  one 
is  more  averse  than  myself  to  routine  practice,  or  a practice  not  based 
wholly  on  the  totality  of  symptoms.  For  a time  I fought  this  in- 
clination, ascribing  it  to  laziness  or  indifference;  but,  in  later  years, 
I am  glad  to  resort  to  it  when  business  is  a little  hurried. 

Professor  Allen  has  said,  that  the  physician  in  time  falls  into  a 
way  of  prescribing  almost  as  by  intuition  ; but,  in  reality,  because  a 
glance  at  his  patient,  a moment  or  two  of  conversation,  some  trick 
of  gesture  or  speech,  his  or  her  nationality,  occupation,  etc.,  rapidly 
stamp  themselves  in  the  prescriber’s  mind  as  a totality  not  to  be 
ignored,  and  but  a few  medical  questions  are  needed  to  complete  the 
picture.  Of  course,  this  is  not  the  rule  of  prescription,  Homoeopa- 
thically,  nor  any  other  way,  but  it  goes  far  in  the  solution  of  the 
ever-present  question,  “ What  shall  I give  this  patient  ?”  And,  really, 
what  to  the  young  medico,  or  the  unobserving  book-worm  doctor, 
seems  intuition  or  “ luck,”  is  naught  but  the  crystallization  of  years 
of  study  of  human  nature,  and  its  clinical  application  in  his  office 
or  at  the  bedside. 

When  I began  practicing,  I chanced  to  alight  in  a section  of  coun- 
try filled  with  swamps  and  sand-dunes.  At  this  time,  fresh  from 
college,  with  the  usual  recent  graduate’s  belief  of  containing  within 
himself  all  that  was  worth  knowing  in  medicine  and  allied  sciences, 
I fell  afoul  of  an  epidemic  of  measles.  My  first  case,  instead  of 
calling  for  Pulsatilla,  or  Sulphur,  as  I had  been  taught  it  would  or 
should,  persisted  in  calling  for  Bryonia.  Other  cases  following  also 
demanded,  and  of  course'  received,  Bryonia,  but  very  much  to  my 


MY  BRYONIA  DAY. 


603 


fear  that  I was  not  doing  my  whole  Homoeopathic  duty.  I recog- 
nized that  this  could  not  be  honest  Homoeopathic  practice,  unless  I 
had  hit  upon  what  Hering,  I think  it  is,  calls  the  epidemic  remedy. 
However,  as  the  patients  got  well,  there  seemed  no  cause  for  com- 
plaint. 

Then  a season  of  whooping-cough  followed,  and  before  I was 
called  to  the  first  case,  in  anticipation  of  such  employment,  I looked 
carefully  over  my  literary  assets,  found  that  Tartar  emetic  and  Coc- 
cus cacti,  and  Drosera,  Lachesis,  and  Zincum  and  many  other  reme- 
dies had  usually  been  indicated,  and  from  this  quiver  I could  cer- 
tainly select  my  Parthian  arrow.  But,  to  my  amazement,  Bryonia 
again  reared  its  unwelcome,  because  I believed  unhomoeopathic,  head, 
and  throughout  that  epidemic,  with  the  exception  of  a few  doses  of 
Sulphur,  Bryonia  governed  the  one  hundred  or  more  cases  which  fell 
to  my  lot  that  season. 

When  the  first  attack  of  “ grip  ” came  I was  reading  carefully 
everything  that  was  being  published  in  the  east  concerning  this  for- 
midable epidemic,  which  was  at  that  time  “ sneezing”  its  way  into 
publicity,  and  noting  especially  the  Homoeopathic  remedies  used  and 
recommended.  Eupatorium  perf.  and  Gelsemium  seemed  everywhere 
else  the  remedies,  yet  when  the  “ grip  ” struck  my  bailiwick,  with 
Eupatorium  high  and  low  in  my  pocket  ready  to  do  efficient  battle, 
I found  that  my  first  prescription  in  a few  cases  was  Allium  cepa, 
which  did  no  good  whatever,  and  though  my  fingers  itched  to  try 
the  Eupatorium,  I saw  the  handwriting  on  the  wall,  and  gave  Bry- 
onia. To  be  brief,  in  the  three  epidemics  which  I followed  in  my 
country  practice  Bryonia  was  my  friend,  and  I lost  no  case. 

When  I reached  Cleveland  one  of  the  medical  professors  sent  me 
to  a case  of  what  is  there  called  winter  cholera,  telling  me  that  Gel- 
semium and  something  else  in  alternation  was  the  usual  prescription 
in  all  such  cases  made  and  provided.  You  already  anticipate  that 
my  familiar  demon,  Bryonia,  got  there  and  cured  that  case  as  it  has 
a great  many  cases  of  winter  cholera  since  that  time. 

How  can  this  be  explained  ? If  I had  any  pet  remedy  in  my 
case  when  I left  my  alma  mater , it  was  Ipecac ; for  that  was  the  first 
remedy  I studied  under  my  preceptor,  and  studied,  indeed,  as  I have 
never  since  studied  another.  Of  Bryonia  I knew  no  more  than  I did 
of  the  other  seventy-five  or  one  hundred  remedies  I had  heard  lectures 
on.  Yet  of  Ipecac  I do  not  believe  I have  used  a hundred  doses 


604 


world’s  iiomceopathic  congress. 


all  told,  while  Bryonia  is  the  bottle  whose  cork  is  always  black  and 
whose  contents  is  at  a low  ebb.  I have  struggled  honestly  and  long 
not  to  fall  into  a rut.  I have  studied  other  allied  remedies  more 
carefully.  I have  used  very  nearly  every  kind  of  repertory  in  the 
market.  I have  re-examined  and  restudied  my  written  cases,  ex- 
punging what  appeared  to  point  too  plainly  to  my  bete  noir.  I have 
refrained  from  asking  innocent  leading  questions,  but  “ still  the  vil- 
lain (Bryonia)  pursues  me.” 

My  preceptor  had  usually  three  or  four  bottles  of  Natrum  mur. 
about  his  person,  with  the  chance  that  all  were  empty  at  once  when 
needed.  Prof.  J.  T.  Kent,  I remember  telling  me,  had  a hard  fight 
with  Arsenicum  ; and  it  has  occurred  to  me  that  perhaps  I am  not 
singular  in  My  Bryonia  Day , but  that  other  practitioners  have  had 
and  do  have  similar  experiences  with  some  one  or  two  remedies  as 
their  key-notes. 

In  speaking  with  a brother-physician  many  years  my  senior,  he 
admitted  that  his  patients,  too,  had  a fashion  of  coming  to  him  in 
groups,  according  to  the  season  of  the  year;  and  while  he  had  never 
thought  of  it  in  that  light  before,  he  did  remember  that  these  groups 
usually  also  grouped  themselves  around  one  or  two  remedies.  He 
recalled  the  instance  of  so  many  of  his  lady  patients  requiring  Pla- 
tina  on  two  or  three  days  for  a persistent  and  very  peculiar  consti- 
pation of  the  bowel ; that  he  went  a little  more  minutely  into  the 
case,  and  discovered  that  they  had  all  been  members  of  a Teachers’ 
Railway  Excursion  from  his  place  (an  interior  Indiana  town)  to 
Niagara  Falls. 

After  an  overflow  of  the  lowlands  of  a certain  city,  another  good 
prescriber  always  found  Natrum  mur.  indicated  in  very  nearly  every 
case  arising  out  of  the  inundation  ; and  I have  myself  followed  a 
sewTer-pipe  laying  with  Natrum  mur.  the  entire  length  of  the  street. 
Still,  this  will  only  account  for  a small  part  of  the  peculiarity  of  My 
Bryonia  Day.  May  it  be  possible  (not  unlike  the  doctor  who  has 
attended  one  case  of  puerperal  fever,  and  is  therefore  in  danger  of 
infecting  all  other  of  his  obstetrical  patients)  that  I am  carrying  the 
bacillus  of  Bryonia,  and  so  thoroughly  infect  every  case  that  comes 
to  me  that  it  becomes  a Bryonia  case  ? If  all  of  my  patients,  or  a 
great  percentage  of  them,  died,  it  might  be  argued  that  I am  a 
crank  on  Bryonia,  with  a Bryonia  hobby,  and  that  I fitted  my  pa- 
tients fo  the  remedy,  instead  of  the  reverse.  But  the  Board  of 


MY  BRYONIA  DAY. 


605 


Health  records  credit  me  with  the  usual  Homoeopathic  percentage 
of  mortality  only  ; so  that  cannot  be  the  solution. 

I think  it  is  well  known  that  people  of  different  nationalities  re- 
quire different  medication — I mean,  as  a general  remedy — one  that 
governs  the  medical  composition  (the  totality  of  symptoms)  as  the 
key-note  governs  the  musical  composition.  If  I am  cast  into  a 
German  or  Dutch  neighborhood  where  lard  is  used  not  alone  in 
cooking,  but  for  every  other  domestic  exigency,  from  greasing  the 
boots  to  greasing  the  hair,  I look  well  to  my  Pulsatilla,  and  more 
especially  is  this  true  in  the  fall,  in  the  “ spare-rib  ” season.  If 
there  be  a preacher’s  convention  in  town,  remembering  their  alleged 
fondness  for  yellow-legged  chickens  and  the  other  good  things  of 
life,  I look  carefully  to  my  Lycopodium  bottle.  A Democratic 
convention  does  not  differ  much  from  a Republican  convention, 
except  as  whisky  differs  from  beer;  Sulphuric  acid  helps  us  out  on 
the  one  hand  and  Nux  or  Sulphur  on  the  other.  In  pic-nic  sea- 
son, if  the  dear  girls  and  ladies  get  caught  in  a shower — the  usual 
accompaniment  of  the  typical  and  classical  pic-nic — and  get  their 
feet  and  ankles  wet,  I know  Belladonna,  like  Mrs.  Micawber,  will 
not  desert  me. 

]f  this  practice,  as  herein  outlined,  could  but  be  made  practical, 
and  applied  to  the  several  walks  of  life,  how  easy  doctoring  would 
become!  Count  Mattei,  with  his  green  and  blue  and  yellow  elec- 
tricity, in  his  palmiest  days,  would  be  no  comparison.  Sch ussier, 
with  his  Shortened  Therapy , would  stand  but  little  show  against  My 
Bryonia  Day  style  of  prescribing.  If  it  were  possible,  let  us  say, 
to  treat  every  German  with  Pulsatilla,  every  Frenchman  with  Nux, 
the  Englishman  with  Colchicum,  or  the  Turk  with  Saw  palmetto, 
what  a medical  revolution  it  would  prove ! Suppose  we  could  be  a 
little  nicer  in  our  distinctions,  and  treat  people  according  to  the 
State  or  city  in  which  they  reside,  how,  even  with  that  addition 
to  the  original  plan,  the  remedies  would  group  themselves  in  twos 
aud  threes  of  remedies  we  would  need  to  know,  thus  giving  more 
time  to  devote  to  bacteriology  and  the  doing  of  laparotomies.  Then 
Philadelphia  might  require  Bryonia,  because  of  its  reputed  love  of 
quiet  and  aversion  to  movement.  Boston  could  be  treated  with 
Baryta  carb.,  if  the  patient  be  a female,  that  being  the  old-maid 
remedy;  or  if  male,  Natrum  mur.  might  be  used  isopathically  to 
antidote  the  great  ingestion  of  Attic  salt.  Cincinnati  would  need 


606 


world’s  homoeopathic  congress. 


Pulsatilla  for  bad  effects  from  pork.  St.  Louis  would  call  for  Sul- 
phur or  Nux  because  of  its  breweries.  Washington  could  safely  be 
turned  over  to  China,  or  perhaps  that  wouldn’t  be  safe  just  now; 
let  us  say  Cinchona,  therefore,  which  usually  antidotes  “ cold  tea.” 
New  York  ought  to  have  something,  and  in  a very  low  potency,  too, 
to  check  its  munificence  and  liberality  in  public  benefactions,  monu- 
ments and  other  States’  physicians;  but  what  that  remedy  is,  no 
repertory  in  my  possession  discloses.  Chicago  would  imperatively 
demand — she  never  asks — Lycopodium,  not  so  much  for  its  un- 
bounded brain-work,  nor,  as  Dr.  Horace  Packard  intimated  a day 
or  two  ago,  because  she  is  “ fast,”  but  because  Lycopodium  is  good 
for  gas  and  wind.  It  is  evident,  without  carrying  the  attenuation  of 
this  idea  any  further,  what  a vista  of  usefulness  is  open  to  some 
inventive  genius  who  will  construct  a Meisterschaft  System,  “ Teach- 
ing How  to  Cure  Folks  in  Ten  Easy  Lessons;”  and  I hereby  waive 
all  royalty  on  the  idea. 

Seriously,  there  must  be  some  rule  or  law  back  of  My  Bryonia  Day , 
but  thus  far  I have  failed  to  find  it.  I cannot  recommend  the  plan, 
because  I have  no  plan ; for  while  I have  mentioned  a few  glaring 
instances  of  the  applicability  of  this  scheme,  in  all  the  rest  of  my 
practice  I have  to  “dig  out”  my  remedy  as  Hahnemann  recommends 
and  teaches.  Perhaps  other  and  older  heads,  having  met  with  a 
similar  experience,  may  give  us  more  light  and  bring  us  from  dark- 
ness to  light. 

DiscussroN. 

Wilson  A.  Smith,  M.D.,  said  that  he  did  not  believe  Professor 
Kraft  was  really  in  earnest  in  what  he  said  concerning  Bryonia ; 
and  the  speaker  illustrated  his  point  with  an  appropriate  story,  which 
was  well  received — and  continuing,  he  said  : I do  not  believe  he 
had  any  such  “Bryonia  days,”  unless  it  was  in  the  earlier  days  of 
his  practice.  There  are  some  who  use  nothing  but  Aconite  on  cer- 
tain days,  and  nothing  but  Sepia  on  others  ; but  you  have  all  had  the 
same  experience,  and  that  was  when  you  had  only  one  case  a day. 
Now,  if  there  were  Bryonia  days,  I would  like  some  of  our  good 
brethren  to  get  up  here  and  tell  us  about  some  of  their  special  days. 
But,  seriously,  I do  not  believe  that  there  are  such  things  as 
Bryonia  days  or  Sepia  days,  any  more  than  my  friend,  Prof.  Kraft 
does.  There  are  days  when  Nux  vomica  may  be  largely  used.  Bry- 
onia is  a colored  man’s  remedy  ; I wonder  where  Dr.  Kraft  has 
been  practicing. 

Howard  Crutcher,  M.D. : In  discussing  the  paper  of  Materia 


MY  BRYONIA  DAY. 


607 


Medica,  by  Dr.  Kraft,  I may  seem  a little  out  of  place.  There  are 
some  points,  however,  that  it  might  be  well  to  emphasize,  even  in  a 
Homoeopathic  Convention.  There  is  no  such  thing  as  a “Bryonia 
day  that  idea  was  not  meant  to  be  circulated  by  Dr.  Kraft.  One 
thing  has  been  steadily,  persistently,  and  systematically  ignored  by 
the  medical  profession  for  three  thousand  years — and  that  is  the  pa- 
tient ; and  it  has  been  done  systematically,  and  I might  say,  malic- 
iously, since  the  dawn  of  earliest  history.  Nowhere  in  medical 
history  is  the  patient  mentioned  as  the  factor  until  the  time  of  Sam- 
uel Hahnemann.  What  we  are  dealing  with  is  not  days  nor  weather, 
but  sick  people  ; not  the  liver — although  it  is  an  attractive  target ; 
nor  stomachs,  nor  heads,  nor  heels,  but  sick  people.  It  is  a most 
difficult  thing,  absolutely  impossible  it  seems,  to  get  some  physicians 
to  appreciate  that  point.  Now,  long  ago  I found  a patient  taking  a 
liver  remedy,  a bowel  mixture,  a sleep  compound,  a tonic,  an  ap- 
petizer, and  one  or  two  other  things.  She  was  complaining;  the 
trouble  was  she  had  forgotten  the  kidneys.  When  leaving  I was 
asked  what  I had  prescribed  ? I said,  “ My  dear  sir,  did  it  occur 
to  you  that  the  only  thing  I came  down  here  to  do  was  to  cure  that 
sick  woman  ?”  “ Well,  what  did  you  give  her?  Did  you  leave 

anything  to  make  her  sleep  ?”  “ No.”  It  seems  absolutely  impossible 
for  the  present  composition  of  the  human  mind  to  lose  sight  of 
Materia  Medica,  and  remember  solely  that  we  are  dealing  with  sick 
people.  Our  sole  duty,  as  therapeutists,  is  to  prepare  these  pictures, 
fitting  them  for  the  niches  wherein  they  belong.  I know  when  I 
was  a student  in  my  preceptor’s  office,  attending  lectures,  I cured  more 
sick  people  than  I was  curing  after  graduating  in  medicine,  and  after 
considerable  experience  at  the  bedside.  When  I was  a student  I 
knewjust  enough,  dared  just  enough  to  take  the  picture  and  prescribe 
for  a man.  Alter  I got  to  be  an  M.D.,  I began  prescribing  at  some- 
body, or  rather  at  my  own  creation  in  the  shape  of  a diagnosis,  with 
corresponding  results.  It  is  the  man  or  woman  we  have  got  to  deal 
with  all  the  time  in  disease.  It  is  not  so  much  typhoid  fever — we 
know  what  the  remedy  is — as  it  is  the  man  we  should  study.  There 
is  very  little  difference  between  Jones’s  typhoid  fever  and  Smith’s 
typhoid  fever.  The  man  and  his  trouble  is  what  we  are  called  upon 
to  relieve. 


608 


world’s  homoeopathic  congress. 


THE  REVIVAL  IN  THERAPEUTICS. 

By  William  E.  Leonard,  M.D.,  Minneapolis,  Minn. 


The  proud  boast  of  Homoeopathy,  so  truthfully  made  forty 
years  ago,  that  it  alone  includes  all  that  is  reliable  in  therapeutics, 
and  that,  therefore,  its  practitioners  are  by  all  odds  the  most  success- 
ful, is  by  no  means  as  true  as  when  first  uttered.  The  times  medical 
have  changed,  and  I believe  that  the  relation  of  Homoeopathy  to 
American  medicine  at  least  is  somewhat  changed.  Or,  in  other 
words,  because  of  the  influence  of  our  system  of  less  medicine,  the 
above  statement  is  true.  Cotemporary  history  of  other  schools  of 
medicine,  the  success  of  many  of  their  notable  individual  practi- 
tioners, as  well  as  the  evidence  of  the  comparative  statistics  presented 
to  this  Congress,  show  a lessening  difference  in  the  mortality  rates  of 
the  diverse  schools. 

This  does  not  reflect  upon  the  truth  of  the  Homoeopathic  law  or 
the  integrity  of  its  followers.  It  does  not  mean,  as  recent  polemics 
would  have  the  people  believe,  that  “ Similia”  is  a worn  out  fad, 
or  that  its  disciples  are  being  enticed  into  the  enemy’s  lines  or 
led  into  employing  his  methods.  Such  occurrences  are  to  be  noted 
here  and  there,  but  not  as  often  as  the  “ Internationals  ” would  have 
us  believe. 

But  it  does  mean  a revival  of  therapeutics  among  medical  men 
generally.  It  means  that,  in  spite  of  numerous  fads  and  novelties 
which  have  served  to  amuse  the  profession  through  the  journals  but 
which  have  deceived  but  few  into  their  actual  employment;  in  spite 
of  the  continued  increase  of  excellent  physiological  preparations  of 
digestive  ferments  and  stomachics  whereby  even  a sick  alimentary 
tract  is  enabled  to  digest  food  and  sustain  life;  and  notwithstanding 
much  waste  of  powder  and  shot  against  the  hated  Homoeopathists, 
the  text-books  slowly  but  inevitably  are  incorporating  smaller  doses, 
and  often  unconsciously  advocating  medicines  Homoeopathic  to  the 
conditions  described,  and  that  thus,  little  by  little,  “ a little  leaven 


THE  REVIVAL  IN'  THERAPEUTICS. 


609 


leaveneth  the  whole  lump.”  Rarely  is  the  medicine  thus  Homoeo- 
pathically  recommended  in  this  new  practice  chosen  with  sufficient 
accuracy  to  at  all  approach  the  “ similimum.”  But  even  an  im- 
perfectly similar  remedy,  in  small  doses,  if  we  believe  Hahne- 
mann’s statement  concerning  the  universality  of  the  law,  will  hasten 
the  cure. 

Let  me  illustrate  this  statement  by  comparing  the  therapeutic  por- 
tion of  former  with  those  of  more  recent  works.  Take  up  Ziems- 
sen’s  Encyclopaedia  of  Medicine , which  was  translated  and  published 
in  1875,  as  being  the  greatest  compilation  of  practice  of  its  genera- 
tion. To  be  sure,  its  bare  therapeutic  hints  smack  greatly  of  the 
meagre  faith  in  medicines  held  by  the  German  in  comparison  wTith 
the  American  practitioner,  as  the  following  will  illustrate.  Speak- 
ing of  the  treatment  of  catarrhal  pneumonia  (vol.  v.,  p.  230),  Jur- 
gensen  considers  the  action  of  the  medicines  ordinarily  used,  i.e., 
muriate  of  Soda  and  carbonate  of  Ammonia,  very  problematical. 
“The  problem  of  diminishing  the  swelling  of  the  mucous  mem- 
brane and  limiting  its  secretion  will  certainly  never  be  solved  by 
giving  medicine  . . . .”  p.  733.  “ I never  give  Tartar  emetic  in 

divided  doses,  but  a full  dose  of  three-quarters  of  a grain,  with, 
eight  to  fifteen  grains  of  powdered  Ipecac.” 

H is  favorite  method  is  to  direct  a small  stream  of  water  againsb 
the  back  of  the  head  over  the  region  of  the  medulla  oblongata,  and 
thus  produce  violent  respiratory  efforts.  This  he  would  do  even  in 
severe  and  late  stages.  Contrast  this  with  the  following  in  William 
Osier’s  Principles  and  Practice  of  Medicine , 1892  (p.  543)::  “ If  the 
disease  comes  on  abruptly  with  high  fever,  minim  or  minim-and  a- 

half  doses  of  the  tincture  of  Aconite  may  be  given The  pain, 

distressing  symptoms,  and  the  incessant  cough  often  demand  opium. 

. ...  If  the  child  has  increasing  difficulty  irf  getting  up  the  mucus? 
an  emetic  may  be  necessary — either  the  wine  of  Ipecac  or,  if  neces- 
sary, Tartar  emetic.  There  is  no  necessity,  however,  to  keep  the 
child  constantly  nauseated.” 

Again,  Ziemssen  (vol.  v.,  p.  609),  in  the  treatment  of  phthisis, 
has  absolutely  nothing  to  offer  in  the  way  of  drugs  but  Peruvian 
bark.  Whereas,  Prof.  Osier  (p.  255)  says  : “Under  no  circum- 
stances is  that  priceless  remedy,  Quinine,  so  much  abused  as  in  the 

fever  of  tuberculosis It  is  of  little  benefit  in  this  type  of 

fever.”  He  advocates  Antifebrin  and  Antipyrin,  used  cautiously, 

39 


610 


world’s  homoeopathic  congress. 


and  finds  a place  for  Creasote,  the  hypophosphites,  Arsenic,  etc., 
which  is  something  more  than  Ziemssen  offers.  This  approach  to 
Homoeopathic  methods  is  better  shown  in  recent  text-books,  e.g ., 
Shoemaker’s  Materia  Medica  and  Therapeutics  (vol.  ii.,  p.  732). 
Under  Lycopodium  we  read  : “ A tincture  of  Lycopodium  has  been 
made  by  subjecting  the  powder  to  prolonged  trituration  with  the 
sugar  of  milk,  after  which  it  readily  dissolves  in  alcohol.  This 
preparation,  in  half-drachm  doses,  is  of  value  in  incontinence  of 
urine  among  adults  and  flatulent  dyspepsia,  attended  by  a copious 
deposit  of  uric  acid  in  the  urine.”  This  is  remarkable  for  an  “ inert 
powder.” 

Again,  under  Aconite  (p.  399):  “Its  control  over  the  circulation 
places  Aconite  in  the  first  rank  in  the  fever  process,  but  in  order  to 
get  the  best  results  it  should  be  given  in  fractional  doses  (every  ten, 
fifteen,  or  twenty  minutes  give  a teaspoonful  of  water  from  a tumbler 
in  which  a few  minims  of  the  tincture  have  been  dropped).  Invalu- 
able in  the  treatment  of  the  ephemeral  fevers  of  childhood  and  hy- 
perpyrexia attendant  upon  the  exanthemata.  In  adults  the  results 
are  also  very  positive,  so  that  Aconite  has  almost  entirely  taken  the 
place  of  the  lancet  in  antiphlogistic  treatment.” 

In  Cerna’s  Notes  on  the  Newer  Remedies  (1893,  p.  44)  under  Cac- 
tus grand.,  we  learn  : u The  plant  has  been  successfully  employed  as 
a stimulant  in  diseases  of  the  heart,  especially  myocarditis  and  val- 
vular lesions.”  Upon  this  Homoeopathic  action  of  cactus  is  based 
the  extensive  use  of  “ Caetine  pellets,”  each  containing  of  a 
grain  of  the  active  alkaloid  of  cactus. 

Many  other  instances  of  imitation,  without  credit,  might  be  given, 
as  evidencing  a decrease  in  the  therapeutic  agnosticism  of  a few 
years  since.  The  growth  of  specialties  in  American  medicine  has 
indirectly  contributed  to  this  revival  in  therapeutics.  Those  who 
had  lost  faith  in  all  but  “ tonics  and  alteratives,”  and  who  preferred 
to  increase  their  fees  and  volume  of  business  by  treating  affections 
for  which  people  demand  only  mechanical  and  palliative  treatment, 
have  deserted  the  field  to  the  general  practitioner.  The  latter  finds 
himself  in  sharp  competition  with  Homoeopathists  for  general  and 
family  practice,  and  is  compelled  to  look  more  closely  into  specific 
medication. 

This  also  is  one  of  the  causes  for  the  undoubted  revival  of  experi- 
mentation and  research  in  Old-School  ranks.  Now-a-days  new  drugs 


THE  REVIVAL  IN  THERAPEUTICS. 


611 


constantly  claim  attention.  Some  of  them  are  confessedly  taken  up 
because  we  Homoeopathists  use  them,  while  most  of  them  are  labora- 
tory products  brought  out  by  the  pharmacists,  and  apparently  of 
only  slight  range  in  disease.  By  the  way,  these  manufacturing 
chemists  stand  between  the  Old-School  profession  and  the  people  in 
much  the  same  relation  as  the  elders  and  vestrymen  of  the  churches 
to  the  pastor  and  the  people,  it  being  very  noticeable  that  the  re- 
forms come  from  them  because  of  popular  pressure,  rather  than 
from  the  cloth  or  profession.  In  other  words,  these  manufacturers 
have  appreciated  the  popular  demand  for  less  medicine,  and  refined 
doses,  and  have  forced!  physicians  to  use  them. 

Among  these  laboratory  products  are  the  various  alkaline  com- 
pounds, the  innumerable  alkaloids,  glucosides  and  vegetable  deriva- 
tives and  these  are  increasing  so  rapidly  that,  as  quoted  in  Cerna’s 
(above-mentioned)  preface,  “ if  each  compound  is  to  be  thoroughly 
studied  by  the  physiologists,  the  result  would  hardly  be  contained  in 
the  world’s  literature.”  If  old  medicine  is  earnestly  thus  striving 
to  increase  its  drug  list  in  a practical  way,  if  it  is  really  striving  to 
find  more  “ specifics  ” for  disease,  it  matters  not  what  explanation  is 
made  of  their  successful  action  when  found,  whether  by  substitution 
or,  as  we  believe,  in  many  instances,  under  the  law  of  “similia.” 
The  fact  remains  that  a real  advance  has  been  made  in  therapeutics. 
Moreover,  in  many  a large  American  city,  are  to  be  found  medical 
men  perfectly  “ regular”  in  all  their  affiliations  who  slyly  and 
quietly,  by  an  occasional  meeting  in  counsel,  or  by  at  still  rarer  in- 
tervals chatting  in  their  library  or  asking  him  to  look  at  some  mem- 
ber of  their  family,  are  weighing  the  methods  of  their  Homoeopathic 
neighbor,  until  finally,  to  use  more  Anglo-Saxon,  they  are  prepared 
to  steal  his  prestige  and  business  by  doing  or  pretending  to  do  as  he 
does. 

Ag&in,  many  intelligent  people,  having  once  seen  the  benefits  of 
smaller  doses  of  medicine,  and  being  naturally  conservative,  and 
with  full  confidence  in  their  family  physician,  demand  from  that 
physician  more  common  sense  and  less  medicine,  although,  perhaps, 
never  actually  coming  from  Homoeopathy.  Such  patrons  do  not  go 
over  as  rapidly  to  the  “ silent  majority  ” as  formerly  and  hence  help 
reduce  the  disparity  in  the  results  of  different  schools  of  medicine. 
And  these  facts,  being  only  straws  perhaps,  all  point  to  the  current 
now  setting  in  towards  the  revival  in  therapeutics.  This  flow  of 


612 


world’s  homoeopathic  congress. 


faith  in  drugs,  as  contrasted  with  the  ebb-time  of  disbelief  of  a few 
years  ago,  is  an  omen  of  no  small  import  in  the  history  of  therapeu- 
tics, and  especially  to  our  school  as  proud  conservators  of  the  only 
science  of  therapeutics.  It  means  that,  if  we  as  a school,  would 
keep  in  the  van  of  drug  study  and  practical  use,  if  we  would  supple- 
ment the  brilliant  pictures  of  such  drugs  as  Nux  and  Pulsatilla , first 
outlined  by  Hahnemann,  with  others  as  useful,  and  teach  the  medi- 
cal world  more  means  of  cure,  we  must  show  more  zeal  in  drug 
study  than  in  the  years  past.  We,  at  least  some  of  us,  must  for  a 
time  depart  from  those  mechanical  and  surgical  methods  which  may 
mean  more  ready  cash  for  the  effort  made,  and  do  something  to  es- 
tablish new  drugs  or  confirm  old  ones.  If  we  do  not  thus  add  to 
our  special  and  peculiar  Homoeopathic  literature,  which  is  at  present 
in  fact  only  a small  proportion  of  the  great  bulk  of  medical  litera- 
ture, we  shall  drift  on  into  empiricism  and  nothingness  and  be  de- 
servedly mentioned  as  false  to  the  trust  imposed  upon  us  by  Hahne- 
mann. There  is  great  need  of  a revival  of  therapeutics  in  Homoeo- 
pathic as  well  as  Old-School  medicine. 

Discussion. 

H.  W.  Westover,  M.D. : There  is  very  little  I can  add  to  what 
Dr.  Leonard  has  stated.  It  certainly  is  true  that  there  has  been  a 
very  marked  and  decided  advance  in  therapeutics  among  the  physi- 
cians of  the  dominant  school,  and  this,  to  a certain  extent,  has 
brought  about  a better  comparison  of  results  between  the  members 
of  the  Homoeopathic  School  and  the  non-Homoeopathic.  This,  I 
think,  has  been  very  largely  due  to  the  Homoeopathic  physicians. 

It  has  made  a demand  for  a more  conservative  treatment,  but  still 
that  is  a nearer  approach  to  results  which  we  find  among  the  Hom- 
oeopaths and  non-Homoeopaths.  I think  if  we  will  scan  the  situa- 
tion carefully  and  honestly,  look  at  things  as  they  are,  we  will  see 
that,  to  a very  large  extent,  among  the  rank  and  file  of  practitioners 
of  the  Homoeopathic  art  there  has  been  a letting  down  in  the  zeal 
with  which  they  have  studied  the  Materia  Medica.  This  is  an  ulti-  1 
mate  fact  and  one  to  which  we  should  not  shut  our  eyes.  If  we  are 
going  to  maintain  the  prestige  which  the  Homoeopathic  School  has 
held  in  the  past,  if  we  are  going  to  do  as  much  in  the  treatment  of 
disease  as  our  knowledge  will  permit  us  to  do,  if  we  are  going  to  do 
the  greatest  good  to  the  greatest  number,  if  we  expect  to  lead  the 
van,  we  must  refer  to  old  methods,  old  rules,  and  not  neglect  this 
Materia  Medica,  which  has  been  the  means  of  our  success  in  the 
years  that  are  gone.  Let  us  not  forget  these  things.  Let  us  not 


THE  REVIVAL  IN  THERAPEUTICS. 


613 


forget  old  and  tried  friends  for  new  ones.  There  is  far  too  great  a 
tendency  among  Homoeopathic  practitioners  to  wander  after  strange 
gods,  to  worship  Baal,  and  that  I certainly  think  we  should  decry. 
Let  us  remember  that  Pyrene  and  Anti  pyrene,  and  all  these  things 
are  strange  gods  to  which  the  Homoeopath  should  not  bow  down,. 
I live  in  a region  far  distant  from  this,  in  Missouri.  Travelling 
representatives  of  the  manufacturing  chemists,  with  their  proprie- 
tary articles,  go  to  these  cities,  villages  or  cross-roads,  where  there 
are  only  two  or  three  physicians,  to  introduce  their  wares.  They 
come  into  my  office  every  week.  They  see  by  my  sign  that  I am  a 
Homoeopathic  physician.  Would  they  not  give  me  the  go-by  if  they 
did  not  receive  encouragement  from  Homoeopathic  physicians  from 
the  Atlantic  coast  to  the  Pacific  Ocean?  These  are  facts ; we  cannot 
shut  our  eyes  to  them,  and  we  should  do  all  we  to  stand  firm  in 
advocating  the  true  principles  of  Homoeopathy,  which  are  as  true 
to-day  as  they  were  in  the  days  of  Hahnemann,  or  when  Hering  and 
Dunham  taught  those  great  principles.  We  should  have  a much 
more  perfect  Materia  Medica  to-day,  more  thoroughly  proven.  We 
have  all  the  added  experience  of  years  from  which  we  can  receive 
encouragement,  instruction  and  improvement.  I adjure  you  at  all 
times  to  con  your  Materia  Medica.  Let  there  be  a revival  of  thera- 
peutics. How  are  we  to  do  it?  Not  simply  by  prescribing  on  iso- 
lated symptoms  here  and  there,  but,  as  Dr.  Crutcher  said,  let  us 
prescribe  for  the  patient,  the  sick  man.  Don’t  shoot  at  a man’s 
liver  or  kidneys  or  stomach,  but  take  the  totality  of  his  symptoms. 
Let  us  remember  that  it  is  by  carefully  conning  our  Materia  Medica, 
by  carefully  studying  the  patient — the  sick  person,  by  looking  at  the 
image  which  that  person  presents,  and  endeavoring  to  secure  a cor- 
responding image  from  our  list  of  remedies,  that  we  can  secure  suc- 
cess, and  can  go  on  from  conquering  to  conquer,  so  that  our  last  days 
will  be  better  than  our  first  days.  It  is  only  by  doing  this  that  we 
can  secure  a revival  in  therapeutics,  and  I think  if  we  will  be  zeal- 
ous, if  we  see  the  light  we  have  and  not  decry  our  Materia  Medica, 
we  will  show  to  the  world  the  great  benefits  which  Homoeopathy 
placed  before  it.  It  is  very  popular  in  these  days  to  talk  about 
being  a live  practitioner  and  all  that,  but  we  should  not  forget  there 
is  a vast  amount  of  good  stored  up  in  these  records  which  have  come 
down  to  us  from  the  past,  and  it  is  our  duty  to  respect  them  and 
utilize  what  we  have.  Let  us  remember  that  everything  is  not  bet- 
ter than  that  which  has  been  useful  in  the  past.  We  should  dis- 
criminate between  that  which  is  good  and  that  which  is  bad,  and  use 
the  great  mass  of  curative  agents  with  which  we  are  surrounded  and 
with  which  we  should  be  familiar,  and  in  this  way  we  can  bring 
about  a revival  in  therapeutics  which  will  be  a credit  to  the  Homoeo- 
pathic system  of  medicine  and  confer  a great  boon  and  blessing  upon 
humanity. 


614 


world’s  homoeopathic  congress. 


J.  H.  IIenry,  M.D. : Some  forty  years  ago,  when  a student  in 
the  Homoeopathic  College  in  Philadelphia,  under  Hering  and  Kitchen 
and  Matthews  and  others,  I was  taught  what  I considered  the  true 
principles  of  Homoeopathy.  We  had  no  such  a thing  as  Hydro- 
line. We  were  confined  to  the  great  law  Similia  similibus  cur antur, 
and  under  that  law  Homoeopathists  were  sent  out  as  missionaries 
over  the  country.  We  met  yellow  fever,  cholera,  scarlet  fever,  pneu- 
monia, and  we  were  the  victors.  We  were  the  victors  because  we 
dealt  not  in  medicines  that  were  made  from  fluid  extracts.  We  dealt 
in  pure  Homoeopathic  remedies,  and  we  treated  diseases  with  them. 
Take,  for  instance,  aconite.  We  have  no  such  thing  in  this  country 
as  a good  Homoeopathic  preparation  of  Aconite,  unless  it  comes  from 
the  pharmacies  of  Germany.  In  the  treatment  of  fever  with  the 
present  Aconite  are  not  favored  with  the  pure  drug  used  by  Ho- 
moeopathic physicians  twenty  years  ago.  Take  Belladonna  and  all 
our  old  standard  remedies  that  were  handed  down  to  us  by  the  ear- 
lier Homoeopaths.  We  went  forth  with  our  little  cases  in  our  pockets, 
treated  patients,  and  were  successful.  Now  I write  to  my  pharma- 
cist to  get  Aconite,  and  I get  a muddy,  dirty  tincture.  I write 
for  Bryonia  and  I get  a dark  tincture.  I get  no  longer  the  beautiful 
yellow  tincture.  The  fault  is  not  always  so  much  in  the  prescriber 
as  it  is  in  the  impurity  of  our  drugs.  Unless  we  pay  more  attention 
to  the  purity  of  our  drugs,  the  destiny  of  Homoeopathy  is  sealed. 
This  paper  is  one  that  I am  glad  to  hear,  because  it  treats  of  the 
past,  the  present  and  the  future  of  Homoeopathy. 


PRACTICAL  PSYCHOLOGY  IN  RELATION  TO  P ATHOG EN ES  Y.  615 


PRACTICAL  PSYCHOLOGY  IN  ITS  RELATION  TO 
PA  TH  0 GENES  Y. 

By  Eldridge  C.  Price,  M.D.,  Baltimore,  Md. 


We  are  impressed  by  the  fact  that  in  the  growth  and  development 
of  medicine,  science,  with  ever-increasing  insistence,  demands,  that 
for  the  purpose  of  successfully  relieving  sickness,  each  case  of  disease 
be  considered  as  an  individual.  This  suggestion  that  the  “ personal 
equation  ” shall  be  taken  into  account  by  the  physician  was  first  made 
by  Samuel  Hahnemann.  And  to-day,  by  every  educated  practitioner, 
whatever  be  his  creed,  the  necessity  of  individualizing  to  a greater  or 
less  extent,  is  acknowledged.  Of  necessity,  the  believer  in  Homoe- 
opathy must  aceept  the  individuality  of  the  human  being  as  he  ac- 
cepts the  major  and  minor  pathogenetic  details  which  constitute  the 
personality  of  the  drug  which  he  prescribes.  Or,  to  reverse  it,  he 
must  recognize  that  each  human  organism  is  a distinct  entity  with 
special  characteristics  before  he  can  hope  to  gain  a clear  understand- 
ing of  the  power  of  the  given  drug  to  modify  mental  and  physical 
activity  when  used  primarily  in  the  field  of  pathogenesy,  and  sec- 
ondarily in  therapeutics. 

Another  suggestion  made  bv  Hahnemann  was,  that  the  symptoms 
of  the  nervous  system,  especially  those  due  to  temperament,  those 
which  go  to  make  up  the  individuality  of  the  patient,  should  be  given 
mature  consideration  before  prescribing  a drug.  The  older  school 
of  medicine  has  not  yet  consented  to  adopt  this  view  ; the  believer 
in  Homoeopathy  is  yet  alone  in  his  acceptance  of  this  profound  truth, 
this  truth  which  is  on  the  border-land  of  an  approximately  perfect 
system  of  therapeutics. 

When  Hahnemann  made  this  last  suggestion  he  was  more  seriously 
handicapped  by  an  imperfect  pathogenesy  of  drugs  than  are  we  of 
the  present  day ; but  even  with  the  scant  material  he  then  possessed 
he  could  see  that  the  truth  of  such  a postulate  was  a logical  necessity, 
or  there  was  no  such  thing  as  a law  of  similars.  On  this  also  de- 


616 


world’s  homoeopathic  congress. 


pended  the  truth  of  the  power  of  infinitesimally  subdivided  matter. 
The  great  formulator  saw  (even  with  his  slender  stock  of  knowledge 
of  psychology)  that  if  through  the  special  senses  material  changes 
could  be  produced  in  the  gross  functions  and  even  structure  of  the 
organism  called  man,  by  mere  ideas  or  intangible  impressions,  then 
there  was  no  mystery  in  the  effect  produced  by  infinitesimally  sub- 
divided matter  when  introduced  into  this  organism. 

We  are  here  on  the  borders  of  an  almost  unexplored  country;  but 
it  is  the  field  in  which  Homoeopathy  has  had  some  of  its  greatest 
triumphs,  and  in  which  it  must  look  for  its  fullest  justification  in  the 
future.  Up  to  the  present  time  the  Homoeopathic  branch  of  the 
medical  profession  has  but  dabbled  in  the  waters  of  the  great  ocean 
of  Homoeopathy ; none  have  been  able  to  venture  boldly  in,  because 
none  have  known  enough  to  swim. 

To  be  able  to  practice  Homoeopathy  according  to  the  ideal  of 
Hahnemann,  the  ideal  of  the  artist,  in  accordance  with  science,  three 
things  we  now  lack  are  necessary : first,  a thorough  knowledge  of 
practical  psychology ; second,  a Materia  Medica  thoroughly  proven 
upon  healthy  experimenters;  and  third,  thorough  correlated  knowl- 
edge of  pathogenesy  and  practical  psychology. 

A Materia  Medica  thoroughly  proven  upon  the  healthy  is  neither 
a thing  of  the  past  nor  of  the  present,  but  it  is  a possibility  of  the 
future.  It  is  one  of  the  ultimate  necessities  of  Homoeopathy,  but 
the  need  for  it  is  not  so  great  as  the  need  for  a knowledge  of  psy- 
chology practically  applied  to  the  pathogenetic  material,  not  only  of 
the  future,  but  applied  to  the  comparatively  little  reliable  material 
already  in  our  possession.  For  intelligent  and  profitable  study  of 
drug  effects,  familiarity  with  such  knowledge  is  necessary.  This  the 
scientific  physician  needs,  and  until  he  becomes  possessed  of  it  medi- 
cine will  continue  to  be  what  it  is  now,  largely  an  empirical  art.  It 
is  true  that  some  scientific  cures  have  been  made  in  accord  with  the 
strictest  requirements  of  pre-vision,  but  these  cures  are  exceptional. 
The  realization  of  the  scientist’s  ideal  should  reverse  this  and  make 
failures  the  exception. 

“But,”  it  may  be  objected,  “ this  state  of  affairs  is  not  possible.” 
We  have  never  claimed  that  it  is  possible;  we  have  only  said  that 
this  reduction  of  the  ideal  to  the  real  must  be  (as  it  is)  the  tendency 
of  Homoeopathy,  if  we  expect  to  progress;  if  we  desire  to  fulfil  the 
most  liberal  possibilities  of  the  law  of  similars.  Whether  it  can  be 


PRACTICAL  PSYCHOLOGY  IN  RELATION  TO  PATHOGENESY.  617 


accomplished  remains  for  the  future  to  decide.  Of  course,  a perfect 
system  of  medicine  is  ideal,  but  the  best  practical  results  are  always 
attained  through  the  inspiration  of  high  ideals. 

Let  us  examine  into  this  relationship  which  we  claim  should  exist 
between  psychology  and  pathogenesy. 

Originally,  psychology  meant  that  which  treated  of  the  human 
soul.  As  thought-evolution  progressed,  the  term  was  modified  into 
science  of  the  soul ; that  is,  correct  knowledge  of  all  manifestations 
supposedly  of  the  functions  of  the  soul.  More  latterly,  students  in 
th  is  field  discovered  that  such  a definition  was  ambiguous,  besides 
involving  the  introduction  of  certain  theological  opinions,  and  hence, 
as  mind  may  be  credited  with  a responsibility  for  all  results  which 
have  been  considered  “ functions  of  the  soul/’  psychology  now  comes 
to  mean  “ mental  philosophy,  the  science  of  the  mind.”  Therefore, 
a study  of  psychology  involves  not  a study  of  mental  conditions 
alone,  but  it  includes  an  examination  into  the  effect  of  mind  upon 
matter,  and  also  the  causes  which  produce  mental  effects,  the  action 
of  matter  upon  mind. 

A knowledge  of  psychology  is  useful  in  many  ways,  but  for  a 
proper  understanding  of  the  meaning  of  supposable  effects  of  drugs 
upon  the  healthy  human  system,  it  is  a necessity. 

In  this  preparatory  work  upon  which  the  foundation  of  the  thera- 
peutics of  the  future  must  be  laid,  anthropology  is  the  starting-point, 
the  study  of  man  considered  from  an  ethnological  standpoint. 
Herein  racial  features  should  be  considered,  with  their  differences  of 
physical  development,  qualifications,  adaptability  to  environment, 
together  with  mental  characteristics,  etc.  Next  should  be  consid- 
ered the  subject  of  ethology  or  character  in  its  various  extremes,  and 
in  its  various  intermediate  phases.  The  several  mental  conditions 
known  as  emotions,  should  be  studied  and  carefully  analyzed,  ex- 
amining into  the  relation  of  these  emotions  to  what  is  commonly 
known  as  temperament.  Temperament  should  then  be  investigated 
in  its  relation  to  the  physical  body,  its  growth,  development  and 
appearance.  Then  again,  our  steps  should  be  retracted ‘to  the 
extent  of  analyzing  the  various  mental  attitudes  which  enter  into 
the  constitution  of  each  accepted  temperament.  The  question  as  to 
whether  there  is  such  a thing  as  temperament  should  also  be  exam- 
ined. Having  carefully  surveyed  these  various  fields,  the  investi- 
gator should  then  proceed  to  examine  into  the  effect  of  physical  con- 


618 


world’s  homoeopathic  congress. 


ditions,  environment,  perversions  of  local  functions  of  organism,  etc., 
upon  the  mind. 

u Man’s  greatest  study  is  man,”  does  not  apply  alone  to  the  body, 
but  it  applies  equally  to  the  study  of  that  which  constitutes  the  ego , 
the  mental  characteristics,  the  expressions  which  originate  charac- 
ter, which  are  founded  upon  character,  which  form  a part  of  char- 
acter, which  are  character.  Man  is  not  all  mind,  nor  is  he  all 
body  ; he  is  a combination  more  or  less  equally  balanced,  of  the 
two. 

Rarely  do  two  witnesses  give  perfectly  concordant  testimony  upon 
a subject  with  which  they  should  be  equally  familiar.  u Point  of 
view”  is  largely  responsible  for  the  discrepancies,  as  no  two  indi- 
viduals can  occupy  precisely  the  same  mental  or  physical  position 
together;  but  inexpert  observation  and  carelessness  of  expression  are 
also  large  factors  of  the  discordant  testimony.  An  examination  of 
the  reliability  of  human  testimony,  therefore,  should  also  enter  into 
this  application  of  psychology  to  pathogenesy.  Herein  comes  the 
critical  study  of  the  superstitions  of  mankind,  beginning  with  the 
fetich,  extending  to  amulets,  talismans  and  charms,  the  king’s  touch, 
and  ending  with  mesmerism  which  has  been  reclaimed  by  science 
under  the  name  of  hypnotism.  Objectivity  and  subjectivity  should 
both  be  carefully  considered. 

Having  thus  systematically  laid  the  foundation  for  scientific 
scrutiny  of  human  testimony  on  the  subject  of  drug  action,  we  are 
then  ready  to  begin  the  study  of  pathogenesy  as  experts,  and  not  till 
then.  I have  more  than  once  called  attention  to  the  fact  that  be- 
cause of  this  lack  of  preliminary  education  in  psychology,  our 
Materia  Medica  has  become  overcrowded  with  material  that  is  abso- 
lutely valueless,  and  (deplorable  fact !)  until  the  necessity  of  this 
preliminary  preparation  is  fully  recognized,  and  has  become  a part 
of  those  who  are  apparently  inexhaustible  fountains  of  symptomatic 
details,  the  flood  of  inaccuracies  will  continue  to  inundate  the  pro- 
fession. 

It  may  be  objected  that  much  good,  as  clearly  stated,  has  been 
done  by  the  application  of  what  the  profession  has  interpreted  as 
the  Homoeopathic  relationship  between  drug  effects  and  disease. 
This  may  safely  be  admitted  and  yet  the  fact  remain,  that  such  good 
results  have  been  secured  in  spite  of  our  collection  of  alleged  patho- 
genetic details,  not  because  of  it.  There  is  no  stronger  proof  of  the 


PRACTICAL  PSYCHOLOGY  IN  RELATION  TO  PATHOGENESY.  619 


truth  of  the  principle  of  similars,  that  it  is  a law,  than  the  very  fact 
that  the  profession  has  been  able  to  apply  Homoeopathy  to  the  cure 
of  the  sick  with  so  defective  a symptomatology. 

But  to  return  from  our  diversion.  After  having  learned  some- 
thing of  the  inter-relationships  of  mental  and  physical  influences,  of 
the  effects  of  mind  upon  matter  and  of  matter  upon  mind,  in  fine, 
having  learned  how  to  weigh  human  testimony,  we  are  prepared  to 
apply  the  results  of  our  investigation  to  the  study  of  pathogenesy. 
From  our  study  we  will  be  possessed  of  some  valuable  facts.  First, 
should  we  make  experiments  with  drugs  upon  the  healthy,  we  will 
know  enough  to  select  persons  in  at  least  moderately  good  health, 
and  we  will  also  know  enough  not  to  select  persons  who  are  under 
either  mental  or  physical  strain,  e.g.,  medical  students,  or  over- 
worked clerks;  nor  will  we  select  habitual  users  of  drugs,  such  as 
tobacco,  alcohol  in  any  form,  tea,  coffee  or  spices,  all  of  which  sub- 
stances, as  we  know,  produce  more  or  less  deviation  from  the  normal 
health  of  the  user.  In  short,  we  will  secure  for  our  experimenters 
persons  as  nearly  normal  in  health  and  as  little  addicted  to  harmful 
habits,  as  possible.  When  we  come  to  examine  the  sources  of  our 
symptomatology,  we  will  know  enough  to  reject  many  details  which 
students  not  trained  to  exact  thought  might  accept,  e.g.,  catarrhal 
symptoms  which  have  been  recorded  in  cold,  damp  weather,  by 
provers  subject  to  chronic  catarrh,  bowel  symptoms  recorded  by  those 
who  are  subject  to  frequent  attacks  of  indigestion  and  diarrhoea,  or 
symptoms  recorded  by  those  taking  two  or  more  drugs  at  the  same 
time,  or  symptoms  recorded  by  those  under  treatment  for  diseased 
conditions,  or  symptoms  noted  by  those  under  intense  mental  excite- 
ment, or  temperamental  symptoms  which  are  congruent  with  the 
normal  condition  of  the  experimenter.  And  we  will  also  know 
enough  to  reject  in  toto,  or  we  will  subject  to  the  severest  scrutiny, 
all  recorded  experiments  which  are  not  preceded  by  such  a conscien- 
tious health-record  as  a knowledge  of  psychology  can  alone  give. 

Herein,  therefore,  is  the  relation  between  practical  psychology 
and  pathogenesy,  that  without  understanding  mankind  through 
psychic  manifestations,  it  is  impossible  to  disentangle  reliable  details 
of  drug-effects  from  the  so-called  pathogenetic  records  extant;  and  it  is 
equally  impossible  to  make  scientific  tests  of  the  effects  of  drugs  upon 
the  healthy  in  the  future;  it  therefore  behooves  all  who  intend  making 
a study  of  drug-effects,  to  first  investigate  the  field  of  practical  psychol- 


620 


world’s  homoeopathic  congress. 


ogy,  and  especially  that  department  which  relates  to  the  fallibility  of 
human  testimony.  In  fact  every  practitioner  of  Homoeopathy  who  is 
a believer  in  the  law  of  similars,  who  can  appreciate  the  relative  sci- 
entific value  of  a priori  Homoeopathy  and  a posteriori  Homoeopathy, 
and  who  is  convinced  that  the  medicine  of  science  has  a greater 
practical  value  than  the  medicine  of  experience — every  such  thinker 
should  turn  his  attention  to  a study  of  this  subject. 

In  the  past,  the  success  of  Homoeopathy  as  a practical  system  of 
medicine  depended  upon  the  success  of  the  practitioners  in  curing  the 
sick.  Enough  practical  believers  in  the  law  were  found  to  satisfy 
the  demands  of  the  people  ; and  with  the  people,  Homoeopathy  to- 
day stands  a recognized  principle.  We  have  met  the  demands  of 
the  past,  and  Homoeopathy  stands  in  the  present  as  a great  a success 
as  this  stupendous  Columbian  Exhibition  ; but  we  are  on  the  verge 
of  a future,  a future  with  demands  far  more  exacting  than  were 
those  of  the  past.  Our  claims  have  been  submitted  to  the  untutored 
mind  of  an  inexpert  public  ; now  we  come  to  have  these  claims  an- 
alyzed by  the  tutored  mind  of  the  expert  son  of  science,  specialism. 
We  must  and  we  will  stand  the  test;  the  Homoeopathic  relationship 
of  drug-effects  to  diseased  conditions  will  be  demonstrated  a law — 
but  the  demonstration  will  not  rest  upon  clinical  observations  (they 
are  but  corroborative  evidence) ; it  will  depend  upon  the  value  of 
our  pathogenetic  material,  and  the  purity  and  reliability  of  this  ma- 
terial will  in  turn  depend  upon  the  understanding  of  practical  psy- 
chology in  its  relation  to  experimental  drug  tests  upon  the  healthy. 

In  conclusion,  we  are  justified  in  submitting,  that  as  there  is  no 
method  of  finding  undoubted  effects  of  drugs  except  by  experiments 
upon  the  healthy,  and  as  these  effects  can  only  be  discovered  after  a 
careful  study  of  the  individuals  upon  whom  the  experiments  are 
made  (as  to  their  normal  mental  and  physical  condition  in  all  the 
varied  manifestation  of  function),  and  as  these  details  can  only  be 
understood  after  a study  of  psychology — therefore  it  becomes  obvious 
that  the  only  way  to  correctly,  understanding^,  and  profitably  study 
drug  action,  is  in  the  light  of  practical  psychology.  And  further, 
as  the  demonstration  of  the  truth  of  the  law  of  similars  depends 
upon  a pure  pathogenesy,  so,  recognizing  Homoeopathy  as  a law  of 
nature,  we  submit,  that  to  fully  understand  this  law  of  nature,  a 
knowledge  of  psychology  is  the  student’s  necessity. 


PRACTICAL  PSYCHOLOGY  IN  RELATION  TO  PATHOGENESY.  621 


Discussion. 

T.  S.  Hoyne,  M.D. : I did  not  hear  all  the  paper,  but  heard 
enough  to  say  that  as  yet  we  know  nothing  about  psychology.  No 
two  drugs  act  precisely  alike;  there  are  no  two  exactly  alike  in 
symptomatology.  There  are  no  two  persons  exactly  alike,  and  the 
proving  of  a drug  upon  two  individuals  will  produce  more  or  less 
different  symptoms.  Hahnemann  informs  us  how  we  are  to  make  these 
provings.  He  tells  us  we  should  select  persons  who  are  in  a state 
of  health  ; persons  who,  during  that  time,  refrain  from  spiced  food, 
as  the  Doctor  just  remarked — but  Hahnemann  nowhere  tells  us  that 
we  should  refrain  from  tobacco.  No  German  ever  stopped  the  use 
of  tobacco  during  provings;  they  are  all  smokers.  No  physician 
told  them  to  stop  the  use  of  beer;  they  have  all  been  great  users  of 
beer.  Now  I claim,  if  a healthy  man  who  is  using  tobacco  or  beer 
stops  that  habit,  he  will  develop  symptoms  at  once.  It  is  a thing 
he  is  accustomed  to,  and  he  may  as  well  stop  eating  at  once.  When 
we  were  proving  a drug,  we  did  not  order  the  prover  to  stop — he  kept 
right  on.  So  you  can  make  a proving  of  tobacco,  a potency  of  it  in  a 
tobacco-user,  and  I will  get  symptoms  from  it.  If  we  are  to  obtain 
provers  that  are  in  perfect  health,  and  who  use  neither  tobacco,  cof- 
fee, tea,  onions,  or  other  things  of  that  sort,  we  will  find  no  provers 
at  all.  In  fact  it  is  very  difficult  to  find  persons  who  would  fulfill 
the  conditions  laid  down  by  the  Doctor.  I want  to  say  one  thing 
about  medical  students,  as  I have  had  a great  deal  to  do  with  them 
as  provers  of  medicine.  If  the  class  do  not  know  what  effects 
they  will  receive  from  the  remedy,  they  make  the  best  provers  in 
the  world.  Take  a class  of  twenty,  and  you  will  find  that  the 
symptoms  will  correspond  more  or  less  all  through  the  list.  Their 
symptoms  come  from  their  imaginations  and  from  their  habits. 

A.  L.  Monroe,  M.D. : As  to  the  psychological  element  to  be 
considered  in  therapeutics,  that  is  a phase  of  our  double-sided  pre- 
scriptions which  is  equally  important,  as  its  complement,  I think  to 
many.  Of  course  that  tendency  is  overcome  with  Homoeopathic  phy- 
sicians to  a great  extent  by  their  being  forced  to  study  the  mental 
symptoms  that  come  from  the  drug.  But  a great  many  physicians 
treat  a human  being  as  though  they  were  mending  a watch  or  some- 
thing of  that  sort,  simply  a machine.  As  we  know  and  believe  all 
human  organisms  are  psychologically  and  physically,  the  same  ; yet 
no  one  ever  knew  a man  with  a humpback  that  did  not  have  a 
hump  mind  somewhere.  You  never  saw  a man  with  a halt  in  his 
gait  that  did  not  have  a halt  in  his  mind  somewhere.  These  symp- 
toms confirm  each  other  and  complement  each  other,  and  in  certain 
physical  conditions  we  are  bound  to  have  certain  mental  symptoms. 
Another  thing,  the  very  question  of  psychology  and  its  practical 
application  in  prescribing  drugs,  goes  a long  way  towards  explaining 
our  advance  of  the  Allopaths.  We  builded  better  than  we  knew. 


622 


world’s  homoeopathic  congress. 


We  know  that  a certain  drug  will  cure  sleeplessness  that  is  caused 
by  grief.  We  are  told  that  a certain  other  drug  will  cure  sleepless- 
ness caused  by  joy.  Is  there  any  one  who  can  tell  us  why  one  cures 
the  sleeplessness  from  joy  and  the  other  the  sleeplessness  from  grief? 
It  is  impossible  to  put  the  material  phases  upon  our  prescriptions, 
and  so  it  is  that  we  cannot  ignore  or  ridicule  the  psychological  study 
of  our  work. 

T.  F.  Allen,  M.D. : There  is  a great  deal  to  be  said  on  this  sub- 
ject. I am  extremely  gratified  with  this  paper.  I did  not  know 
what  ground  Dr.  Price  would  take,  but  it  certainly  seems  to  me  a 
matter  of  the  highest  importance,  and  he  has  struck  the  right  note. 
I wish  all  our  medical  students  were  compelled  to  study  psychology 
the  first  year  as  a preliminary  course  before  studying  medicine,  just 
as  we  teach  our  Normal  School  teachers  psychology  that  they  may 
better  understand  the  child.  We  can  all  exercise  a good  influence 
not  only  in  proving  drugs  but  in  recording  the  effects  of  drugs  upon 
patients.  Some  of  us  enthusiasts  are  inclined  to  attribute  the  cure 
of  the  patient  too  much  to  the  drug  or  medicine.  In  my  younger 
days  I was  called  to  treat  a case  that  had  been  going  on  three  or 
four  weeks  of  haemorrhage.  Nothing  would  stop  the  constant  spit- 
ting of  blood.  I was  called  in  as  a kind  of  experiment  to  see  what 
could  be  done.  I made  up  my  mind  from  the  symptoms  of  the 
patient  that  Arnica  ought  to  cure  that  patient,  and  I put  up  three 
powders  and  laid  them  on  a shelf  by  the  bedside,  with  instructions 
to  take  at  intervals  of  two  hours  and  take  nothing  else  until  I 
came  back.  After  twelve  hours  I visited  the  patient,  and  she  had 
not  spit  a mouthful  of  blood  since  my  visit,  and  not  a particle  of 
blood  was  expectorated  after  that  time.  I watched  the  patient  four 
or  five  years,  and  there  those  doses  of  Arnica  remained,  and  they 
were  never  taken.  It  was  a great  disappointment  to  me.  If  those 
powders  had  been  taken  you  would  all  have  heard  of  it  as  a wonder- 
ful cure.  I find  myself  more  and  more  inclined  to  doubt  my  senses. 
I want  to  verify  them  over  and  over.  This  matter  of  proving  drugs 
may  not  be  a matter  of  such  general  interest.  Some  of  us  must  do 
the  work,  and  I like  to  see  men,  these  skeptical  men  who  like  to 
verify  these  things,  be  sure  they  are  right.  There  is  no  better  work 
done  than  is  accomplished  by  the  skepticism  of  the  Baltimore  Club 
of  which  Dr.  Price  is  the  leading  spirit,  I believe.  It  is  a splendid 
work,  and  we  need  it  if  our  Materia  Medica  is  to  be  regenerated. 
Such  skepticism  does  not  interfere  with  the  success  of  Homoeopathy. 
It  will  only  give  it  a better  and  truer  foundation.  That  we  ought 
to  be  skeptical  goes  without  saying,  because  we  cannot  help  believ- 
ing Homoeopathy.  Professor  Hoyne  said  that  it  was  his  observa- 
tion that  a class  of  medical  students  make  the  best  pro  vers  in  the 
world  ; I beg  to  differ  with  the  doctor.  Dr.  Wesselhoeft,  of  Boston, 
tried  sugar  of  milk  with  his  provers,  and  he  was  well  situated,  having 


PRACTICAL  PSYCHOLOGY  IN  RELATION  TO  PATHOGENESY.  623 


both  men  and  women  students.  He  found  that  those  students 
developed  most  remarkable  results  from  the  admistration  of  the  Sac. 
lac.;  that  they  would  come  to  him  with  the  most  wonderful  prov- 
ings. They  naturally  will  seek  to  interest  their  professor,  and  in 
this  way  will  try  to  please  him  by  making  statements  as  to  the 
symptoms.  There  is  psychology  for  you  with  a vengeance.  The 
best  provers  I can  find  are  impecunious  young  doctors  waiting  for 
patients. 

Dr.  Hoyne  : But  these  are  medical  students. 

Dr.  Allen  : I mean,  after  they  pass  out  from  under  the  Pro- 
fessor. 

Dr.  Bowen,  of  Indiana : Dr.  Allen,  did  you  assure  that  woman 
that  you  would  cure  that  hsemorrhage? 

Dr.  Allen  : It  was  a man.  I did  not  tell  him  that  I would  cure 
him. 

Dr.  Bowen  : It  was  not  a psychological  cure? 

Dr.  Alien:  They  asked  me  what  I thought  of  the  case,  and  I 
said  I really  did  not  know.  These  powders  seemed  to  me  the  thing, 
and  I said  I would  do  the  best  I could. 

Dr.  Price,  in  closing  the  discussion  on  his  paper  said:  It  has 
been  stated  that  we  know  little  or  nothing  of  psychology.  That  we 
should  study  it.  But  it  happens  we  do  know  something  of  psychol- 
ogy. Spencer  and  Wibeaux  have  worked  in  that  field.  If  we  would 
study  the  standard  works  on  psychology,  we  would  all  find  it  would 
be  of  great  benefit  in  Materia  Medica.  We  know  that  if  an  indi- 
vidual does  not  know  anything  about  his  normal  condition,  it  is 
impossible  for  him  to  tell,  when  he  takes  a drug,  what  manifestations 
appear  after  taking  that  drug.  There  is  not  one  man  in  a hundred 
that  can  tell  you  how  he  felt  yesterday  or  ten  minutes  ago.  That  is 
why,  of  course,  the  counter-test  of  sugar  of  milk  is  used  to  get  at 
the  normal  condition  of  the  patient,  then,  when  he  takes  the  drug  all 
those  symptoms  are  eliminated. 

Now.  there  is  another  point  about  Materia  Medica  that  we  should 
get  right,  and  that  is,  in  the  practical  application  of  the  study  of 
psychology.  There  has  hfen  carelessness  in  medical  provings,  and 
the  original  compiler  has  allowed  error  to  slip  in.  If  the  work  had 
been  done  by  practical  psychologists  the  mistakes  never  would  have 
occurred. 

Now,  so  far  as  the  German  not  stopping  the  use  of  tobacco  in 
provings,  that  don’t  make  it  right.  Tobacco  is  one  of  our  most  pow- 
erful poisons, ^nd  no  doubt  that  is  one  reason  why,  probably,  all  our 
old  German  practitioners  gave  so  many  symptoms  that  were  unrelia- 
ble, because  they  were  mixed  up  with  tobacco  effect.  It  goes  without 
saying,  that  a man  not  specially  under  the  influence  of  a drug  of  any 
kind,  will  get  effects  from  the  drug  he  is  attempting  to  prove.  Now, 
if  you  will  refer  to  some  of  the  standard  works,  some  of  the  symp- 


624 


world’s  homceopathic  congress. 


toms  referred  to  in  the  Encyclopaedia  of  Drug  Pathogenesy,  or  Allen’s 
Encyclopaedia , you  will  find  twenty  records  of  experiments  with  one 
drug,  in  which  every  prover  manifested  the  same  symptoms,  unless 
he  had  headache  or  vertigo.  Take  any  record  of  twenty  or  more 
provers,  or  even  less,  and  I do  not  think  you  can  find  any  one  symp- 
tom that  has  run  through  every  record  of  the  symptom  that  is  char- 
acteristic of  that  individual  drug.  It  may  be  the  symptom  that  is 
characteristic  of  the  local  action  of  the  drug,  or  any  other  foreign 
substance  upon  the  stomach,  or  something  of  that  kind,  but  you  will 
always  find  it  is  especially  characteristic  of  that  one  drug. 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


625 


PRIMARY  AND  SECONDARY  SYMPTOMS ; OR  THE 
OPPOSITE  ACTION  OF  LARGE  AND 
SMALL  DOSES. 

By  Charles  Mohr,  M.D.,  Philadelphia,  Pa. 


Much  confusion  exists  among  medical  men  for  want  of  a proper 
comprehension  of  our  subject;  and  false  claims  as  to  principles  of 
selection  and  the  modus  operandi  of  cures  are  often  made  when  pri- 
mary and  secondary  symptoms  of  drugs  are  used  as  guides  in  deter- 
mining the  size  of  the  dose. 

This  is  not  strange,  however,  since  the  terms  primary  and  second- 
ary, as  applied  to  drug-action,  are  susceptible  of  different  inter- 
pretations, and  are  used  with  different  significations  by  different 
authors. 

Of  the  pictures  of  primary  and  secondary  effects  of  drugs  which 
we  find  in  the  works  of  Old-School  writers,  and  which  have  been 
made  the  basis  of  the  “ law  of  the  dose  ” by  some  writers  of  the 
Homoeopathic  School,  I quite  agree  with  the  late  Dr.  Dunham’s 
estimate,  that  “they  are  composite  pictures  made  up  from  a variety 
of  observations  on  patients  and  from  cases  of  poisoning,  and  bear 
no  more  resemblance  to  a pathogenesis  on  a single  individual  than 
the  composition  of  an  artist  which  has  the  mountains  of  Ecuador 
covered  with  the  forests  of  Oregon  and  decked  with  the  flowers  of 
Java  presents  to  a faithful  landscape  from  nature.” 

Let  me  rehearse  what  the  writers  of  the  Homoeopathic  School  have 
said  concerning  the  subject  under  consideration. 

Hahnemann,  in  his  essay,  “Suggestions  for  Ascertaining  the 
Curative  Powers  of  Drugs,”  published  in  1796,  and  which  you  can 
read  in  the  Lesser  Writings , says : “ Most  medicines  have  more  than 
one  action;  the  first  a direct  action,  which  generally  changes  into 
the  second  (which  I call  the  indirect  secondary  action).  The  latter 
is  generally  a state  exactly  the  opposite  of  the  former.  In  this  way 
most  vegetables  act.”  He  illustrates  his  meaning  thus  : “ LTnder 

40 


626 


world's  homoeopathic  congress. 


Opium  a fearless  elevation  of  spirit,  a sensation  of  strength  and 
high  courage,  an  imaginative  gaiety  are  part  of  the  direct  primary 
action  of  a moderate  dose  on  the  system ; but  after  the  lapse  of  eight 
or  twelve  hours  an  opposite  state  sets  in,  the  indirect  secondary  ac- 
tion, and  there  ensue  relaxation,  dejection,  diffidence,  peevishness, 
loss  of  memory,  discomfort,  fear.” 

It  must  he  noted  here,  however,  that  Hahnemann  admitted  quali- 
fications as  to  his  general  statement  as  to  the  opposite  primary  and 
secondary  action  of  medicines  and  specified  metals  and  minerals 
which  “ continue  their  primary  action  uninterruptedly,  of  the  same 
kind,  though  always  diminishing  in  degree,  until  after  some  time 
no  trace  of  their  action  can  be  detected,  and  the  natural  condition  of 
the  organism  is  restored.” 

In  the  preface  of  the  Fragmenta,  published  in  1805,  Hahnemann 
further  says : “ Simple  drugs  produce  in  the  healthy  body  symptoms 
peculiar  to  themselves,  but  not  all  at  once,  nor  in  one  and  the  same 
series,  nor  all  in  each  experimenter 

A certain  drug  evokes  some  symptoms  earlier  and  others  later, 
which  are  somewhat  opposed  and  dissimilar  to  each  other;  indeed, 
may  be  diametrically  opposed.  I call  the  former  primary,  or  of  the 
first  order,  and  the  latter  secondary,  or  of  the  second  order. 

For  each  individual  drug  has  a peculiar  and  definite  period  of 
action  in  the  human  body,  longer  or  shorter,  and  when  this  has 
passed,  all  the  symptoms  produced  by  the  drug  cease  together. 

Of  the  drugs,  therefore,  the  effects  of  which  pass  over  in  ‘a  brief 
space  of  time,  the  primary  symptoms  appear  and  disappear  within  a 
few  hours.  After  these  the  secondary  appear  and  as  quickly  disap- 
pear. But  the  exact  hour  in  which  any  symptom  may  be  wont  to 
show  itself  cannot  be  positively  determined,  partly  because  of  the 
diverse  nature  of  men,  partly  because  of  different  doses. 

I have  observed  some  drugs  the  course  of  whose  effects  consisted 
in  two,  three,  or  more  paroxysms,  comprising  both  kinds  of  symp- 
toms, both  the  primary  and  the  secondary  ; the  former,  indeed,  as  I 
have  stated  in  general  terms,  appeared  first  and  the  latter  second. 
And  sometimes  it  seems  to  me  I have  seen  symptoms  of  a kind  of 
third  order. 

Under  the  action  of  moderate  or  small  doses,  the  symptoms  of 
the  first  order  came  chiefly  to  view  ; less  frequently  those  of  the 
second  order.  I have  chiefly  preserved  the  former,  as  most  suitable 
to  the  medical  art  and  most  worthy  to  be  known.” 


PRIMARY  AND  SECONDARY  SYxMPTOMS. 


627 


To  illustrate  his  views  he  prefixed  or  appended  to  the  symptoma- 
tology of  the  drugs  mentioned  in  the  Fragmenta  the  following 
remarks : 

Under  Aconite:  “Through  the  whole  course  of  action  of  this 
plant,  its  effects  of  the  first  and  second  order  were  repeated  in  short 
paroxysms  two,  three  or  four  times  before  the  whole  effect  ceased. 
These  effects  were  as  follows  : 

Coldness  of  the  whole  body  and  dry  internal  heat;  chilliness; 
sense  of  heat,  first  in  the  hands,  then  in  the  whole  body,  especially 
in  the  thorax,  without  sensible  external  heat. 

Alternating  paroxysms  (during  the  third,  fourth  and  fifth  hours), 
general  sense  of  heat,  with  red  cheeks  and  headache,  worse  on  mov- 
ing the  eyeballs  upward  and  laterally;  then  shivering  of  the  whole 
body,  with  red  cheeks  and  hot  head ; then  shivering  and  lachryma- 
tion,  with  pressing  headache  and  red  cheeks.” 

Under  Chamomilla:  “ The  course  of  its  action  is  run  in  parox- 
ysms of  several  hours’  duration,  comprising  symptoms  of  each  order, 
free  spaces  or  remissions  being  interjected,  so,  nevertheless,  that  in 
the  earlier  paroxysms  the  symptoms  of  the  first  order;  in  the  later, 
those  of  the  second  order,  predominate.” 

Under  Ignatia : “Inconstancy,  impatience,  vacillation,  quarrel- 
someness, wonderful  mutability  of  disposition — now  prone  to  laugh- 
ter, now  to  tears.  These  mental  symptoms  are  wont  to  be  repeated 
at  intervals  of  three  or  four  hours.” 

Commenting  on  these  quotations  from  Hahnemann,  Dr.  Carroll 
Dunham  has  truly  said : “ In  his  definition  of  primary  and  second- 
ary symptoms,  Hahnemann  blended  the  elements  of  time  and  of 
causation  or  nature  (viz.,  that  these  classes  were  opposed  in  their 
nature).  The  secondary  symptoms  were  not  an  independent  series, 
but  were  secondary  by  virtue  of  their  relation  of  opposition  in 
nature  to  a series  of  preceding  symptoms.” 

Hahnemann  pointed  out  very  clearly,  however,  that  there  are 
symptoms  in  every  proving  to  which  there  can  be  no  symptoms  of 
an  opposite  nature.  He  says  : “Our  organism  always  bestirs  itself 
to  set  up  in  opposition  to  the  first  drug-effect  the  opposite  condition, 
if  such  a condition  can  exist.”  In  other  words,  such  symptoms  as  in 
their  nature  did  not  admit  of  an  opposite  condition  (as,  for  exam- 
ple, pain,  cutaneous  eruptions,  etc. ) could  not  be  called  primary , 
because,  in  the  nature  of  things,  they  could  not  be  followed  by  an 


628  world’s  homoeopathic  congress. 

opposite  class  of  symptoms ; nor  could  they  be  called  secondary, 
because,  in  the  nature  of  things,  they  could  not  have  been  preceded 
by  an  opposite  series  which  could  stand  to  them  in  the  relation  of 
primary  symptoms. 

Hahnemann  also  recognized  symptoms  occurring  occasionally 
which  he  denominated  contradictory,  which  were  not  secondary,  but 
how  to  distinguish  them  from  the  secondary  symptoms  we  are  not 
told.  In  the  Organon  he  gives  instances  of  what  he  regards  as  sec- 
ondary symptoms,  viz. : “The  gayety  which  follows  the  use  of  coffee 
is  a primary  symptom ; the  subsequent  drowsiness  and  lassitude  are 
secondary  symptoms.  The  sleep  which  follows  Opium  is  a primary, 
and  the  subsequent  insomnia  a secondary  symptom.  The  purging 
of  cathartics  is  a primary,  and  the  subsequent  constipation  a second- 
ary symptom.  The  constipation  of  Opium  is  a primary,  and  the 
subsequent  diarrhoea  a secondary  symptom.” 

According  to  the  rules  laid  down  in  the  Organon,  we  are  to  use 
the  primary symptoms  in  prescribing,  never  the  secondary. 

In  the  Materia  Medica  Pura,  however,  we  find  Hahnemann  to 
deviate  from  his  definitions  and  illustrations  in  the  Organon.  In 
the  preface  to  Belladonna  he  says  : “There  is  no  known  drug  of 
long  action  which  expresses  itself  in  so  manifold  (two  and  three-fold) 
alternate  conditions.  . . . Of  none  of  these  alternate  conditions 
(Wechselwirkungen)  can  it  be  said  that  they  are  beyond  the  primary 
action.”  The  symptoms  referred  to  are: 

Contracted  pupils  and  dilated  pupils. 

Abdominal  pains,  compelling  to  bend  backward  and  to  sit  still ; 
to  move  forward,  and  not  admitting  of  motion. 

Suppressed  stool  and  urine,  and  involuntary  stool  and  micturi- 
tion, and  constant  tenesmus. 

Sleeplessness  and  deep  slumber. 

In  the  preface  to  Nux  vomica,  Hahnemann  says:  “The  symp- 
toms of  a single  dose  of  Nux  vomica  are  wont  to  recur  several  days 
in  succession  at  the  same  time  of  day,  even  at  the  same  hour,  or 
every  other  day.  Hence  the  usefulness  of  this  drug  in  some  typical 
diseases  when  the  symptoms  otherwise  correspond.  Besides  this 
periodicity  of  the  symptoms,  and  besides  the  alternation  of  heat  and 
cold,  there  follow  also  upon  one  another,  here  and  there  (as  is  the 
case  also  with  other  drugs),  symptoms  which  differ  very  much  from 
one  another,  and  appear  to  be  opposed  to  each  other,  although  they 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


629 


all  belong  to  the  primary  action  of  the  drug.  We  call  these  alternate 
actions  ( W echsel  w ir k un gen ) .” 

Other  Nux  vomica  symptoms  referred  to,  are: 

Anorexia  and  great  appetite. 

Constipation  with  tenesmus,  and  diarrhoea  with  desire  and  tenes- 
mus. 

Discharge  of  mucus  from  the  nose,  and  dry  obstruction  of  the 
nose. 

Dr.  C.  Hering,  in  1844,  rejected  Hahnemann’s  explanation  of  pri- 
mary and  secondary  symptoms,  but  admitted  that  there  are  in  every 
proving  symptoms  which  appear  early  and  late,  and  although  they 
may  appear  opposed  to  each  other,  they  are  all  to  be  made  the  basis 
of  prescriptions.  Indeed,  he  says  the  longer  lasting,  more  perma- 
nent and  more  opposed  the  later  symptoms  are  to  the  earlier,  the 
more  useful  they  are  in  practice.  He  declares  that  “all  symptoms 
which  arise  in  provings  of  the  higher  potencies  are  similar  to  the 
later  effects  of  the  lower  or  so-called  stronger  doses,  and  are  not 
like  the  first  effects  of  strong  doses  ” — and  adds  that  the  great  char- 
acteristics of  remedies  accompany  both  the  earlier  and  later  symp- 
-toms,  e.g .,  the  burning  of  arsenic.” 

Hering  therefore  deduces  the  following  law  of  dose  : “ Having 
chosen  the  remedy,  according  to  the  symptoms  of  a case,  from  the 
complete  correspondence  of  the  characteristics  in  disease  and  drug, 
we  have  only  to  consider  whether  the  symptoms  of  the  case  gener- 
ally have  more  resemblance  to  the  earlier  ( primary ) symptoms  of  the 
drugs,  and  then  we  give  the  lower  potencies;  or  more  resemblance  to 
the  later  (secondary)  effects,  that  is,  to  the  symptoms  produced  by  the 
higher  potencies,  and  then  we  give  the  higher  potencies.” 

Dr.  E.  M.  Hale,  in  1860,  expressed  the  belief,  and  in  1874  reit- 
erated it,  that  he  had  discovered  the  law  of  dose.  He  states  that 
“ the  proper  dose  for  each  case  may  be  selected  with  as  much  cer- 
tainty as  the  proper  remedy.”  Assuming  that  all  drugs  produce, 
and  all  diseases  present,  two  series  of  symptoms  (primary  and  sec- 
ondary), and  that  in  one  or  the  other  of  these  classes  is  embraced 
every  symptom  of  drug  or  disease,  he  lays  down  the  following  rule: 
“If  the  primary  symptoms  of  a disease  are  present,  and  we  are 
combating  them  with  a remedy  whose  primary  symptoms  corres- 
pond, we  must  make  the  dose  the  smallest  compatible  with  reason  ; 
and  if  we  are  treating  the  secondary  symptoms  of  a malady  with 


630 


world’s  homoeopathic  congress. 


a remedy  whose  secondary  symptoms  correspond,  we  must  use  as 
large  a dose  as  we  can  with  safety.” 

Von  Grauvogl,  in  his  Lehrbuch  der  Homoeopathie , says  : 

“ In  ignorance  of  the  law  of  proportional  oscillation,  some  have 
sought  to  generalize  these  motions,  and  to  call  primary  effect  that 
which  we  bring  to  pass,  and  secondary  effect  that  which,  is  the  reflex 
action  of  the  organism  after  the  effect  is  complete.  In  this  another 
mistake  was  made,  viz.  : that  it  was  generally  thought  that  the  sec- 
ondary effect  could  always  be  considered  and  looked  for  as  the  oppo- 
site of  the  primary  effect,  and  hereupon  indications  were  to  be  built 
up.  This  could  only  come  to  pass  by  the  cotemporaneous  but  im- 
practical further  division  of  this  alternation  of  phenomena  into 
chemical  and  dynamical , of  which  the  latter  were  held  to  be  the 
more  enduring.  For  example:  primary  effect  of  Quinine,  swelling 
of  the  spleen  ; secondary  effect,  atrophy  of  the  same  ; or,  primary 
effect  of  Ipecac,  nausea,  convulsive  cough,  etc. ; secondary  effect, 
relaxation  of  the  musculature,  etc. 

At  the  same  time,  the  secondary  effect  was  sometimes  considered 
as  only  an  intermediate  stage,  from  which  recovery  might  and  should 
proceed;  as  for  example,  from  Alcohol,  first  excitement,  then  bodily 
malaise  (Katzenjaramer),  finally  the  normal  condition  again.  And 
while,  with  the  so-called  dynamic  remedies,  the  primary  effect  was 
to  form  the  indication,  it  was  to  consist,  with  regard  to  chemical 
remedies,  in  the  waiting  for  the  secondary  effect;  e.g .,  with  Arsenic, 
primary  effect,  paralysis  and  emaciation ; secondary  effect,  convul- 
sions, gain  in  flesh  and  invigoration  of  the  body,  and  other  similar 
arbitrary  divisions,  which,  however,  are  not  taken  from  practical 
life. 

That  the  whole  question  of  primary  and  secondary  effects  turns 
upon  the  dose,  not  upon  the  question  whether  substances  operate 
chemically  or  dynamically,  is  easy  to  demonstrate.  But  first,  we 
must  have  decided  whether,  in  this  question,  we  will  set  out  from 
the  large  dose  of  the  physiological  school,  or  from  the  small  Homoeo- 
pathic dose,  since  in  both  cases,  there  are  primary  and  secondary 
effects.  Sulphur,  for  instance,  in  the  Allopathic  dose  of  the  physio- 
logical school,  produces  at  first  watery  diarrhoea,  as  a local  effect 
upon  the  intestinal  canal,  according  to  the  law  of  causation  ; but  not 
always  in  the  Homoeopathic  dose,  because  it  lacks  this  local  effect 
according  to  the  succession  of  cause  and  effect,  for  it  brings  the  Sul- 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


631 


phur^rsf,  not  into  the  intestinal  canal,  but  into  the  blood.  Soon, 
however,  diarrhoea  is  produced  by  Sulphur,  even  in  a Homoeopathic 
dose,  but  not  in  consequence  of  accelerated  secretion  of  the  inner 
wall  of  the  intestine,  irritated  by  the  Sulphur,  but  in  consequence 
of  increased  formation  of  bile  and  of  its  discharge  into  the  intes- 
tines. For  this  reason  the  diarrhoea  produced  by  the  large  dose  of 
Sulphur  is,  at  first,  not  bilious,  though  this  is  the  effect  of  the  small 
dose. 

The  secondary  effect,  however,  in  both  cases,  as  soon  as  no  more 
Sulphur  is  given,  is  precisely  the  same , to  wit,  obstruction.  But 
this  obstruction  is  no  longer  the  effect  of  Sulphur,  whether  given  in 
an  Allopathic  or  a Homoeopathic  dose,  but  phoronomic,  the  result 
of  the  proportional  oscillation  of  the  organic  activities. 

If  we  take  Sulphur  in  Homoeopathic  dose  only,  then  we  have  a 
series  of  phoronomic  changes,  according  to  the  law  of  reciprocal 
action,  by  which  always  two  symptoms,  the  one  following  the  other, 
show  that,  in  the  interior  of  the  organism,  movements  have  arisen, 
of  which  the  preceding  is  always  the  cause  of  the  succeeding.  In 
this  instance  we  should  not,  and  strictly  speaking,  cannot  speak  any 
more  of  primary  and  secondary  effects,  and  for  the  reason  that  here 
the  primary  effect  can  be  no  longer  established  according  to  the  in- 
dividuality, since  in  one  case,  cough  with  mucous  expectoration,  is 
the  first  thing  noticeable,  in  another,  palpitation  of  the  heart,  in  the 
third,  a hsemorrhoidal  flow. 

For  the  sake  of  curing,  we  must  tints,  in  many  cases,  commit  such 
a penetrating  remedy  as  Sulphur  in  a minimal  dose  (often  after  one 
single  dose),  for  some  time  to  the  counter-actions  and  reciprocal  ac- 
tions of  the  organism,  and  if  the  indication  has  been  correct,  the 
result  cannot  fail,  and  all  the  same  whether  we  had  to  give  the  Sul- 
phur for  some  kind  of  eruptions,  an  irregular  menstruation,  or  a 
case  of  gout,  etc.,  in  accordance  with  the  concomitant  circum- 
stances  

Hence  the  cure  of  such  diseases  by  Sulphur  is  effected  not  in  con- 
sequence of  a secondary  effect , according  to  the  law  of  proportional 
oscillation,  as  warmth  succeeds  the  coldness  of  the  hand  which  has 
been  in  cold  water,  but  in  consequence  of  reciprocal  effects  induced 
by  it  and  propagating  themselves  from  part  to  part,  within  the 
organism,  whereby  the  Sulphur  taken  (by  the  organism)  may  have 
been  removed  therefrom  long  ago.  These  are,  therefore,  no  secon- 


632 


world’s  homoeopathic  congress. 


dary  effects,  but  series  of  effects  which  themselves  again  have  become 
the  causes  of  other  effects,  and  if  we  allow  these  series  of  effects,  or 
to  speak  scientifically,  these  reciprocal  actions,  to  run  their  course, 
undisturbed,  then  we  may  again  designate  this  only  as  “permitting 
the  remedy  to  expend  its  force, in  direct  contrast  with  the  so-called 
secondary  effects. 

If  we  were  harboring  the  delusion  that  we  had  to  produce,  or 
wait  for  these  secondary  effects  in  order  to  attain  a cure,  would  we 
thus  establish  indications,  that  we  first  had  to  disturb  the  self-activity 
of  the  organism  so  that  we  might  afterward  restore  its  equilibrium 
again,  then  we  should  with  such  senseless  indications,  which  at  best, 
could  be  thought  of  only  by  the  worshipers  of  the  vis  medicatrix 
naturae,  have  effected  nothing  but  superfluous  torture;  for,  to  what 
would  it  lead,  to  give  laxatives,  that  constipation  might  follow;  or 
to  hasten  menstruation  with  Cuprum,  Pulsatilla,  etc.,  that  it  might 
afterward  remit;  to  irritate  or  paralyze  the  functions  of  the  organism 
to  the  very  verge  of  their  capability  of  resistance,  that  they  might 
be  able  to  help  themselves? 

In  order  to  bring  to  a decision  in  a practical  way  the  contending 
opinions  relative  to  primary  and  secondary  effects  of  drugs,  let  us 
adduce  an  example  of  phoronomic  motion: 

If  we  take  several  times  a day  a few  drops  of  tincture  of  Bella- 
donna, our  organism  experiences  in  various,  but  specific  directions, 
an  accelerated  exchange,  and  in  other  directions  a retarded  exchange. 

When  first  taking  this  drug  in  small  doses,  and  for  some  days 
thereafter,  there  is  evidently  a greater  quantity  of  carbonic  acid  ex- 
creted by  the  lungs,  while  during  the  action  of  stronger  doses  a 
smaller  quantity  is  excreted.  In  general  after  the  use  of  Belladonna 
the  excretion  of  the  infusible  salts  in  the  urine  is  diminished ; on 
the  contrary,  the  urea,  the  vesical  mucus,  the  fusible  salts,  and  the 
extractive  matter  are  increased. 

At  first  the  pulse  is  retarded  two  or  three  beats  in  the  minute, 
while  at  the  same  time  an  accelerated,  i.e.,  an  increased  excretion 
from  the  mucous  membrane  of  the  organs  of  deglutition  takes  place. 
If  we  persist  in  the  use  of  the  drug,  injection  and  inflammation  of 
the  same  parts  take  place,  but  now  with  acceleration  of  the  pulse, 
four  or  five  beats  in  the  minute,  and  thus  beyond  the  usual  indi- 
vidual frequency.  Hence,  if  the  capillary  vessels  in  any  part  are 
overfilled,  the  beat  of  the  heart  is  correspondingly  retarded ; but,  if 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


633 


inflammation  and  swelling  take  place,  then  the  pulsations  are  in- 
creased again,  and  remain  at  this  height  for  three  or  four  days  even, 
without  any  more  Belladonna  having  been  taken. 

These  are  clearly  the  specific  effects  of  Belladonna,  and  specific 
counter-effects  of  the  organism,  because  these  occurrences  as  often  as 
they  are  reproduced,  must  inevitably  return  in  the  same  manner, 
and  this,  as  long  as  the  power  of  resistance  of  the  organism  against 
the  influence  of  the  Belladonna  is  not  exhausted,  or  the  movements 
of  the  Belladonna  are  not  removed  by  those  of  some  other  substance. 

If,  for  instance,  during  those  inflammatory  swellings  in  the  organs 
of  deglutition  we  take  some  drug  retarding  interchange , such  as 
Coffee,  in  repeated  doses,  then  the  affections  in  the  throat  experience, 
at  once}  a marked  alleviation,  and  on  the  second  day  have  already 
disappeared,  while  the  pulsation  of  the  heart  returns  at  the  same 
time  to  its  individual  frequency,  and  thus  much  sooner  than  if  these 
Belladonna  affections  had  been  left  to  themselves. 

Coffee  accelerates,  indeed,  the  frequency  of  the  pulse,  but  decreases 
its  force  manifestly,  and  the  pulse  afterwards  ’is  retarded  below  the 
individual  (normal)  frequency,  and  is  small  and  weak.  This  in- 
crease of  the  pulse,  however,  is  not  accompanied  by  an  increased 
excretion  of  carbonic  acid  from  the  lungs,  as  usually  occurs  in  a 
proving  of  Belladonna.  Coffee  not  only  diminishes  the  exhaled 
carbonic  acid  for  the  moment,  but  constantly  more  and  more,  the 
longer  it  is  taken,  and  thereby  only  the  excretion  of  the  solid  sub- 
stances of  the  urine,  the  urea,  the  uric  acid,  and  urates,  is  diminished . 
Although  Coffee  at  first  accelerates  the  movements  of  the  bowels,  it 
yet  retards  them  afterward,  more  and  more;  in  the  blood,  the  solid 
substances  of  the  cruor,  the  serum,  the  albumen,  and  the  blood-cells 
are  increased,  and  the  latter  become  even  melanotic,  as  after  the  use 
of  Belladonna,  but  they  increase  so  that  they  manifestly  diminish 
the  reception  of  oxygen,  and  the  excretion  of  carbonic  acid,  which 
again,  is  not  the  case  after  the  use  of  small  doses  of  Belladonna, 
when  they  are  rapidly  turned  to  bile  in  the  liver,  and  are  no  more 
brought  into  the  circulation. 

But  if,  after  the  use  of  Belladonna  we  take  Coffee  in  large  quanti- 
ties, then  the  inflammatory  process  induced  by  the  action  of  the 
Belladonna  is  brought  suddenly  to  a pause,  and  even  the  increased 
secretion  of  bile  produced  by  the  Belladonna  is  suddenly  suppressed, 
with,  at  the  same  time,  an  increased  frequency  of  the  pulse.  With 


634 


WORLDS  HOMOEOPATHIC  CONGRESS. 


Coffee,  moreover,  the  augmented  frequency  of  the  pulse  (a  substitute 
in  the  motions  of  the  central  circulatory  system  for  the  stagnation  of 
the  blood  in  the  peripheric  system)  constantly  increases,  and  with- 
out any  inflammatory  conditions  being  associated  therewith  (as  is 
the  case  with  Belladonna),  this  substitution  is  gradually  weakened 
and  finally  lost  entirely. 

Here,  we  thus  find  not  the  least  ground  for  the  division  of  the 
symptoms  of  Belladonna  or  of  Coffee  into  a primary  and  secondary 
effect  ; in  both  cases  we  saw,  on  the  contrary,  reciprocal  actions  in 
a specific  manner,  and  varying  only  according  to  the  dose.  A contrary 
effect,  however,  we  saw  only  between  the  action  of  Belladonna  and 
that  of  Coffee  following  it,  since  the  latter  opposed  the  motions  of  the 
former. 

Just  as  the  so-called  secondary  effects  must  become  known  by  the 
art  of  observation,  by  the  differential  diagnosis  between  the  amount  of 
motion  of  morbid  substances  and  curative  substances,  just  so  it  must 
be  in  the  case  of  all  drugs  as  regards  the  repetition  of  the  dose.  If 
we  intend,  for  instance,  in  the  scheme  of  Belladonna,  nothing  but 
lasting  depression  of  the  pulse,  then  it  is  self-evident  that,  when  this 
depression  is  once  reached,  and  not  before,  the  dose  which  produced 
this  effect  ought  not  to  be  repeated  till  a pause,  or  rather  the  propor- 
tionally too  early  restoration  of  the  frequency  of  the  pulse,  or  its 
renewed  increase,  announces  itself ; moreover,  if  we  continue  to  ad- 
minister the  remedy  without  regarding  this,  we  get,  at  once,  other 
Belladonna  symptoms  for  which  we  did  not  seek — difficulty  of  swal- 
lowing, dilation  of  the  pupils,  etc. 

As  regards  the  quantity,  it  hence  holds  good,  according  to  natural 
laws , that  with  a changed  quantity  of  a dose  of  the  same  substance, 
a changed  quality  is  always  given,  as  regards  the  organism , although, 
naturally  enough,  not  as  regards  the  substance;  and,  as  regards  the 
effect,  that,  with  every  repetition  of  the  dose  a new  primary  effect  is 
produced,  at  once,  in  the  sphere  determined  by  the  quality.  If  we 
water  a plant  as  often  as  is  necessary  for  its  growth,  it  will  not  be 
injured.  If  we  repeat  this  watering  too  often,  it  grows  too  luxuri- 
antly, and  perishes.  This,  however,  is  no  secondary  effect,  but  only 
the  result  of  the  primary  effect  too  often  introduced  of  the  unsuita- 
ble repetition  of  the  dosed’ 

Dr.  P.  Jousset,  the  clinical  teacher  in  the  Hospital  Saint-Jacques, 
of  Paris,  thus  states  the  doctrine  in  relation  to  dose: 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


635 


“1.  Every  medicine  produces  on  the  healthy  body  two  successive 
actions,  primary  and  secondary.  These  two  actions  are  always  op- 
posed one  to  another. 

2.  The  stronger  the  dose  of  medicine,  the  less  marked  is  the 
primary  action.  If  the  dose  is  excessive,  the  secondary  action  only 
is  developed. 

3.  The  weaker  the  dose,  the  more  manifest  the  primary  action.” 

Dr.  Charles  J.  Hempel,  now  deceased,  but  well  known  as  a trans- 
lator of  the  works  of  Hahnemann  and  Jahr,  and  the  author  of  a 
voluminous  Materia  Medica,  held  views  similar  to  Dr.  Hering,  but 
goes  deeper  into  the  interpretation  of  the  phenomena.  In  his  lec- 
tures he  says  : 

“ I shall  have  frequent  occasion  to  show  you  that  drugs  seem  to 
affect  the  organism  in  two  opposite  ways,  and  may,  therefore,  be 
Homoeopathic  to  two  pathological  conditions,  holding  towards  each 
other  relations  of  antagonism.  We  may  illustrate  this  point  by  the 
well-known  condition  of  fever.  The  first  stage  of  an  inflammatory 
fever  is  not  a full  and  bounding  pulse,  a hot  and  dry  skin,  flushed 
face,  and  so  forth  ; an  opposite  group  of  symptoms  occur.  The  pa- 
tient experiences  a chill,  or  cold  creepings  along  the  back ; he  looks 
pale,  hollow-eyed,  the  hands  and  feet  are  cold;  the  pulse  is  thin, 
feeble,  rather  slower  than  natural,  or,  at  any  rate,  not  much  accele- 
rated. This  condition  is  soon  superseded  by  the  opposite  group  of 
phenomena,  generally  designated  as  fever.  The  chill  is  the  primary 
effect  of  the  disease;  the  fever  constitutes  a secondary  effect,  or  the 
reaction  of  the  organism.  In  selecting  a remedial  agent  for  this 
derangement,  it  should  be  Homoeopathic,  not  only  to  the  primary 
chill  but  also  to  the  secondary  group,  fever.  Aconite  is  such  a 
remedy.  Aconite  is  Homoeopathic  to  the  chill,  which  marks  the  first 
invasion  of  the  disease,  and  to  the  fever  which  marks  the  beginning 
of  the  organic  reaction.  We  are  seldom  called  to  a patient  during 
the  primary  invasion  of  the  disease ; the  organic  reaction  is  generally 
fully  established  when  we  first  see  the  patient.  Nevertheless,  we 
prescribe  Aconite,  knowing  full  well  that  the  inflammatory  stage 
must  have  been  preceded  by  a chill. 

We  say  that  Aconite  is  Homoeopathic  to  the  chill,  and  we  prove 
this  experimentally  by  taking  a large  dose  of  this  drug,  of  course 
within  conservative  limits,  which  will  uniformly  cause  a more  or  less 
perceptible  chill,  coldness  of  the  skin,  depression  of  the  pulse,  all 


636 


world’s  homoeopathic  congress. 


which  symptoms  disappear  after  a certain  interval  of  time,  and  are 
followed  by  the  opposite  condition,  fever.  A small  dose  of  Aconite 
will  not  produce  the  primary  chill,  but  will  at  once  excite  the  organic 
reaction  characterized  by  the  usual  phenomena  of  heat,  flushed  face, 
dryness  of  mouth,  etc.  This  shows  the  importance  of  proving  drugs 
in  massive  doses.  It  is  massive  doses  that  develop  the  primary  drug 
symptoms;  small  doses  do  not  develop  these  primary  symptoms 
because  the  organic  reaction  very  speedily  supersedes  them. 

In  practice  it  is  of  the  utmost  importance  that  we  should  dis- 
criminate between  the  primary  and  secondary  action.  If  we  are 
called  upon  to  prescribe  for  a group  of  symptoms  corresponding  with 
the  primary  action  of  a drug,  we  give  a larger  dose  than  we  should 
do  if  we  had  to  prescribe  for  a group  corresponding  with  the  sec- 
ondary action  or  organic  reaction.” 

Dr.  Hempel  further  adds  that  Aconite  and  Nux  vomica  may  be 
used  as  Homoeopathic  remedies  in  paralysis  as  well  as  tetanus;  Ipecac 
may  remove  complete  atony  as  well  as  spasmodic  irritability  of  the 
stomach  ; Opium  cures  diarrhoea  as  well  as  constipation,  excessive 
wakefulness  as  well  as  drowsiness  and  stupor;  Mercury  will  check 
as  well  as  promote  the  secretory  action  of  the  pancreas;  Secale 
answers  in  uterine  hsemorrhage  from  atony  as  well  as  painful  con- 
traction from  spasm. 

The  late  Dr.  Carroll  Dunham  and  Dr.  Richard  Hughes,  of 
Brighton,  England,  have  given  this  subject  very  careful  considera- 
tion, and  I commend  their  writings  for  lucid  and  interesting  discus- 
sions of  the  conflicting  views  of  the  authors  I have  quoted. 

Dr.  Hughes  says:  “This  organism  of  ours  into  which  we  intro- 
duce drugs  to  prove  them  is  a living  one;  it  does  not  merely  pas- 
sively suffer  under  what  is  done  to  it,  but  reacts  thereupon.  If  the 
impression  made  by  a foreign  agent  is  sufficiently  potent,  it  bends 
before  it  with  such  subsequent  recoil  as  the  case  demands.  But  it  is 
readily  conceivable  that  the  impression  may  be  so  slight  that  the 
only  notice  taken  of  it  by  the  organism  is,  so  to  speak,  a resenting 
push  in  the  opposite  direction  ; and  this  also  may  be  the  earliest  re- 
sponse to  the  influence  of  a drug,  while,  as  its  action  gathers  force, 
it  bends  the  function  it  modifies  in  its  own  way.” 

Dr.  Hughes  accepts  Dr.  Hale’s  view  as  to  what  is  primary  and 
what  secondary  in  the  action  of  drugs,  and  also  that  “ in  any  case  of 
disease  we  must  select  a remedy  whose  primary  and  secondary  symp- 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


637 


toms  correspond  with  those  of  the  malady  to  be  treated/’  always 
adding  the  proviso,  “ that  there  be  such  a succession  of  opposite 
states  in  either  or  both  which  does  not  by  any  means  hold  good  in 
all  cases.”  He  objects  to  making  a difference  in  dose  according  as 
the  primary  or  secondary  stage  of  the  disease  is  present  and  calling 
the  practice  Homoeopathic  in  both  cases. 

A medicine  may  be  Homoeopathic  to  two  apparently  opposite  con- 
ditions, but  no  difference  of  dose  is  necessary  in  the  two  spheres  of 
action  ; at  least,  no  such  difference  as  advised  by  Dr.  Hale,  who,  Dr. 
Hughes  declares,  is  plainly  practicing  antipathy  when  he  uses  doses 
sufficiently  large  to  induce  primary  effects  to  remove  conditions  like 
the  secondary  reactions  which  are  observed  in  drug  effects. 

Dr.  Dunham  so  clearly  expresses  my  own  views  in  relation  to  this 
wThole  subject  that  I will  conclude  with  quotations  from  a paper, 
written  in  1875,  entitled  Primary  and  Secondary  Symptoms  of  Drugs 
as  Guides  in  Determining  the  Dose. 

“ The  very  terms  primary  and  secondary ,”  as  illustrated  by  Hahne- 
mann in  the  Fragmenta,  Organon , and  Materia  Medica  Pur  a,  “ seem 
to  imply  a succession  of  symptoms,  more  or  less  opposed  in  character, 
and  all  of  them  differing  from  the  equilibrium  of  function  which  we 
recognize  as  health.  The  instances  given,  and,  indeed,  the  only  pos- 
sible instances  of  which  a “more”  or  “ less,”  or  an  “ opposite,”  may 
be  predicated,  as,  for  example,  temperature,  sleep,  certain  mental 
conditions,  and  the  secretions  and  excretions  generally.  Thus  we 
may  have  an  unnaturally  prolonged  sleep  or  wakefulness,  gayety  or 
despondency,  and  a plus  or  minus  of  sweat,  alvine  discharge,  urine, 
etc.  But  how  could  we  have  an  opposite  condition  to  any  specified 
pain  or  subjective  sensation,  to  parenchymatous  deposit,  cutaneous 
eruption,  etc.  The  absence  of  these  phenomena  would  be  pro 
tanto  a state  of  health  ; it  would  not  be  an  opposed  morbid  condition 
or  sensation. 

The  possibility,  then,  of  classifying  symptoms  into  primary  and . 
secondary  on  the  basis  of  the  relative  nature  of  the  symptoms,  is  not 
coextensive  with  symptomatology;  it  is  partial,  confined  to  a mod- 
erate number  of  conceivable  morbid  phenomena. 

Shall  we,  then,  in  the  second  place,  base  the  distinction  on  the 
element  of  time,  and  call  the  symptoms  which  first  occur  primary, 
and  those  which  come  later  secondary  ? Where,  then,  shall  we  draw 
the  line?  How  many  hours  or  days  shall  we  allow  for  the  develop- 


638 


world’s  homoeopathic  congress. 


ment  of  primary  symptoms?  In  view  of  the  immense  differences  in 
the  rapidity  with  which  the  curriculum  of  action  of  different  drugs 
is  run,  it  is  obvious  that  a special  rule  must  be  established  for  each 
drug.  Nor  is  this  the  only  difficulty.  The  results  of  different  doses 
on  the  same  provers,  and  of  different  doses  or  even  the  same  dose  on 
different  provers,  are  so  various,  that,  first,  as  Hahnemann  intimates 
in  the  preface  to  the  Fragmenta , the  symptom  which  appears  in  one 
prover  to-day  will  not  appear  for  several  days  in  another  prover; 
and,  secondly,  a very  small  dose  may  produce  only  one  series  of 
symptoms;  a larger  dose  two  series  of  opposed  symptoms;  a still 
larger  dose  two  series  differently  opposed ; and  a very  large  dose 
again,  only  one  series. 

On  looking  over  the  register  of  symptoms  of  Argentum  nitricum, 
we  find  reported  as  occurring  early  in  the  proving,  irritation  of  the 
bladder  and  urethra,  and  increased  frequency  and  quantity  of  urine, 
and  as  occurring  later  in  the  proving,  diminution  in  frequency  of 
micturition  and  in  the  quantity  of  urine.  Surely,  one  might  pro- 
nounce the  former  to  be  primary,  and  the  latter  secondary  symptoms. 
But  on  examining  the  provers’  day-books , we  find  that  the  majority 
of  the  provers  (being  those  who  took  large  doses)  report  the  former , 
and  not  the  latter  symptoms.  It  was  the  prover  who  took  the  30th  who 
reported  diminished  urine,  and  he  did  not  report  any  increase  at  any 
time.  These  symptoms,  therefore,  which  appear  in  the  register  to 
be  opposed,  and  properly  distinguishable  as  primary  and  secondary, 
did  not  bear  to  each  other  any  relation  of  opposition  or  correlation, 
as  they  might  have  done  had  they  occurred  in  the  same  individual. 
They  are  different,  unrelated,  independent  effects  of  different  doses 
in  different  individuals. 

Most  of  the  provers  of  Tellurium  taking  the  3d  trit.  had,  on  the 
first  and  subsequent  days,  symptoms  of  the  general  sensibility  of 
sweat,  of  the  skin,  of  the  bladder,  etc.  But  one  prover  who  took 
-the  4th  trit.  had  no  symptoms  at  all  until  the  14th  or  15th  dav, 
when  cutaneous  symptoms  affecting  the  ear  appeared,  and  were  very 
persistent  and  tr  ublesome.  Were  these  symptoms  secondary  be- 
cause they  came  later  than  other  symptoms  in  other  provers?  And 
secondary  to  what?  How  can  John’s  lumbago  be  secondary  to 
James’s  toothache?  But  during  the  second  month  this  same  prover, 
his  ear  symptoms  having  vanished,  had  symptoms  referred  to  the 
dorsal  spine.  Were  these  secondary  to  the  ear  symptoms  because 


PRIMARY  AND  SECONDARY  SYMPTOMS. 


639 


they  came  later?  Certainly  as  regards  time  they  were  secondary, 
because  later ; but  being  in  nature  wholly  unrelated — neither  oppo- 
site nor  similar — they  cannot  be  called  secondary  as  regards  nature 
nor  as  regards  rank  or  value.  Both  have  been  repeatedly  verified 
in  practice. 

Again,  we  are  told  that  coldness — a condition  corresponding  to 
the  chilly  stage  of  fever — is  the  'primary  effect  of  Aconite,  and  that 
a state  corresponding  to  the  hot  stage  of  fevers  is  the  secondary  effect 
of  that  drug.  Let  us  hear  Hahnemann.  In  the  introduction  to 
Aconite  he  says : “ Aconite  is  one  of  a few  drugs  whose  primary 
action  consists  in  several  alternating  conditions  of  chill  or  coldness  and 
heat.”  And  now  let  us  study  the  day-books  of  the  Austrian  provers 
of  Aconite. 

Rothausl  took  tincture  of  Aconite  in  doses  regularly  increasing 
from  six  drops  daily  to  fifteen  drops  daily  for  nine  days,  when,  feel- 
ing powerful  effects,  he  ceased  taking  it  and  noted  his  symptoms. 

From  the  second  to  the -eighth  day  inclusive,  he  had  the  following 
constantly-recurring  symptoms  : restlessness  at  night,  bad  dreams? 
unnatural  heat  of  body , rawness  and  increased  secretion  in  the  larynx, 
cough,  vertigo,  headache.  On  the  ninth  day,  after  midnight,  severe 
chill  in  paroxysms  of  shivering,  starting  from  the  prsecordia,  lasting 
two  hours,  followed  by  burning,  dry  heat,  with  frequent,  feverish 
pulse,  and  this  was  followed  by  moderate  sweat. 

For  the  next  six  days  he  had  various  troublesome  symptoms  af- 
fecting the  chest  and  limbs,  and  on  the  sixteenth  day  of  the  proving 
he  had  again,  at  night,  a febrile  paroxysm  consisting  of  chill,  heat 
and  sweat,  the  first  less  severe,  the  last  more  abundant,  than  on  the 
ninth  day. 

On  the  seventeenth  day,  at  night,  a similar  febrile  paroxysm. 
Then  for  seven  days  symptoms  of  increasing  severity  in  the  head 
and  chest,  ending  with  haemoptysis  on  the  nineteenth  day,  and 
finally,  on  the  twenty-fourth  day,  a very  severe  and  well-marked 
and  defined  neuralgic  head  and  faceache. 

How  can  the  ingenuity  of  the  most  ambitious  lawgiver  find  a pre- 
text for  dividing  the  symptoms  (especially  the  febrile  symptoms)  of 
this  excellent  proving  into  primary  and  secondary?  A febrile  par- 
oxysm occurred  on  the  ninth,  sixteenth  and  seventeenth  days ; before 
it  and  after  it  were  well-marked  symptoms  of  the  chest  and  extremities. 
Which  shall  be  primary  and  which  secondary  if  date  of  occurrence 
determine  the  question?  Which,  if  nature  or  if  rank  determine  it? 


640 


world’s  homoeopathic  congress. 


Certainly,  if  lateness  of  occurrence  stamps  a symptom  as  second- 
ary, then  the  neuralgic  head  and  faceache — the  very  last  symptom 
reported  by  Rothausl — must  be  classed  as  secondary.  Not  so  fast, 
however  ! In  the  proving  of  Aconite  by  Zlatarovich  with  the  second 
decimal,  which  he  took  in  increasing  and  very  large  doses  for  seven 
days  without  effect,  the  very  first  symptom  was  a violent  neural- 
gic head  and  faceache,  almost  identical  with  that  described  by  Roth- 
ausl on  his  twenty-fourth  day. 

It  appears,  then,  that  Rothausl’s  last  symptom  was  Zlatarovich’s 
first.  If  the  time  of  occurrence  determines  the  class,  we  must  rank 
Rothausl’s  headache  among  the  secondary  and  Zlatarovich’s  identi- 
cal headache  among  the  primary,  and  thus  we  have  the  same  symp- 
tom in  each  class,  which  is  a reductio  ad  absurdum. 

It  will  be  noticed  that  these  identical  symptoms,  produced  at  dif- 
ferent times  in  different  provers  of  Aconite,  were  produced  by  differ- 
ent doses.  The  opposite  symptoms  of  Argentum  nitricum  in  dif- 
ferent provers  resulted  from  different  doses.  . . . 

There  are  many  drugs  which,  having  certain  constant  characteristic 
symptoms,  have  also  series  of  alternating  symptoms  relating  chiefly 
to  the  secretions.  Among  them  we  may  mention  Veratrum  album , 
which  has  “Thin  stool  passing  unnoticed  with  flatus.  Frequent 
liquid  stools.  Liquid  stools  unnoticed  with  flatus.  Diarrhoea  of  acrid 
ffieces,  etc.”  And  also,  “Constipation  from  thickness  and  hardness 
of  fseces.  A desire  and  compulsion  to  stool  in  the  upper  abdomen, 
and  yet  no  stool  or  a very  difficult  one,  as  if  from  inactivity  of  the 
rectum  or  as  if  the  rectum  took  no  part  in  the  peristaltic  motion  of 
the  upper  intestines.”  Also  Hahnemann  quotes  from  Greditig: 
“ Diarrhoea,  with  copious  sweat,”  and  “ long-continued  constipation.” 

The  efficacy  of  Veratrum  in  the  treatment  of  diarrhoea  of  an 
appropriate  character,  is  universally  conceded  in  our  schools,  and  in 
my  own  practice.  Veratrum  has  for  many  years  been  a frequently 
used  and  highly  valued  remedy  for  constipation  in  persons  of  all 
ages,  but  especially  in  infants  and  young  children,  in  whom  diges- 
tion appearing  to  be  well  performed,  the  evacuation  of  faeces  ap- 
pears nevertheless  to  be  impossible  because  of  the  inertia  of  the 
rectum — a fact  demonstrated  by  the  circumstance  that  a healthy  stool 
can  be  procured  almost  at  will  by  irritation  of  the  rectum,  as  by  the 
common  practice  of  introducing  into  the  anus  a piece  of  oiled  pa- 
per, or  a rubber  bougie.  We  have  here  the  apparent  anomaly  of 
the  same  remedy  equally  efficacious  in  diarrhoea  and  constipation. 


TEIMARY  AND  SECONDARY  SYMPTOMS. 


641 


Nux  vomica  furnishes  a sim'ilar  example.  Its  efficacy  in  cer- 
tain forms  of  constipation  as  well  as  of  dysenteric  diarrhoea,  is  well 
known. 

Let  us  now,  for  a moment,  examine  a little  more  closely  the  nature 
of  the  functions,  affecting  which  the  alternate  series  of  opposed  con- 
ditions (which  have  been  called  primary  and  secondary)  are  mostly 
observed  in  drug-proving.  1st.  They  are  such  as  in  the  nature  of 
things  are  periodic  and  not  continuous  ; characterized  by  periods  of 
repose  and  activity,  and  susceptible  of  quantitative  and  qualitative 
correlative  interchange  among  themselves.  Thus,  sleep  is  periodic, 
and  capable  of  being  supplemented  to  a degree  by  other  forms  of 
repose  to  the  nervous  system.  The  intestinal  canal,  the  genito  uri- 
nary apparatus,  the  skin,  in  so  far  as  secretion  and  excretion  are  con- 
cerned, have  periods  of  activity  and  repose;  and  the  inactivity  of  one 
may  be  made  up  by  increased  activity  of  another.  And  thus  the  func- 
tion of  any  one  of  these  apparatus  may  vary  widely  at  different  times 
without  a condition  of  opposition  being  established.  For  this  reason, 
then,  the  mere  quantity  of  one  of  the  excretions,  or  the  degree  in 
which  any  one  of  these  periodic  and  convertible  functions  is  per- 
formed, does  not  rank  first  among  the  indications  on  which  the 
selection  of  a drug  is  to  be  based.  If  we  now  analyze  the  prescrip- 
tions of  Veratrum  and  Nux  vomica  referred  to,  we  shall  find  certain 
constant  phenomena  characterizing  both  the  constipation  and  the 
diarrhoea,  and  which  would  determine  the  prescription  almost  with- 
out reference  to  the  excretion.  The  Veratrum  diarrhoea  is  uncon- 
trolled and  almost  unnoticed  by  the  patient,  liquid  faeces  escaping 
with  the  flatus.  Here  we  have  a paretic  and  anaesthetic  state  of  the 
rectum  and  sphincter.  The  Veratrum  constipation  exists  solely 
because  the  rectum  does  not  perform  its  expulsive  functions,  and  is 
not,  as  normally  as  it  should  be,  irritated  thereto  by  the  presence  of 
faeces.  Here,  likewise,  is  a paretic  and  anaesthetic  condition  ; but 
Veratrum  is  not  fully  indicated  in  either  case  without  the  char- 
acteristic general  symptoms — general  depression  of  vitality,  pre- 
dominant coldness  of  the  body,  pallor  and  cold  sweat  of  the  fore- 
head or  of  the  whole  body  on  slight  emotion  or  exertion ; as,  for 
example,  on  having  a diarrhoeic  stool,  or  making  the  ineffectual  effort 
to  a stool,  if  constipated. 

Both  the  constipation  and  the  diarrhoea  of  Nux  vomica  are  char- 
acterized by  increased  but  uncoordinated  activity  of  the  intestine, 

41  • 


642 


world’s  homoeopathic  congress. 


evinced  by  tormina  and  tenesmus  and  frequent  insufficient  stools,  so 
that  the  condition  of  intestinal  action  is  the  same,  whether  there  be, 
as  in  one  case,  a minus , and  in  the  other  a plus,  of  excretion — and, 
indeed,  in  the  Nux  vomica  patient,  these  conditions  often  alternate. 
These  remarks  and  instances  will  sufficiently  illustrate  my  conclu- 
sions, viz.  : 

That  the  appearance  or  non-appearance  of  opposed  series  among 
the  symptoms  of  a drug  depends  chiefly,  if  not  altogether,  upon  the 
dose  in  which  the  drug  was  proved  ; and  that  the  question  of  the 
constant  and  necessary  appearance  of  such  series  cannot  be  deter- 
mined until  experiments  with  a uniform  and  the  least  possible  dose 
shall  have  been  made  by  many  provers  with  the  same  drug,  and  in 
the  case  of  many  drugs — and  therefore  that,  1st.  although  in  our 
Materia  Medica,  as  it  now  exists,  pathogeneses  do  present  certain 
series  of  symptoms  more  or  less  opposed,  nevertheless  (excluding 
the  symptoms  of  the  agony,  which  are  not  available  in  practice),  in- 
asmuch as  these  series  of  symptoms  occur  in  different  orders  in  dif- 
ferent provers,  according  to  dose  or  idiosyncrasy,  no  sound  practical 
distinction  can  be  drawn  between  them,  based  on  assumed  differ- 
ence of  nature,  by  virtue  of  which  they  can  be  designated  respec- 
tively as  primary  and  secondary.  2d.  That  symptoms  apparently 
opposed  (not  including  those  of  the  agony)  occurring  in  a drug- 
proving are  equally  available  as  guides  in  the  selection  of  remedies. 

Coming  now  to  the  special  subject  of  this  paper,  I justify  the 
length  at  which  the  preliminary  subjects  have  been  discussed,  by 
the  suggestion  that  if  I have  shown  that  there  is  no  basis  for  a 
division  of  drug-symptoms  into  primary  and  secondary,  I have 
thereby  shown  the  impossibility  of  a law  of  dose  based  on  such 
a division.  Or,  if  admitting  that  in  pathogeneses  there  do  appear 
groups  of  symptoms  apparently  opposed,  I have  shown  that  these 
refer  only  to  certain  functions,  and  by  no  means  embrace  or  could 
be  made  to  include  the  symptoms  of  the  entire  organism.  I have 
thereby  shown  that  an  alleged  law  of  dose,  based  on  the  existence 
of  these  groups  must  necessarily  be  partial,  and  therefore  devoid  of 
that  generality  of  application  to  the  entire  pathogenesis  which  alone 
would  justify  the  appellation  “ Law;”  and  I claim  to  have  shown 
these  things.” 


PHYTOLACCA — LEAF,  FRUIT  AND  ROOT. 


643 


PHYTOLACCA— LEAF,  FRUIT , AND  ROOT.— THE 
VALUE  OF  EACH. 

By  Robert  Boocock,  M.D.,  Flatbush,  L.  I.,  N.  Y. 


When  we  have  found  a use  for  anything  not  before  fully  known, 
or  developed  that  which  was  but  partly  understood,  some  investiga- 
tors would  be  tempted  to  make  further  search  for  other  more  hidden 
beauties  or  features  that  may  prove  of  greater  service  in  the  cause 
of  humanity.  Thoughts  such  as  these  have  led  me  to  the  study  of 
this  very  valuable  plant,  as  well  as  a desire  to  see  its  history  and 
usefulness  properly  enrolled  in  our  World’s  Congress  meeting.  It 
will  doubtless  prove  true  that  all  I may  write  will  not  be  new,  but 
if  I repeat  known  facts  concerning  the  plant  it  will  be  only  because 
they  are  necessarily  inseparably  connected  with  the  new  data  which 
I hope  to  present,  and  I will  begin  as  I would  the  examination  of  a 
patient,  with  its  history,  and  follow  with  its  value  by  provings  and 
its  curative  power  as  evidenced  by  clinical  facts. 

Scoke  root,  Poke  root,  or  Garget  root;  Phytolacca,  radix  et  bacca, 
U.  S.  Ph. 

Botanical  History. — This  plant  is  a large,  succulent,  perennial 
herb,  with  a very  thick,  light- colored  green  leaf  almost  oval  in 
shape,  a deep  channel  down  the  centre  of  leaf,  and  twelve  or  more 
deep  veins  branching  from  and  running  to  the  edges;  but  before 
they  quite  reach  the  edge  they  turn  again  towards  the  point  of  the 
leaf,  as  if  nature  designed  the  water  to  be  held  on  the  leaf  as  long 
as  possible  for  some  wise  purpose.  At  night  they  shine  like  phos- 
phorus, though  not  quite  so  bright.  Upon  closer  inspection  there  may 
be  seen  the  beautiful  cellular  texture  throughout  the  leaf,  together 
with  a number  of  irregular-sized  white  spots,  but  which  latter,  on 
being  examined  through  a magnifying-glass,  prove  to  be  diseased 
spots  of  an  irregular  shape  and  size,  reminding  one  of  tuberculous 
lung  tissue.  Only  the  outer  edge  of  the  spots,  however,  are  white — 
at  that  point  where  it  comes  in  contact  with  the  green  leaf — while 


644 


world’s  homoeopathic  congress. 


towards  the  centre  of  the  spot  we  have  a deepening  in  color  and 
depth.  I am  inclined  to  think  that  a closer  and  more  persistent 
proving  of  what  is  here  mentioned  merely  as  a suggestion  may 
prove  of  great  curative  power  in  tuberculosis  of  the  lung.  So  much 
for  the  leaf. 

Fruit. — The  cylindrical  racemes  of  white  flower  (which  ought  to 
have  a place  in  our  gardens  for  their  beauty),  then  the  dark  purple 
juicy  berry.  These  latter  are  sweet  and  pleasant  to  the  taste  when 
first  taken  into  the  mouth,  but  presently  it  changes  to  a tannic  acid 
taste,  and,  if  the  seeds  be  broken  by  the  teeth,  they  emit  a pungent, 
bitter  taste.  The  flower  is  pretty,  but  the  fruit  is  more  beautiful. 
The  whole  plant  increases  in  size  and  beauty  until  fully  matured ; 
then  the  stems,  in  a measure,  partake  of  the  purple  color  of  the 
fruit.  The  plant,  however,  is  not  done  with  when  flower,  fruit,  and 
stem  are  gone.  The  thick,  light-colored  fleshy  root,  somewhat  like  a 
parsnip  in  color  and  shape,  but  very  much  larger,  is  the  oldest  known 
medicinal  part  of  the  plant,  and  is  full  of  clinical  value.  This,  when 
fully  grown,  will  measure,  across  the  crown,  many  inches,  dividing 
itself  into  two  or  three  large  branches.  Externally,  the  root  is  brown, 
and  light-colored  within.  When  dry,  it  is  gray,  hard,  wrinkled,  and 
inodorous.  Taste,  sweetish  acrid.  Mr.  Edward  Preston,  Jr.,  found 
starch,  tannin,  gum, sugar,  resin,  fixed  oil,  a volatile  acid,  and  an  alka- 
loid, which  latter  he  calls  Phytolaccine.  Claussen  obtained  from 
Phytolacca  seed  a neutral  principle,  and  for  this  the  name  last  given 
was  also  proposed.  From  medicinal  sources  we  learn  that  all  parts  of 
the  mature  plant  are  active,  and  in  sufficient  doses  cause  vomiting  and 
purging.  It  has  also  some  narcotic  power  or  stupefying  influence,  and 
in  poisonous  doses,  in  addition  to  the  intestinal  symptoms,  convul- 
sions, coma  and  death  may  follow.  Its  action  is  slow  and  pro- 
tracted. 

The  clinical  uses  made  of  this  plant  are  as  follows:  emetic;  rheu- 
matism; scrofula;  inflamed  breasts,  ovaries  and  testicles;  cancer  and 
indolent  ulcers  ; tonsillitis;  diphtheria. 

Provings. 

On  chewing  the  matured  leaf  at  different  times  a smarting  and 
burning  is  produced  throughout  the  whole  of  the  mouth  and  throat, 
hard  to  bear;  no  swelling;  dry  cough  and  hiccough;  belching  of 
wind  and  inclination  to  vomit;  a feeling  as  if  the  occiput  were 


PHYTOLACCA — LEAF,  FRUIT  AND  ROOT. 


645 


grasped  or  compressed.  It  leaves  in  the  mouth  a greasy,  smooth 
feeling;  but  the  most  intense  feeling  of  distress  is  in  the  stomach 
which  is  very  full,  and  the  contents  swell  upwards  from  a cramp- 
like, spasmodic  feeling  like  a wave  passing  from  the  bottom  up- 
ward ; the  hiccough  is  very  distressing,  a pain  extends  through  to 
the  back  under  the  scapula — more  to  the  right  than  to  the  left. 
The  pain  which  is  deep-seated  begins  in  the  neck  and  renders  it  dif- 
ficult to  hold  up  the  head,  with  an  inclination  to  drive  the  head 
deep  into  the  pillow  for  rest.  This  cerebro-spinal  action  makes  one 
very  weak,  causing  a dragging  of  the  feet  which  catch  and  stumble 
in  walking. 

There  is  difficulty  in  breathing  as  if  the  lungs  were  swollen  and 
had  not  room  to  properly  expand,  and  the  effort  to  do  so  causes  a 
cough — or  a hiccough  and  belching  of  wind — which  may  continue 
for  several  hours  after  eating;  during  this  time  the  salivary  glands 
discharge  freely,  but  the  secretion,  if  held  in  the  mouth,  will  work 
itself  into  a thick  foam;  the  smarting  in  the  fauces  produces  a swell- 
ing of  the  uvula,  a lumpy  feeling  in  the  throat,  but  which  does  not 
interfere  with  swallowing,  except  that  the  frothy  saliva  does  not  go 
down  readily,  being  apparently  held  in  the  upper  part  of  the  throat; 
the  voice  is  thick  and  weak,  and  there  is  no  desire  to  make  any 
effort  to  be  heard;  prover  is  very  weak,  retired  early  and  slept  well. 
When  awake  there  is  a soreness  in  the  throat  and  an  inclination  to 
clear  the  husky  voice  by  hawking  up  phlegm,  which  comes  up  freely. 
Urine  is  free. 

Phytolacca  Berries — During  my  proving  of  this  fruit — the  sug- 
gestion for  which  proving  I found  in  Hale’s  New  Remedies , first 
edition,  some  years  ago,  I was  much  annoyed  at  my  bodily  shape, 
and  was  rather  overjoyed  as  I remembered  the  reputed  powers  of 
these  berries  over  adipose  tissue. 

Having  determined  to  make  a proving  of  the  berries,  I secured  them 
from  my  garden,  prepared  and  took  them,  and  in  a few  months  reduced 
my  proportions  and  again  became  shapely,  having  lost  my  protuberant 
abdomen.  (Report  of  this  will  be  found  in  the  Homoeopathic  Recorder 
of  January,  1893.)  The  juice  of  these  berries  when  first  pressed  is 
of  a deep  and  bright  reddish  color  and  dyes  of  the  same  color ; but 
when  long  kept  it  becomes  darker  in  appearance ; and  if  alcohol  be 
used  to  preserve  its  color  (which  it  does)  it  loses  its  power  to  stain, 
or  else  the  stain  soon  fades  away ; the  power  to  reduce  adipose  tissue 


646 


world’s  homceopathic  congress. 


is  not  destroyed  though  somewhat  decreased.  This  latter  fact  caused 
me  to  inquire  further  into  the  properties  of  this  berry,  and  my  con- 
clusion is  that  alcohol  is  not  the  best  preservative  vehicle. 

I became  convinced  that  birds  could  digest  the  whole  berry,  hull, 
seed  and  juice,  and  so  their  fat  is  rapidly  consumed;  but  in  which 
part  of  the  fruit  this  great  virtue  resided  I had  no  means  of  saying 
without  first  making  a proving.  In  consequence  I have  been  re- 
proving them,  taking  the  leaf  and  stalk  first,  and  the  hard  seed 
next,  chewing  them  after  having  had  them  well-washed  and  dried, 
and  free  from  the  juice,  and  the  following  is  the  result: 

I began  by  chewing  the  seed,  putting  a pinch  of  the  seed  in  my 
mouth,  as  they  were  drying  them,  and  chewed  them  vigorously,  but 
their  bitterness  was  not  pleasant.  I found  they  had  power  to  affect  the 
muscles  of  the  abdomen.  So  I sent  a quantity  of  the  seeds  to  Messrs. 
Boerieke  & Tafel  for  pulverization  and  trituration  to  the  first ; of 
this  I have  taken  a powder  two  or  three  times  daily  od  an  empty 
stomach,  and  in  the  month  of  experiment  I have  reduced  my  girth 
measure  three  inches.  This  led  me  to  think  that  the  principal  virtue 
over  adiposis  lies  in  the  acid  of  the  berry  and  seed,  and  that  Phyto- 
lacca semen,  lx  trit.,  has  a peculiar  power  of  its  own,  the  taste 
being  still  slightly  bitter.  On  proving,  the  first  effect  is  felt  in  the 
head,  pain  or  dull  feeling,  right  side  over  the  temporal  region,  and 
is  most  from  within,  as  if  there  was  a fulness  under  the  temporal 
bone;  it  then  passes  across  the  head  to  the  left  side  and  presses  under 
what  is  usually  spoken  of  as  the  “ bump  of  veneration  ;”  there  is  a 
slight  feeling  of  fulness  in  the  ears,  and  an  aching  in  the  atlas,  at 
the  base  of  the  skull.  It  then  is  felt  in  the  stomach,  producing  a 
severe  pain  (such  as  I have  heard  described  as  arising  from  a per- 
forating ulcer)  going  through  to  the  back,  but  no  feeling  of  fulness 
or  belching  of  gas,  only  pain.  One  fat  lady  to  whom  I gave  it  had 
to  decrease  the  dose  and  take  it  less  frequently  because  of  this  pain 
in  the  stomach  and  abdomen. 

The  pains  in  the  abdomen  seem  to  be  in  the  muscles  or  between 
them  and  the  peritonaeum.  The  pains  are  of  a drawing  character, 
and  they  draw  inward  as  if  there  was  a contraction  or  a shortening 
of  the  broad  ligaments,  and  the  seat  of  this  drawing  is  below  the 
umbilicus. 

It  has  power  to  contract  the  prostatic  gland  or  to  expand  the 
bladder,  for  large  quantities  of  urine  can  be  held  in  my  own  case, 


PHYTOLACCA — LEAF,  FRUIT  AND  ROOT. 


647 


I can  hold  a good  four  ounces  and  have  only  to  pass  it  four  times 
in  a day.  The  water  is  light  colored  and  leaves  a lime  deposit.  All 
express  themselves  as  passing  more  water  and  of  holding  it  longer. 
Many  of  my  own  women  patients  have  large  pouches  of  fat  below 
the  umbilicus  that  rest  upon  the  thighs  when  sitting ; this  presses 
up  the  bladder  and  contracts  it  so  that  it  in  some  cases  it  is  difficult 
to  say  whether  the  bladder  is  enlarged  or  only  relieved  from  the 
pressure  as  the  fat  is  reduced. 

But  there  is  a dull  feeling  amounting  to  a soreness  in  the  region 
of  the  kidney  and  making  one  believe  it  will  have  power  over  the 
enlarged  kidney.  The  aching  is  similar  to  that  described  by  the 
sufferers  from  Bright’s  disease.  It  never  amounts  to  a pain,  only  to 
an  aching  and  tired  feeling,  that  makes  a chair  with  a good  back  to 
it  feel  comfortable. 

I have  fancied  that  my  hips  were  somewhat  stiff  and  sore  during 
the  time  I was  taking  it,  but  have  not  been  any  less  able  to  do  my 
duty  or  play  my  favorite  game  of  cricket. 

The  proving  of  the  Phytolacca  root  has  been  so  well  made  by  so 
many  and  is  so  well  known,  that  I cannot  say  anything  new  about 
it,  but  only  this,  that  my  provings  have  confirmed  the  symptoms 
as  described  in  our  Materia  Medica,  and  especially  in  the  Encyclo- 
paedia of  Allen. 

I could  give  you  many  cases  that  have  been  greatly  reduced  in 
flesh  and  made  to  feel  comfortable  in  their  actions  and  breathing, 
but  as  it  is  too  early  in  some  cases,  perhaps  I had  better  not. 

I have  seen  it  stated  that  the  Phytolacca  tincture  of  Dr.  Howe  is 
made  from  the  whole  plant.  Well,  perhaps,  that  may  be  the  better 
way — and  yet  I am  somewhat  inclined  to  believe  that  there  is  some 
truth  in  what  is  called  the  law  of  signatures — so  far  as  to  believe 
that  the  breathing  organs  of  a plant  may  possess  more  affinity  to  or 
for  the  breathing  organs  of  the  sufferers.  And  the  instinct  of  the 
lower  animals  leads  them  to  eat  the  leaves  in  most  cases  of  medi- 
cinal plants,  and  only  rarely  the  branch  or  bark ; seldom  if  ever  the 
root. 

I am  sure  that  in  the  Phytolacca  leaf  we  have  a very  valuable 
cough  remedy.  In  those  dry  throats  with  much  tickling  in  the 
throat  that  nothing  seems  to  reach — which  produces  such  distressing 
coughs,  dry  bronchial  coughs  with  sensation  of  roughness  and  increase 
of  heat  in  trachea  and  difficult  or  no  expectoration. 


648 


world’s  homoeopathic  congress. 


A few  cases  of  this  kind  of  cough  have  been  greatly  and  promptly 
relieved. 

How  shall  we  make  our  tinctures,  seeing  that  alcohol  has  some 
detrimental  influence  over  some  parts  of  the  plant  or  fruit  and  leaf 
or  color,  and  thus  to  a certain  extent  will  mar  or  interfere  with  its 
usefulness  in  some  of  its  finer  shades?  Fully  believing  that  the 
bountiful  benefactor  who  has  created  all  things  to  satisfy  the  perfec- 
tion in  Himself,  would  not  put  even  the  coloring  matter  to  the  fruit 
or  flower  if  there  was  nothing  to  serve  thereby — so  that  in  my  judg- 
ment everything  should  be  taken  as  nature  has  prepared  it. 

Glycerine  is  the  most  pleasant  way,  but  it  cannot  be  accepted  or 
made  to  apply  to  all  the  modes  of  usefulness. 

The  acetic  acid  or  vinegar  keeps  it  best  and  clearest  in  all  its 
ways,  but  this  makes  a combination  and  cannot  be  used  unless  we 
make  a proving  of  it  as  such,  and  that  I propose  to  do  during  the 
next  two  weeks. 

September  8,  1892,  measurement  is  thirty-one  and  one-half  inches, 
tight,  abdomen. 


REPORT 


OF  THE 

SECTION  IN  OBSTETRICS. 


Chicago,  III.,  Thursday,  June  1,  1893. 

The  Section  in  Obstetrics  convened  in  Room  7 of  the  Art  Build- 
ing, and  was  called  to  order  by  T.  Griswold  Comstock,  M.D.,  of  St. 
Louis,  Mo.,  Chairman  of  the  Section,  who  then  read  his  Inaugural 
Address. 

At  the  conclusion  of  the  address  the  Chair  announced  a paper  by 
John  C.  Sanders,  M.D.,  of  Cleveland,  O.,  on  “ Scarlatina  in  the 
Gestative  and  Puerperal  States.”  The  author  of  the  paper  being 
absent,  it  was  accepted  by  title. 

E.  S.  Bailey,  M.D.,  of  Chicago,  111.,  read  an  essay  entitled  “The 
Habitual  Death  of  the  Foetus  in  Utero.”  It  was  discussed  by  Drs. 
R.  Ludlam,  of  Chicago;  R,  N.  Foster,  of  Chicago,  and  Arthur 
Fisher,  of  Montreal,  Canada. 

A paper  by  H.  E.  Spalding,  M.D.,  of  Boston,  Mass.,  on  “ The 
Levator  Ani  as  Related  to  Parturition,”  was  read  by  title  and  ac- 
cepted, as  was  also  a paper  by  L.  L.  Danforth,  M.D.,  of  New  York, 
N.  Y.,  entitled  “A  Comparative  Study  of  the  Operative  Procedures 
Applicable  to  the  Commoner  Varieties  and  Degrees  of  Pelvic 
Deformity.” 

George  B.  Peck,  M.D.,  of  Providence,  R.  I.,  then  read  a paper 
on  “The  Rational  Treatment  of  Certain  Puerperal  Disorders.”  The 
paper  was  discussed  by  Drs.  L.  C.  Grosvenor,  of  Chicago,  111. ; 
Alonzo  Boothby,  of  Boston,  Mass. ; R.  N.  Foster,  of  Chicago,  111. ; 
R.  Ludlam,  of  Chicago,  111. ; C.  H.  Coggswell,  of  Cedar  Rapids, 
la. ; H.  W.  Robey,  of  Topeka,  Kan. ; Sheldon  Leavitt,  of  Chicago, 

111.; , of  Harvey,  111.;  J.  W.  Hingston,  of  North  Platte, 

Neb.;  Phoebe  J.  B.  Waite,  of  New  York,  N.  Y. ; F.  B.  Righter,  of 
Lincoln,  Neb. ; F.  J.  Becker,  of  Postville,  la. ; Martha  G.  Ripley, 


650 


world’s  homoeopathic  congress. 


of  Minneapolis,  Minn. ; C.  B.  Kinyon,  of  Rock  Island,  111.,  and 
by  the  author  of  the  paper. 

“The  Year’s  Progress  in  Obstetrics,”  a paper  by  Sheldon  Leavitt, 
M.D.,  of  Chicago,  111.,  was  read  bv  its  author  and  discussed  by  Drs. 
L.  C.  Grosvenor,  of  Chicago,  111. ; Martha  G.  Ripley,  of  Minneap- 
olis, Minn.;  J.  W.  Hingston,  of  North  Platte,  Neb.;  H.  E.  Beebe, 
of  Sidney,  O.,  and  by  Dr.  Leavitt,  the  essayist, 

“ Puerperal  Fever,”  by  J.  B.  G.  Custis,  M.D.,  of  Washington, 
D.  C.,  was  read  by  the  writer. 

Next  came  an  essay  on  “ Puerperal  Eclampsia,”  by  Lemuel  C. 
Grosvenor,  M.  D.,  of  Chicago,  111.,  which  was  read  by  its  author. 

“ Puerperal  Insanity,”  by  M.  D.  Youngman,  M.D.,  of  Atlantic 
City,  N.  J.;  wras  presented  by  the  Chairman.  In  the  absence  of  the 
author,  the  paper  was  read  by  the  Secretary  of  the  Section. 

The  Chairman  here  announced  that  the  three  papers  just  read 
were  open  for  discussion.  The  debate  was  participated  in  by  Drs. 
L.  C.  Grosvenor,  of  Chicago,  111. ; Clara  Yeomans,  of  Clinton,  la., 
J.  B.  Gregg  Custis,  of  Washington,  D.  C. ; S.  W.  S.  Dinsmore,  of 
Sharpsburg,  Pa.,  and  M.  D.  Youngman,  of  Atlantic  City,  N.  J. 

“Some  of  the  Diseases  Preventing  and  Complicating  Pregnancy,” 
a paper  by  Henry  C.  Aldrich,  M.D.,  of  Minneapolis,  Minn.,  was 
presented  by  title.  The  Section  then,  on  motion,  adjourned. 


SECTIONAL  ADDRESS  IN  OBSTETRICS. 


651 


SECTIONAL  ADDRESS  IN  OBSTERICS. 

By  T.  Griswold  Comstock,  M.  D.,  of  St.  Louis,  Mo. 


Whilst  in  the  enjoyment  of  a grateful  pride  for  the  very  distin- 
guished place  assigned  me  before  this  learned  body — representing 
the  ablest  practical  and  scientific  activities  of  the  entire  civilized 
world — I confess  to  a sense  of  distrust  as  to  my  ability  to  meet  the 
requirement  of  this  distinguished  occasion.  I appreciate  it  as  the 
opportunity  of  my  lifetime — not  attained  in  the  past,  and  with  no 
reasonable  expectation  that  it  will  be  duplicated  to  me  in  the  future. 

While  thanking  you  most  heartily  for  this  preferment,  I beg  to 
throw  myself  upon  your  kind  forbearance  and  indulgence  as  I pro- 
ceed with  the  duties  of  the  hour. 

And  first  of  all,  shall  we  not  indulge  a profound  sense  of  grati- 
tude to  the  all-wise  Giver  of  all  good  and  perfect  gifts,  that  our  lots 
and  lives  have  fallen  to  us  in  these  pleasant  places  of  wonderful 
progress  in  all  the  departments  of  human  activity.  Never  before  in 
all  historic  humanity  have  we  witnessed  the  like,  whether  by  per- 
sonal experience  or  history,  in  all  that  pertains  to  commerce,  science, 
agriculture,  law,  statecraft,  medicine,  art,  and  last,  but  not  least,  the 
church.  One  hundred  years  ago  a prediction  as  to  present  results 
in  all  these  departments  would  have  entitled  the  prophet  to  serious 
consideration  in  the  line  of  qualification  for  residence  in  a lunatic 
asylum.  In  statecraft  the  old  modes  of  bitterness,  strife  and  vio- 
lence are  giving  way  to  the  peaceful  ones  of  gentleness,  conciliation 
and  compromise  by  means  of  arbitration.  From  present  indications, 
the  soldier  must  ere  long  beat  his  spear  into  a pruning-hook  and  his 
sword  into  a plowshare,  when  the  nations  shall  learn  war  no  more. 
May  we  not  indulge  the  fond  hope  that  the  universal  brotherhood 
of  both  nations  and  individuals  is  rapidly  approaching? 

In  science  and  natural  history,  we  delight  to  do  homage  to  such 
luminaries  as  Darwin,  Huxley  and  our  own  brilliant  Edison.  In 
statecraft  and  political  economy,  we  find  such  notable  worthies  as 
Bismarck,  Gladstone  and  Lincoln. 


652 


world’s  H0MCE3PATHIC  CONGRESS. 


In  commerce  and  finance  the  merchant  princes,  financial  kings 
and  railroad  magnates,  have  given  an  impetus  to  trade,  transporta- 
tion, travel  and  personal  communication,  by  land  and  sea,  never 
before  dreamed  of,  and  contributing  a blessing  alike  to  the  peasant 
in  his  humble  home,  and  the  king  upon  his  throne. 

To  the  church,  we  are  indebted  for  the  humanizing  and  blissful 
graces  given  us  by  Christianity,  and  presented  to  us  by  the  faithful, 
indefatigable  works  of  Phillips  Brooks,  Spurgeon,  Talmage  and 
Joseph  E.  Cook,  I take  pleasure  here  in  placing  great  church- 
workers  on  the  roll  of  honor.  For  whether  we  esteem  Christianity 
a myth,  a fiction  or  a reality ; whether  we  be  atheists,  skeptics  or  re- 
ligionists, it  is  simply  absurd  to  deny  that  its  elevating  and  ennobling 
influences,  are  the  very  foundation  stones  of  our  present  progressive 
civilization,  refinement  and  enlightenment. 

In  our  own  blessed  profession,  we  are  proud  of  and  grateful  for 
such  noble,  indefatigable  workers  as  Virchow,  Charcot,  Sir  Joseph 
Lister,  Gross,  Marion  Sims,  Thomas,  Ludlam,  Helmuth,  and  last 
but  by  no  means  least,  the  immortal  Hahnemann. 

Many  of  these  noble  worthies  have  gone  beyond  ; while  they  rest 
from  their  labors,  “ their  works  do  follow  them.” 

In  the  last  2000  years,  three  events  have  transpired,  and  have 
exerted  an  influence  upon  human  destiny,  that  to  our  linjited  ken,  is 
simply  incomprehensible  and  approaches  infinity. 

Reverently,  devoutly,  with  no  thought  of  comparison  I meution 
the  birth  and  the  work  of  our  Lord  and  Saviour  Jesus  Christ,  who 
gave  us  a system  of  morals  and  benevolence,  pure,  sweet  and 
gentle ; secondly,  the  life  and  public  service  of  Columbus  in  the  dis- 
covery of  a new  continent ; thirdly,  Hahnemann’s  discovery  of  a 
new  symptomatic  and  therapeutic  chart,  for  the  cure  of  disease.  It 
does  not  matter  whether  we  accept  the  claims  and  purposes  of  these 
three  great  events,  without  dissent  or  protest;  or  whether  we  enter 
protest  to  much  or  little;  the  fact  remains  that  results  have  been  in- 
comprehensible to  our  finite  ken.  Christ  furnished  a rule  of  life 
and  conduct,  with  lofty  aspirations  without  parallel,  precedent  or 
sequent.  Columbus  got  an  immortality  in  history  by  doubling  the 
metes  and  bounds  of  the  then  known  terra  firma  ; whilst  Hahne- 
mann got  an  almost  equal  immortality,  by  revolutionizing  and  up- 
turning the  destructive  and  heroical  modes  of  old-time  physic. 

The  sublime  inspiration  of  a persistent,  ever-prevailing  idea,  was 


SECTIONAL  ADDRESS  IN  OBSTETRICS. 


653 


present  with  each,  and  brought  results  corresponding  to  the  inspira- 
tion. This  inspiration  of  an  idea,  is  the  key-note  in  the  history  of 
every  great  and  noble  enterprise  in  life’s  work.  By  the  terms  of  my 
thesis  I should  be  confined  to  the  limits  of  the  past  year’s  progress. 
But  we  find  1892  lapping  backward  into  1891,  and  forward  into 
1893,  in  such  fashion  as  to  make  precise  conformity  difficult ; we 
shall  therefore  roam  and  revel,  when  and  where  we  please,  in  the 
abundance  of  opportunities  around  us. 

There  is  a noteworthy  tendency  to  simplicity  in  the  management 
of  utero-gestation,  and  the  parturient  and  puerperal  states.  They 
are  no  longer  to  be  regarded  as  states  of  disease,  but  as  normal  and 
physiological  conditions,  requiring  neither  medicine  or  manual 
manipulations ; and  should  be  trusted  to  a rational  hygiene  in  its 
broadest  sense.  In  labor  the  officious  and  vicious  manipulations 
and  handlings  so  often  prevalent,  should  be  condemned.  The  ob- 
stetrist  with  an  aseptic  hand,  through  a well-cleaned  vulva,  should 
ascertain  the  exact  presentation  and  relative  adaptation  of  parts  to 
the  process,  and  then  largely  leave  the  issue  to  dame  nature’s  efforts. 
We  do  not  mean  to  ignore  disinfectants  as  such  ; but  above  all  and 
best  of  all  we  commend  plenty  of  soap  and  hot  water.  Formerly 
the  result  as  to  mortality,  was  largely  against  hospital  experience,  as 
compared  with  private  practice.  Precisely  the  reverse  is  true  now ; 
and  attributable  to  the  scrupulously  clean  doctors,  nurses  and  patients 
to  be  found  in  every  well-regulated  lying-in  hospital. 

The  most  enlightened  practitioners  are  now  engaged  in  an  effort 
to  dispense  with  the  constant  handling  and  manipulating  heretofore 
in  vogue;  especially,  among  midwives,  in  the  management  of  labor. 
In  many  cases  this  vice  is  not  altogether  chargeable  to  the  obstetri- 
cal attendant.  The  patient  being  in  pain,  very  naturally,  with  her 
friends,  appeals  to  the  attendant  for  help.  This  she  expects  him  to 
do  by  keeping  his  hand  constantly  within  the  vulva.  Women  in 
confinement  or  approaching  confinement,  should  be  educated  out  of 
any  such  foolish  demand  or  expectation. 

In  olden  times,  Ergot  by  its  incautious  use,  was  a fearful  imple- 
ment of  destruction  in  the  hands  of  practitioners  of  midwifery.  It 
was  especially  the  “ help  at  hand”  for  the  midwife.  Its  power  for 
evil  to  both  mother  and  child  is  so  great  that  medical  men  of  the 
best  repute  have  practically  abandoned  it  altogether  as  a parturient. 
The  following  aphorism  from  Prof.  Pajot  we  fully  indorse.  lie  says: 


654 


world’s  HOMCEOrATHIC  CONGRESS. 


“As  long  as  the  uterus  contains  anything , he  it  child,  placenta,  mem- 
brane or  clots , never  administer  Ergot.”  We  are  aware  that  not  a few 
practitioners  will  give  Ergot  for  inertia  uteri  after  the  delivery,  but 
we  insist  that  it  should  not  be  given  unless  the  placenta  is  passed,  and 
the  uterus  free  of  clots.  Then  its  opportunity  for  legitimate  use  is 
as  a haemostatic,  in  the  prevention  and  cure  of  post-partum  haemor- 
rhage. Ergot  was  once  designated  as  pulvis  ad  partum , but  from 
its  incautious  use,  it  may  well  be  named  as  pulvis  ad  mortem. 
Formerly  we  had  no  little  trouble  in  the  use  of  Ergot  for  the  want 
of  a permanent  and  reliable  preparation.  Several  preparations  of 
the  fluid  extract  are  now  obtainable  which  are  excellent,  but  the 
preparatiou  coming  to  us  and  called  Ergotole,  from  Sharp  & Dohme, 
of  Baltimore,  is  the  best,  and  will  be  found  more  efficient  than  any 
other.  In  this  connection  it  may  be  wTell  to  mention  hot  water 
irrigations,  as  one  of  the  best  haemostatics  in  not  only  midwifery 
practice,  but  also  in  surgical  practice.  In  cases  of  post-partum 
flooding,  should  hot  water  not  suffice,  its  alternate  use  with  ice-water 
injections  may  be  serviceable  as  a means  of  startling  the  patulous 
sinuses  into  healthy  contractions. 

We  have  recently  arrived  at  a much  safer  and  better  understand- 
ing as  to  the  indications  and  contra-indications,  justifying  and  requir- 
ing the  use  of  the  forceps.  Many  a woman  and  child  have  been 
lost  for  the  want  of  prompt  and  timely  use  of  this  valuable  instru- 
ment; while  others  have  been  sacrificed  by  its  incautious  and  pre- 
mature application. 

When  the  labor  is  protracted  and  mother  or  child  in  any  danger 
from  the  delay , and  the  danger  will  cease  with  rapid  delivery — if  the 
circumstances  are  such  that  the  forceps  may  be  used — they  are  always 
indicated. 

As  a substitute  for  the  Caesarean  section,  much  interest  just  now 
is  being  exercised  in  behalf  of  symphyseotomy  or  synchondrotomy. 
Of  course,  this  operative  mode  is  not  a novelty.  It  was  proposed 
and  practiced  a very  long  while  ago.  First  by  De  la  Corrue  in 
1631,  then  by  Sigault  in  1768,  and  by  Stolz  modified  into  a pubeo- 
tomy.  Winckel,  of  Munich,  says  of  the  operation  : 

“ It  has  not  fulfilled  what  was  predicted  of  it,  but  has  produced, 
in  many  instances,  what  was  not  expected — injuries  of  the  bladder, 
stretching  of  the  sacro-iliac  articulations,  and  caries  of  the  anterior 
wall  of  the  pelvis.  May  this  be  forever  entombed  /”  Notwit  hstand- 


SECTIONAL  ADDRESS  IN  OBSTETRICS. 


655 


ing  the  above,  from  so  conservative  and  experienced  a man  as 
Winckel,  we  are  obliged  to  keep  up  with  the  changes  and  experi- 
ences of  this  present  age. 

Recently,  under  the  advantages  of  superior  surgical  skill,  com- 
bined with  our  practical  experience  of  aseptic  procedures,  some 
encouraging  results  are  said  to  have  been  attained  from  this  opera- 
tion. An  interesting  article  upon  the  operation  in  question,  giving 
statistics  and  results,  may  be  found  in  the  April  number  of  the 
Medical  Century , Chicago.  Obviously,  the  advantage  to  be  gained 
is  in  saving  the  integrity  of  the  peritonaeum  and  the  uterine  wall. 
We  therefore  hope  for  this  operation  a creditable  success  in  the  near 
future.  The  drawback  in  the  operation  would  seem  to  consist  in 
tardy  rearticulation  of  the  divided  symphysis.  With  suitable  sur- 
gical, pelvic  constraint,  and  requisite  avoidance  of  locomotion,  this 
difficulty  may  possibly  be  reduced  to  the  minimum. 

The  operation  known  as  episiotomy,  while  not  a novelty  or  any- 
thing new,  has  recently  been  brought  into  more  pronounced  notice, 
as  a means  of  relief,  to  prevent  laceration  of  the  perinseum.  The 
operation  is  very  simple,  consisting  in  making  lateral  incisions  into 
the  labia.  It  has  been  called  “the  young  practitioners’  operation.” 
This  is  an  unjust  fling  against  it.  It  is  an  operation  practiced  in 
the  best  lying-in  institutions  in  Germany.  We  first  learned  it  when 
a pupil  of  Prof.  Braun  in  Vienna,  and  have  had  occasion  to  prac- 
tice it  occasionally  for  the  past  thirty  years.  Any  mode  of  manage- 
ment which  so  safely  and  simply  prevents  the  dire  disaster  of  peri- 
neal rupture  ought  not  to  be  lightly  esteemed.  These  lateral  in- 
cisions repair  soon  with  or  without  trifling  surgical  assistance.  It 
may  be  advisable  in  some  cases  to  apply  catgut  sutures.  In  this 
place  we  have  a word  to  say  as  to  the  time  for  surgical  repair  of  a 
lacerated  perinseum.  In  olden  time  repair  was  postponed  almost 
indefinitely,  and  only  attempted  in  very  bad  cases. 

A great  deal  of  the  work  the  gynaecologist  has  to  do,  is  caused  by 
the  injuries  that  happen  during  parturition.  To  protect  the  peri- 
nseum during  the  passage  of  the  child’s  head  and  shoulders,  is  the 
duty  of  the  skilled  accoucheur.  Lacerations  of  the  perinseum,  un- 
repaired, cause  untold  miseries  to  women,  and  render  their  lives 
wretched.  They  are  liable  to  occur  in  labors  where  instruments  are 
not  employed,  or  they  may  result  from  their  unskillful  use.  But 
such  accidents  often  happen  to  the  most  experienced  and  skillful 


656 


world’s  homceopathic  congress. 


obstetrist,  and  the  circumstances  of  the  case  may  be  such  that  they 
cannot  be  avoided.  After  every  labor  the  accoucheur  should  (before 
leaving  the  lying-in  room)  carefully  examine  the  vulva  by  an  ocular 
inspection  to  assure  himself  of  its  exact  condition.  If  rupture  of  the 
perinseum  has  occurred,  it  is  his  duty  to  repair  it  at  once. 

This  should  be  done  as  soon  after  the  delivery  as  may  be  practi- 
cable— within  the  first  six  hours  if  possible;  it  is  unsafe  to  wait 
longer  than  sixteen  hours.  However,  in  two  cases  in  my  own  ex- 
perience, the  operation  proved  a success,  when  made  twenty-four 
hours  after  the  delivery.  The  consensus  of  opinion  of  the  authori- 
ties in  midwifery  the  world  over,  now  insists  upon  the  immediate 
repair  of  a perinseum  ruptured  during  labor.  In  giving  this  opinion 
so  positively,  it  may  be  supplemented  by  the  statement,  that  there 
are  exceptions  to  this  rule — the  circumstances  of  the  case  may  be 
such  that  the  primary  operation  will  be  contraindicated. 

An  operation  for  laceration  of  the  cervix  during  labor,  may  with 
entire  propriety  be  deferred  beyond  the  puerperal  state,  and  yet  its 
immediate  repair  is  already  advised  by  some  experienced  obstetrists. 

Saturating  the  vulva  with  hot  oil,  to  be  kept  hot  by  frequent 
application  of  compresses  out  of  hot  water,  has  recently  come  into 
much  use  and  favorable  notice  as  a simple  and  practicable  means  for 
relaxing  the  unyielding  parts,  threatened  with  laceration.  This  is 
to  be  practiced  just  when  the  head  is  ready  to  pass  through  the 
outlet. 

To  Dr.  Thomas,  of  New  York,  belongs  the  credit  of  having  re- 
cently introduced  and  practiced  a modification  of  the  Caesarean  sec- 
tion as  a substitute  for  craniotomy.  Early  in  the  present  century, 
Ritgen,  Sir  Charles  Bell,  Raudeloque,  and  others  conceived  and 
suggested  the  plan  of  which  the  industry  and  skill  of  Dr.  Thomas 
have  made  a practical  illustration.  It  is  known  as  laparo-elytrot- 
omy.  Its  object  is  to  effect  delivery  in  pelvic  deformities  without 
craniotomy,  and  at  the  same  time  save  the  integrity  of  the  perinseum 
and  the  uterine  wall ; an  object  and  result  most  devoutly  to  be 
wished  for  by  every  cautious  and  conscientious  practitioner.  No 
prudent  surgeon  ever  passes  his  knife  through  these  parts  without  a 
painful  misgiving,  with  all  the  precautions  against  sepsis.  The 
initial  incision  in  this  operation,  is  made  an  inch  above  Poupart’s 
ligament.  Then  by  a cautious  dissection  and  separation  of  the  peri- 
tonaeum from  its  sub-cellular  connections,  it  is  pushed  up  so  as  to 


SECTIONAL  ADDRESS  IN  OBSTETRICS. 


657 


enable  the  surgeon  to  dissect  down  to  the  cervical  end  of  the  vagina, 
which  is  freely  cut  laterally  (across)  so  as  to  reach  the  foetal  head 
through  the  os  and  deliver  above  the  symphysis  pubis.  Anatomi- 
cal familiarity  with  the  parts,  a steady  hand,  and  a bright  eye, 
render  the  operation  by  no  means  difficult;  and  while  statistics  are 
by  no  means  all  that  might  be  desired,  in  the  way  of  favorable 
results,  yet  the  operation  promises  well,  as  a dernier  ressort.  In  ex- 
tenuation of  any  unfavorable  result  in  this  and  kindred  cases,  it 
should  be  borne  in  mind,  that  surgical  interference  is  usually  de- 
ferred until  the  bodily  vitality  of  the  mother  is  so  low,  that  the 
simplest  surgical  operations  are  liable  to  terminate  disastrously. 

Occipito-posterior  position  of  the  foetal  head  in  labor,  has  of 
course  been  liable  to  occur  at  any  time  since  labor  and  child-bearing 
came  to  be  a fact.  Yet,  it  does  not  seem  to  have  received  careful 
recognition  and  systematic  attention  until  recently.  According  to 
Dr.  Uvedale  West,  who  studied  the  subject  very  carefully,  it  seems 
to  have  occurred  79  times  in  2585  labors;  all  of  the  labors  being 
exceptionally  difficult.  The  failure  of  recognition  seems  to  grow 
out  of  a seeming  obscurity  of  the  parts  in  the  matter  of  examina- 
tion. I remember  at  a medical  society  one  evening,  the  manakin 
with  the  foetal  head  in  this  position  under  cover,  was  presented  for 
opinion,  from  several  men  of  ability  and  experience,  not  one  of  whom 
recognized  or  diagnosed  the  position  correctly.  Practically,  the  state 
of  the  case  consists  in  the  failure  of  the  occiput  to  rotate  anteriorly 
towards  the  symphysis ; so  that  the  occiput  is  situated  posteriorly  at 
the  promontory,  while  the  forehead  and  face  are  at  or  under  the  sym- 
physis, presenting  the  very  longest  diameter  that  can  be  made  of  the 
face  and  cranium,  to  one  of  the  shorter  pelvic  diameters.  A marked 
peculiarity  of  such  cases  is,  that  the  chin  instead  of  being  pressed 
down  upon  the  sternum  is  drawn  as  far  away  as  possible;  this  fact 
serving  as  an  important  element  in  the  matter  of  diagnosis. 

Three  modes  of  management  have  been  suggested.  The  first  is 
to  leave  the  case  to  the  efforts  of  nature,  under  the  hope  that  a spon- 
taneous rotation  of  the  occiput  may  bring  it  under  the  symphysis 
and  so  terminate  the  labor  as  one  of  the  normal  varieties.  And, 
what  is  remarkable,  not  a few  of  such  cases  thus  terminate  favorably 
by  the  unaided  powers  of  nature.  The  second  is  to  make  pressure 
upon  the  frontal  bone  sons  to  bring  the  chin  to  its  normal  positiou 
on  the  sternum,  while  making  oblique  lateral  pressure  on  the  head 

42 


658 


world’s  homceopathic  congress. 


under  the  symphysis,  with  a view  of  inducing  rotation  of  the  occi- 
put towards  the  symphysis.  In  fine  the  manipulations  of  the  ac- 
coucheur should  be  such  as  to  constantly  favor  flexion  of  the  head, 
which  will  facilitate  the  descent  of  the  occiput,  and  resist  the  descent 
of  the  forehead,  by  pushing  it  towards  the  sternum,  keeping  it  in  a 
constant  state  of  flexion. 

The  third  method  is  to  deliver  with  the  forceps  with  the  occiput- 
posteriorly.  In  the  main,  experience  will  show  from  the  results  of 
any  or  all  three  modes,  that  it  were  much  more  lucky  to  have  es- 
caped the  case  altogether,  than  to  be  responsible  for  its  manage- 
ment. 

The  question  whether  it  is  ever  a legitimate  operation  to  destroy 
the  child’s  life  to  save  the  mother,  is  one  that  must  be  answered. 
We  will  not  discuss  it  in  extenso,  for  we  could  easily  write  many 
pages  upon  it. 

To  sum  up,  a case  may  occur,  where  the  labor  has  been  greatly 
prolonged,  where  the  mother’s  pulse  is  very  rapid  and  weak,  and 
the  temperature  so  high  as  to  indicate  danger  from  complete  ex- 
haustion, that  may  terminate  suddenly  with  death,  unless  she  is 
relieved  by  an  immediate  and  rapid  delivery.  Added  to  this,  the 
pulsations  of  the  foetal  heart  being  very  faint — indeed,  almost  in- 
audible— and,  consequently,  the  absolute  indications  for  the  Caesa- 
rean section  are  absent.  In  such  a dilemma,  when  the  mother  can- 
not last  much  longer,  if  the  obstetrist  (who  we  will  suppose  is  an 
expert  as  a surgeon)  elects  to  make  a rapid  Caesarean  section — either 
by  the  Porro,  or  Sanger  method,  in  all  probability  the  result  will  be 
fatal  to  both  mother  and  child.  Either  craniotomy  or  embryotomy 
must  be  a last  resort.  So  many  objections  are  made  to  this  serious 
operation,  that  the  practitioner  must  be  certain  that  there  is  nothing 
left  hut  a resort  to  it.  A short  time  since,  we  were  in  consultation 
with  a celebrated  practitioner  (an  ex-professor)  in  a case  of  lingering 
labor,  with  occipito-posterior  position,  where  the  head  was  impacted, 
and  rotation  could  not  be  made.  The  forceps  were  tried,  but  it  was 
impossible  to  effect  the  delivery.  This  ex-professor  proposed  the 
Caesarean  section,  but  the  family  dissented  in  the  most  positive 
terms.  The  doctor  insisted  that  he  would  withdraw  from  the  case, 
if  the  operation  was  refused.  The  impaction  was  so  firm,  the 
mother’s  condition  so  low,  and  the  child’s  vitality  in  such  doubt, 
that  craniotomy  was  the  only  resort. 


SECTIONAL  ADDRESS  IN  OBSTETRICS. 


659 


In  this  connection  we  beg  permission  to  call  attention  to  a re- 
markable case  of  Caesarean  section  reported  in  the  December  number 
of  the  Chicago  Clinique , by  our  esteemed  colleague,  Prof.  R.  Lud- 
lam.  We  here  give  an  abstract  of  the  case  : 

A woman  some  months  pregnant,  was  found  to  have  a contracted 
pelvis,  with  two  fibroids  blocking  up  the  uterine  outlet.  An  explo- 
ratory incision  was  made,  and  the  uterus  was  found  to  contain  a 
living  foetus.  One  of  the  fibroids  was  removed,  and  the  incision 
was  closed.  When  the  pains  came  on,  at  the  full  term  of  gestation, 
in  December  following,  Dr.  Ludlam  performed  the  Caesarean  sec- 
tion, with  antiseptic  precautions,  and  removed  a healthy  child, 
weighing  eight  pounds,  and  saved  both  mother  and  child.  It  is  due 
our  friend  Dr.  Ludlam,  to  state  that  his  conception  of  the  compli- 
cated difficulty  was  not  only  bold,  but  brilliant  and  practical  in  the 
extreme. 

In  the  matter  of  therapeutics  peculiar  to  utero-gestation  and  the 
puerperal  state,  there  is  such  a growing  tendency  to  consider  these 
states  physiological  and  normal,  as  to  discourage  the  practice  of 
drug  administration  almost  altogether. 

In  obstetrical  therapeutics  we  have  recently  made  more  advance 
in  the  uses  of  electricity  than  in  any  other  direction.  This  agent 
has  come  to  the  front  recently  after  such  fashion  in  commerce,  sci- 
ence, art,  propulsion  and  heat,  as  to  make  one’s  head  almost  giddy 
when  he  stops  to  think  of  present  realities  and  immediate  future 
promise.  To  the  obstetrist  it  possesses  peculiar  interest  in  the  man- 
agement of  uterine  inertia,  and  spastic  irregular  uterine  action.  In 
the  severe  lumbar  pains  of  the  first  stage  it  serves  a valuable  pur- 
pose ; also  for  cramps  of  the  lower  extremities  in  the  second  stage. 
For  such  purposes,  both  the  galvanic  and  faradic  currents  will  be 
found  useful,  in  accordance  with  the  special  symptoms. 

The  destruction  of  the  foetus  in  extra-uterine  pregnancy  by  the 
faradic  current  has  been  recently  proposed,  and  received  practical 
attention.  If  the  dead  foetus  becomes  encysted  so  as  to  convert  it 
into  a benign  tumor,  we  may  have  relatively  a happy  solution  or 
conclusion  of  a grave  difficulty.  Should  signs  of  decay  and  disin- 
tegration take  place  after  the  faradic  application,  we  should  promptly 
resort  to  laparotomy  to  save  the  patient  from  the  horrors  and  com- 
plication of  a widespread  septicaemia.  We  should  say  of  such  cases 
as  we  did  of  occipito-posterior  position  : it  is  much  better  to  escape 


660 


world’s  homoeopathic  congress. 


them  altogether  than  to  be  responsible  for  management  and  re- 
sult. 

The  puerperal  state  is  subject  to  various  febrile  disorders ; some 
transient,  some  more  permanent.  We  think  the  peritoneal  form 
usually  known  as  puerperal  fever  is  less  frequent  than  formerly,  and 
even  now  not  so  frequent  as  may  be  supposed.  We  believe  there  is 
a puerperal  fever  which  is  a zymotic  affection  or  an  essential  disease, 
and  other  forms  that  are  septicaemia.  No  doubt  the  majority  of 
puerperal  fevers  originate  from  heterogenetic  causes,  and  may  be  re- 
garded as  puerperal  septicaemic.  This  is  the  opinion  of  the  majority 
of  clinicians,  who  esteem  it  de  facto  as  a septic  process  and  closely 
allied  to  surgical  fever. 

No  doubt  cases  of  puerperal  fever  may  occur  from  auto-infection 
as  well  as  hetero-infection.  When  the  results  of  traumatism  are 
considered,  it  would  seem,  in  certain  cases,  to  be  independent  of 
either.  The  practical  thought  to  be  kept  in  mind  is,  that  woman  in 
the  puerperal  state  is  much  predisposed  to  the  adverse  influence  of 
any  toxic  agent  that  may  happen  to  be  near  her.  Precisely  the  re- 
verse is  true  during  utero-gestation.  But  in  the  puerperal  state 
neighborship  to  cases  of  any  malignant  or  contagious  form  of  disease 
always  renders  puerperal  fever  probable.  Physicians  in  attendance 
upon  diphtheria,  scarlet  fever,  or  malignant  typhus  should  decline 
all  obstetrical  calls  or  engagements.  Physicians  afflicted  with  obsti- 
nate chronic  ulcerations  and  discharges,  e.g.,  ozena,  should  never 
trust  themselves  in  the  lying-in  chamber.  It  does  not  seem  proba- 
ble— only  exceptionally — that  this  fever  is  propagated  by  any  specific 
contagion,  as  we  find  in  the  causation  of  small-pox,  scarlet  fever, 
measles,  and  whooping-cough.  Yet  of  two  women  in  the  same  ward 
or  room,  both  in  the  puerperal  state,  if  one  should  chance  to  get  puer- 
peral fever,  she  will  very  likely  communicate  it  to  the  other. 

As  perfect  asepsis  in  labor  is  the  first  care  of  the  obstetrist,  anti- 
septic agents  should  be  always  within  reach.  There  is  quite  a list 
of  those  that  possess  distinct  virtues. 

Hot  sterilized  water,  Boric  acid,  Calendula,  Listerine,  Corrosive 
sublimate,  Creolin,  and  Lysol  all  have  their  especial  uses  as  anti- 
septic agents,  but  after  sterilized  water  Lysol  is  the  most  reliable.  It 
is  one  of  the  most  powerful  germicides  that  we  possess,  and  in  gynae- 
cological and  obstetrical  practice  is  perfectly  innocuous.  It  is  not 
costly,  being  derived  from  tar-oils  by  boiling  with  alkaloids  and  fats. 


SECTIONAL  ADDRESS  IN  OBSTETRICS. 


661 


It  is  employed  in  solutions  of  from  one-lialf  to  three  per  cent.  Subli- 
mate, which  is  a powerful  germicide,  and  is  dangerous  to  some  pa- 
tients. Drs.  Welsh  and  Vance  think  that  it  has  already  done  more 
harm  than  good.  We  are  not  quite  ready  to  banish  it  from  the 
accoucheur’s  armamentarium , but  it  must  be  used  with  great  caution. 
In  a solution  of  taaoTj  our  own  experience,  it  is  absolutely  safe. 
In  organic  kidney  affections  it  is  contra-indicated.  The  trouble  with 
it  would  seem  to  be  that  it  is  an  agent  so  powerful  that  we  are  all 
the  while  in  danger  of  getting  more  than  we  bargained  for.  The 
puerperal  woman  would  seem  to  be  especially  susceptible  to  its  toxic 
action,  as  deaths  have  been  reported  from  its  use  when  used  in  a 
solution  of  j/q  q-,  and  possibly  in  solutions  still  weaker. 

The  obstetrist  will  by  no  means  seem  to  have  discharged  his  whole 
duty  without  suitable  attention  to  the  little  stranger.  Formerly,  if 
the  said  stranger  indulged  anticipations  as  to  the  immediate  future 
after  his  arrival,  he  expected  a hearty  scrubbing  in  hot  soapsuds,  as 
a means  of  bodily  renovation,  at  the  expense  of  damage  to  both  skin 
and  eyes.  Now  we  treat  him  to  frictions  in  warm  oil,  followed  by  a 
warm  bath  without  soap,  and  drying  frictions  with  warm  soft  cloth, 
all  accomplished  so  dexterously  and  quickly  as  to  save  exhaustion 
and  bodily  depression.  If  he  arrives  in  anything  like  a feeble  or 
bad  condition,  he  gets  the  warm  oil  frictions  only,  and  is  at  once 
enveloped  in  a soft  wTarm  blanket. 

The  former  elaboration  of  finery  in  dress  for  the  young  child 
should,  in  all  cases,  give  place  simply  to  a canton  flannel  gown,  a 
buttock  napkin,  and  the  " belly-band.” 

The  eyes  and  mouth  should  be  carefully  washed  with  a new  sponge 
and  warm  water.  Should  there  be  a reason  to  suspect  any  specific 
or  unclean  condition  of  the  mother’s  genitals,  the  eyes  should  be 
treated  to  a drop  of  Corrosive  sublimate,  1 to  4000,  or  a drop  of 
nitrate  of  silver  solution,  1 per  cent,  strength,  to  be  followed  by  a 10 
per  cent,  solution  of  Boric  acid,  three  times  a day  as  a lotion,  for 
one  week.  This  precaution  may  save  the  practitioner  as  well  as 
the  child  from  the  horrors  and  consequences  of  ophthalmia  neona- 
torum. 

If  the  child  be  a male,  carefully  examine  the  aperture  of  the  fore- 
skin, and  if  very  narrow  dilate  at  once  and  completely  expose  the 
glans,  in  order  that  it  may  be  kept  clean  and  that  there  shall  be  no 
phimosis. 


662 


world’s  homoeopathic  congress. 


And  now,  Mr.  President  and  Members  of  the  Congress,  the  lim- 
ited space  and  time  which  I may  prudently  occupy  on  this  occasion, 
when  there  are  so  many  others  with  something  valuable  to  say,  have 
only  allowed  me  to  cast  about  and  touch  points  of  interest  and  im- 
portance in  the  most  casual  way.  If  I have  in  the  smallest  degree 
contributed  to  your  entertainment,  I shall  feel  profoundly  thankful 
for  the  use  I may  have  been  able  to  make  of  my  opportunity.  In 
any  event,  allow  me  to  indulge  the  hope  that  you  will  at  least  esteem 
me  diligent  and  conscientious  in  the  discharge  of  the  duty  you  have 
imposed  upon  me — Quod  Erat  Demonstrandum— Amen. 


SCARLATINA  IN  GESTATIVE  AND  PUERPERAL  STATES.  663 


SCARLATINA  IN  THE  GESTATIVE  AND  PUERPERAL 

STATES. 

By  John  C.  Sanders,  M.D.,  Cleveland,  Ohio. 


Of  all  the  varied  zymotic  maladies  possible  to  the  gestative  and 
puerperal  states  of  woman  there  is  none  more  obscure  in  its  aetiology, 
or  ambiguous  in  its  symptomatology,  or  problematic  in  its  diagno- 
sis, or  more  freighted  with  peril  in  its  issue  than  scarlatina,  which 
has  been  chosen  as  the  theme  of  this  brief  paper.  Scarlet  fever  may 
attack  either  the  gestative  or  the  puerperul  state.  We  will  consider 
the  subject  in  this  order : 

I. — As  declaring  itself  in  the  gestative  state. 

If  the  exposure  to  the  infection  has  occurred  in  the  early  months 
of  gestation  the  attack  follows  not  much  beyond  the  average  period 
of  incubation  in  the  non-gravid  state,  and  predominantly  is  induc- 
tive of  abortion.  That  this  should  occur  doubtless  depends  on  two 
causative  conditions ; one  is  the  exceeding  high  temperature  of  the 
maternal  blood,  for  no  other  fever  carries  so  high  a temperature 
either  in  adult  life  or  childhood,  and  this  alone  would  very  surely 
compromise  embryonic  life,  and  another  is  the  doubtless  direct  toxic 
effect  of  the  virus  on  the  embryo,  for  it  admits  of  no  question  that 
the  embryo  becomes  infected  through  the  virus,  of  which  the  mother’s 
blood  can  be  the  sole  bearer. 

The  attack  is  inaugurated  most  universally  with  a severe  chill, 
and  with  or  without  more  or  less  severe  anginal  symptoms,  early  de- 
clared fever  ensues,  characterized  by  exceedingly  high  temperature, 
carrying  the  mercury  up  to  103r5¥°  Fahr.  to  104°  and  304r5o°  Fahr. 
and  all  this  within  the  period  of  twenty-four  hours.  In  case  angi- 
nal symptoms  accompany,  the  attack  is  more  often  imputed  to  cold, 
so  called,  or  some  special  and  extreme  meteorological  changes.  The 
fever  will  rage  on  hardly  longer  than  thirty-six  or  forty-eight  hours 
when  abortive  phenomena  ensue,  with  a declared  rash  on  face,  hands, 
and  arms.  The  discharges  from  the  womb  soon  become  tainted, 


664 


world’s  homoeopathic  congress. 


either  patent  or  detectable  only  on  close  observation.  The  rash 
runs  down  over  the  body  and  limbs  and  feet  not  uniformly  in  one 
unbroken  blush,  but  in  detached  areas.  As  the  rash  extends  the 
febrile  phenomena  continue  with  increased  intensity,  complicated  and 
blended  with  the  metritic  irritation  and  distresses  of  the  abortive 
act.  The  intense  blood  heat,  the  thirst,  the  dry  tongue  and  mouth, 
the  burning  or  stinging  or  itching  rash,  the  uterine  suffering,  the 
offensive  discharges  lochial  or  otherwise,  the  vigilance  and  restless- 
ness and  more  or  less  delirium,  make  the  case  extreme  and  critical. 
Here  will  arise,  if  not  before,  the  problematic  question  of  the 
greatest  import.  Is  this  rash,  faintly  outlined  it  may  be,  and  occur- 
ring not  in  a continuous  blush,  but  in  detached  areas,  zymotic  from 
scarlet  fever  infection  or  is  it  the  skin  discoloring  of  septic  poison  ? 
Is  the  case,  in  brief,  one  of  zymotic  or  non-zymotic  puerperal  fever? 
There  is  demanded  the  most  searching  and  exhaustive  inquiry  into 
the  history  of  the  patient  and  family  with  the  view  to  determine  the 
exact  provocation  of  the  attack,  whether  it  was  autogenetic  or 
heterogenetic.  For  the  infection  may  have  run  through  very  cir- 
cuitous and  unexpected  routes. 

Apart  from  the  presumptive  evidence  of  a clearly  defined  tracery 
of  exposure  to  scarlet  fever  infection  there  are  points  of  differen- 
tial diagnosis  that  will  contribute  to  the  solution  of  the  problem. 

1.  In  scarlet  fever  infection  the  onset  and  progress  of  the  puer- 
peral fever  are  more  violent  and  carry  a higher  average  tempera- 
ture. 

2.  The  anginal  symptoms,  if  any  accompany  the  case,  are  more 
extreme  than  what  pertains  to  a non-specific  sore  throat. 

3.  The  tongue  becomes  red  and  dry  much  sooner  and  more  papil- 
lary than  in  septic  fever. 

4.  The  rash  rarely  appears  until  after  the  abortive  act  is  com- 
pleted, so  far  as  the  loss  of  the  embryo  is  concerned,  but  appears 
earlier  than  the  rash  of  septic  infection  would  declare  itself. 

5.  The  rash  or  skin  discoloration  is  a different  rash  and  closely 
examined  is  found  more  diffused  and  miliary  in  character  which  is 
not  true  of  septic  staining  of  the  skin. 

II. — As  declaring  itself  in  the  puerperal  state.  * 

If  the  exposure  to  scarlet  fever  occurs  in  the  later  months  of  ges- 
tation, the  infection  may  remain  and  is  prone  to  remain  a latent, 
dormant  force  until  labor  at  full  term  is  declared  and  completed, 


SCARLATINA  IN  GESTATIVE  AND  PUERPERAL  STATES.  665 


but  immediately  thereafter  will  burst  forth  in  form  of  a declared 
puerperal  scarlet  fever.  This  incubation  may  have  an  extension 
back  away  to  the  seventh  and  a half  and  even  to  the  seventh  month, 
and  give  no  evidence  whatever  of  itself  for  this  protracted  period,  as 
has  occurred  in  a case  of  recent  experience  of  mine.  The  mother 
had  been  called  upon  by  a neighboring  friend  at  this  date  of  her 
gestation,  whose  sister,  very  ill  with  scarlet  fever,  she  had  visited 
and  nursed.  This  was,  in  her  case,  the  only  possible  source  of  in- 
fection, as  was  determined  by  the  most  searching  inquiry.  For 
nearly  two  months  the  infecting  virus  had  remained  in  dormant  in- 
cubation and  manifested  its  true  character  not  until  twelve  hours 
after  delivery,  when  there  was  first  noticeable  a rash  on  the  mother’s 
face,  which  gradually  extended  to  her  neck  and  throat,  arms,  wrists 
and  back  of  hands,  and  in  twenty-four  hours  the  entire  body  be- 
came stained  with  the  rash.  The  fever  was  inaugurated  with  the 
rash  and  intensified  with  its  extension,  carrying  the  temperature  to 
104t5q°  Fahr.  in  twenty-four  hours,  with  all  its  ordinary  phenomena. 
No  anginal  symptoms  appeared.  The  itching  and  burning  of  the 
skin  was  extreme.  Her  lochia  became  exceedingly  tainted;  her 
milk  fully  formed  but  rapidly  disappeared,  though  partially  re- 
turned after  established  convalescence  which  took  place  at  the  expi- 
ration of  the  middle  of  the  second  week.  On  the  morning  of  the 
second  day  her  babe,  fair  of  skin  at  birth,  showed  the  same  rash 
phenomena  with  the  mother,  and  became  covered  from  head  to  foot ; 
its  fever  gradually  increased  as  the  rash  progressed.  The  babe  sur- 
vived and  became  convalescent  soon  after  the  mother’s  restoration  to 
normal  temperature.  The  exfoliation  in  the  two  cases  exceeded  any- 
thing I had  ever  before  seen. 

The  problematic  question  in  this  case  was,  what  was  this  fever? 
Was  it  septic  or  zymotic?  Here  was  a woman  apparently  perfectly 
well  at  the  close  of  her  gestation,  and  whose  labor  was  primiparous 
and  every  way  natural,  at  the  end  of  twelve  hours  gave  evidence  of 
febrile  symptoms  and  whose  face  showed  stains  of  rash,  and  at  the 
end  of  thirty-six  hours  carried  a temperature  of  104T57P  Fahr., 
whose  lochia  became  checked  and  very  offensive  and  whose  breasts 
collapsed  with  entire  loss  of  milk.  Anxiety  and  alarm  gathered 
around  the  case,  and  the  matter  of  diagnosis  as  well  as  prognosis 
became  serious  and  embarrassing.  Reliance  was  put  upon  the  diag- 
nostic points  before  made,  but  one  of  the  factors  was  wanting. 


666 


world’s  homoeopathic  congress. 


There  had  been  no  conscious  exposure.  Not  until  several  days  after 
the  case  had  been  designated  scarlatina,  were  the  facts  recalled  of  the 
neighbor  friend’s  ill-timed  visit,  while  nursing  her  sister,  very  ill 
with  the  malady.  This  at  once  poured  a flood  of  light  upon  the 
case  and  removed  all  ambiguity. 

One  object  of  this  brief  paper  is  to  awaken  a caution  which  I am 
convinced  has  been  too  little  heeded  by  the  profession  at  large,  as  to 
the  exposure  of  the  gestative  woman  to  this  very  common  zymotic 
malady,  freighted  as  it  is  with  such  grave  suffering,  such  embarrass- 
ing problems  of  aetiology  and  diagnosis  and  such  imperiling  possi- 
bilities both  to  the  mother  and  her  embryo  or  child.  Against  any 
such  exposure  the  gestative  woman  should  be  guarded  to  the  limit 
of  every  possibility. 

Another  object  is  to  bring  into  prominence  the  surprising  possi- 
bility of  so  protracted  and  so  dormant  incubation  of  the  infecting 
virus,  as  the  full  appreciation  of  this  possibility  may  furnish  a key 
to  some  puerperal  histories,  that  carried  to  their  isssue,  whether  of 
resolution  or  death,  unsettled  questions  as  to  their  exact  character. 

Another  object  is  to  elicit  expressions  of  opinion  with  the  view  of 
determining  what  shall  be  regarded  as  indisputable  diagnostic  evi- 
dence by  which  we  can  unerringly  differentiate  between  the  rash  of 
true  scarlatina  as  affecting  the  gestative  and  puerperal  states,  and  the 
rash  that  is  contingent  upon  septic  poison. 


THE  HABITUAL  DEATH  OF  THE  FCETUS  IN  UTERO.  667 


THE  HABITUAL  DEATH  OF  THE  FCETUS  IN  UTERO. 

By  E.  S.  Bailey,  M.D.,  Chicago,  III. 


Mrs. , age  twenty-eight  years,  American,  large  and  strong, 

came  to  my  clinic  February,  1893,  and  asked  this  question : “ Why 
is  it  that  I cannot  give  birth  to  a living  child?”  The  history  she 
gave  was  as  follows:  She  had  been  married  eight  years;  had  always 
had  perfect  health,  never  having  employed  a physician  except  as  an 
accoucheur;  never  had  taken  any  medicine,  and  says  that  she  is  in 
perfect  health  now.  Except  at  confinements  she  had  never  been  ill, 
and  had  recovered  promptly  and  perfectly  from  four  labors.  She 
looked  the  picture  of  health,  but  her  misfortune  had  caused  a deep 
melancholy.  She  returned  three  times,  and  with  all  the  quizzing  I 
could  give  or  examinations  I could  make,  I could  not  find  any  cause 
for  her  unnatural  labors. 

Turning  my  attention  to  the  possibility  of  the  husband’s  health 
as  a factor  in  the  child’s  death,  I could  not  discover  that  he  had  ever 
had  any  disease  that  could  have  accounted  for  parental  influence 
causing  immature  children.  In  detail,  let  me  say  that  the  mother 
had  conceived  and  carried  without  inconvenience,  up  to  the  time  of 
the  foetal  death,  in  a perfectly  natural  manner.  She  never  had  shown 
a sign  of:  1.  Syphilis;  2.  Anaemia;  3.  Uterine  disease  or  of  any 
of  its  appendages ; 4.  Uterine  displacement;  5.  Cellulitis  or  perito- 
nitis; 6.  Laceration  of  the  cervix;  7.  Fevers;  8.  Chorea;  9.  Bright’s 
disease;  10.  Tumors;  11.  Poisoning  from  lead,  arsenic,  etc.;  12. 
Icterus  or  liver  diseases;  13.  Traumatisms;  14.  Overwork;  15. 
Reflexes,  as  headaches,  nausea;  16.  Intemperance;  17.  Narcotics 
or  opiates;  18.  Heredity  did  not^influence  her  case,  as  all  of  her 
sisters  are  mothers;  19.  Abortions  at  an  early  date;  20.  Kidney 
lesions,  non -inflammatory.  Any  one  of  these  causes  have  been 
deemed  sufficient  to  cause  foetal  death. 

On  the  husband’s  side,  he  had  never  suspicioned  that  he  had  in 
any  way  had:  1.  Syphilis;  2.  Nephritis;  3.  Diabetes;  4.  Phthisis; 


668 


world’s  homceopathic  congress. 


5.  Cancer;  6.  He  was  in  the  prime  of  life,  never  had  beeil  intem- 
perate ; 7.  No  eruptive  diseases ; 8.  Brothers  were  fathers ; 9.  No 
malaria;  10.  No  tobacco  or  lead  poisoning.  In  fact,  it  was  difficult 
to  obtain  a single  clue  to  any  physical  defect  through  indiscretions  or 
disease. 

We  next  turned  attention  to  the  cause  of  death  of  the  foetus,  as 
each  miscarriage  was  due  to  the  presence  of  a dead  foetus  in  utero. 
The  first  child  she  carried  during  eight  months  of  gestation.  When 
born,  it  had  been  dead  several  days.  The  second  child  was  born  at 
the  fifth  month,  the  third  at  the  seventh  month,  and  the  fourth  at 
the  eighth  month.  All  the  children  seemed  perfectly  formed,  were 
not  macerated,  and,  so  far  as  the  patient  could  tell,  there  were  never 
any  marks  of  syphilis.  Once  the  attending  physician  said  that  there 
was  something  the  matter  with  the  cord,  but  she  never  had  any  ex- 
planation given  her,  and  renewed  the  question  fervently:  “Why  can 
I not  have  a living  child?” 

These  cases,  so  far  as  the  aggregate  in  literature  is  concerned,  are 
not  especially  rare,  but  they  do  not  occur  frequently  in  individual 
practice.  Each  practitioner  could  probably  narrate  one  or  more 
cases,  but  taken  as  a class  of  cases  they  are  rare.  Two  perti- 
nent questions  arise  here  : What  are  the  causes  ? What  can  be 
done? 

The  answer  to  the  first  question,  as  found  in  the  recent  literature, 
is  very  briefly  condensed  in  the  following  list  of  causes  of  death  of 
the  foetus  : A.  The  premature  detachment  of  the  placenta — 1.  Through 
traumatism;  2.  Violent  exertions ; 3.  Infective  fevers;  4.  Nephri- 
tis. B.  Diseases  of  the  placenta — 1.  Syphilitic;  2.  Infective  fevers; 
3.  Tuberculosis;  4.  Apoplexy;  5.  Infarct;  6.  Torsions;  7.  Inflam- 
matory changes;  8.  Fibrous  bands.  C.  Diseases  of  the  foetus — 1. 
Torsion  of  the  cord;  2.  Obliteration  of  the  bloodvessels  of  the  cord; 
3.  Partial  or  incomplete  development  of  the  cord  ; 4.  Irregularities 
or  abnormalities  in  its  placental  attachments;  5.  Thrombus;  6- 
Mummified  fibrous  cords;  7.  Fatty  degeneration  of  the  cotyledons. 

What  can  be  done?  The  ansvfcr  is  plain.  The  majority  of  these 
cases  will  trace  out  to  be  either  syphilitic  or  else  to  be  accounted  for 
by  the  velamenatous  insertion  of  the  cord.  The  former  is  recognized 
best  by  microscopical  examination.  This  examination  should  be 
made  immediately  after  the  expulsion  of  the  placenta.  The  presence 
of  gumma  or  syphilitic  nodules  is  the  true  test.  Fraencle  has  never 


THE  HABITUAL  DEATH  OF  THE  FCETUS  IN  UTERO.  669 


been  able  to  demonstrate  syphilis  of  the  placenta  earlier  than  the 
sixth  month. 

The  marginal  attachment  of  the  cord  and  the  white  infarct  of  the 
placenta  or  the  various  torsions  are  beyond  the  power  of  the  diag- 
nostician or  of  any  form  of  medical  interference.  In  the  cases 
where  the  lesion  exists,  as  in  the  nerve-centres  or  circulatory  system, 
hygienic  conditions  and  constitutional  treatment  is  the  only  form  of 
treatment  that  promises  any  measure  of  success.  In  the  cases  similar 
to  the  one  I refer  to,  there  being  no  lesions,  I would  try  the  treat- 
ment usually  known  as  the  anti-syphilitic,  using  Mer.  cor.,  6x  trit., 
once  daily  for  some  months. 

In  case  the  lesion  is  syphilitic,  repeated  pregnancies  have  been 
known  to  have  the  effect  of  elimination,  and  the  mother  may  finally 
give  birth  to  a child  viable  and  full  of  promise. 

I have  condensed  my  paper  to  a mere  outline,  but  as  there  is  little 
likelihood  of  a discussion,  it  will  not  have  taken  long  to  have  men- 
tioned the  outlines  of  this  subject. 

Discussion. 

Dr.  Ludlam  : Ladies  and  Gentlemen,  I inquired  of  the  profes- 
sor whether  my  colleague  mentioned  mental  shock  as  a cause  of 
abortion.  We  all  know,  I think,  that  this  is  a cause.  There  is  such 
a long  list  of  causes  he  overlooked  this,  I think.  Mental  shock 
often  induces  this  result,  but  that  there  are  causes  that  might  acci- 
dentally have  the  effect  there  is  no  doubt.  Dr.  Bailey’s  subject  is, 
however,  as  I understand  it,  the  habitual  abortion  that  occurs  over 
and  over  again  in  the  same  patient.  The  impossibility  of  the  woman, 
such  as  he  cited,  giving  birth  to  a living  child — the  affliction  which 
she  must  undergo  under  those  circumstances  in  not  becoming  a 
mother — is  surely  terrible.  Surely,  if  there  is  anything  we  can  do 
in  such  a case  or  anything  we  can  suggest  as  a means  of  preventing 
such  an  experience,  we  ought  to  study  such  a question  very  care- 
fully. For  my  part,  I think  there  are  times  in  cases  not  having 
gone  quite  so  tar  as  these  where  I have  induced  early  labor,  and  the 
mothers  have  been  blessed  with  living  children.  I suggest  that  we 
might  think  of  this  thing  a little  oftener  than,  perhaps,  we  have 
been  inclined  to  do,  because  it  is  expedient  and  is  more  justifiable 
now  than  it  ever  was  before. 

Dr.  Foster:  I would  like  to  offer  a suggestion  or  two  with  ref- 
erence to  such  a case.  It  would  seem  that  all  of  the  well-known 
causes  of  the  death  of  the  child  in  utero  have  been  pretty  well  con- 
sidered, and  were  well  considered,  I think,  in  the  paper  read  by  Dr. 
Bailey. 


670 


world’s  homoeopathic  congress. 


There  is  another  possible  cause,  however,  to  which  I would  like 
to  call  attention.  Perhaps  it  might  be  valuable.  Perhaps  I might 
put  it  in  this  way:  I would  say  that  the  woman  would,  perhaps, 
have  a better  chance  of  giving  birth  to  a living  child  if  she  had  an- 
other husband.  There  have  been  such  instances  on  record.  Where 
either  parent  is  not  fruitful,  he  or  she  is  likely  to  be  in  a subsequent 
marriage.  We  see  a similar  state  of  facts  oftentimes  in  the  vegeta- 
ble world,  where  we  will  find  a little  piece  of  ground  that  will 
always  faii  to  ripen  its  fruit.  It  will  permit  a certain  kind  of  fruit 
to  grow  until  before  it  has  reached  maturity.  Other  kinds  of  fruit 
it  will  mature.  I am  under  the  impression  that  this  case  of  Dr. 
Bailey’s  comes  somewhere  in  that  line. 

Arthur  Fisher,  M.D.,  Montreal,  Can. : To  me  there  would  be 
a suspicion  of  constitutional  conditions,  and  if  I could  not  do  any- 
thing else,  I would  be  strongly  inclined  to  treat  with  sulphur  and 
perhaps  with  other  remedies. 


THE  LEVATOR  ANI  AS  RELATED  TO  PARTURITION.  671 


THE  LEVATOR  ANI  AS  RELATED  TO  PARTURITION. 

By  Henry  Edwin  Spalding,  M.D.,  Boston,  Mass. 

There  seems  to  be  a general  misconception  concerning  the  ana- 
tomical structure  and  functions  of  the  normal  levator  ani,  and  little 
appreciation  of  the  influence  it  may  exert  on  child-birth,  and  of  the 
accidents  to  which  it  is  liable. 

Being  generally  disregarded  when  normal  in  character,  it  natu- 
rally follows  that  it  is  often  overlooked  when  abnormally  developed, 
and  the  evil  consequences  resulting  from  its  injury  not  generally 
understood. 

Enclosing,  as  it  so  nearly  does,  supplemented  by  the  coccygeus, 
the  pelvic  outlet,  it  has  been  called  “ the  diaphragm  of  the 
pelvis.” 

In  most  cases  it  is  so  thin  as  to  be  nearly  membranous,  its  fibres 
being  arranged  in  flat  bundles,  loosely  held  togsther,  with  here  and 
there  spaces  filled  with  fat  and  connective  tissue.  This  peculiarity 
of  structure  adapts  it  most  favorably  to  bear  the  strain  and  disten- 
sion incident  to  child-birth. 

The  levator  ani  has  its  origin  in  part  from  the  bones  and  in  part 
from  the  fascia  of  the  pelvis.  Of  those  portions  having  a bony 
origin  the  larger  and  more  important  is  that  coming  from  the  hori- 
zontal ramus  of  the  pubes.  This  portion,  moreover,  most  interests 
us  as  obstetricians. 

The  anterior  edges  of  this  muscle  do  not  meet  at  the  symphysis, 
but  are  separated  by  a space  of  about  an  inch.  The  portion  arising 
from  the  pubes  is,  at  its  point  of  origin,  about  one  and  one-half 
inches  wide,  and  its  insertion  is  about  one  and  one-fourth  inches 
below  the  upper  border  of  the  ramus. 

This  bundle  of  fibres  is  much  thicker  than  the  rest  of  the  levator, 
and  its  edges  are  so  thickened  and  rounded  as  to  itself  resemble,  to 
the  touch,  two  independent  bundles  of  fibres.  In  some  cases  it  be- 
comes so  hypertrophied  as  to  give  rise  to  severe  vaginismus  and  dys- 


672 


world’s  homceopathic  congress. 


tocia.  Following  the  origin  backward  from  the  pubic  ramus  it  is 
found  to  arise  from  a crescentic-shaped  line  of  fascia  extending  to 
the  ischial  spine,  whence  arises  that  smaller  portion  which  has  a 
bony  origin.  The  portion  arising  from  this  curved  line  of  fascial 
origin  is  strengthened  by  the  pelvic  fasciae,  the  tendinous  fibres 
of  which  are  flattened  and  spread  out  upon  both  its  upper  and  under 
surfaces. 

The  course  of  this  muscle  is  downward  and  backward,  and,  ex- 
cept a small  bundle  of  fibres,  extends  back  of  the  rectum.  That 
which  passes  anterior  to  the  rectum  is  a bundle  of  fibres  only  a few 
lines  wide.  It  has  its  origin  at  that  point  of  pubic  attachment 
farthest  from  the  symphysis,  and,  crossing  the  larger  belly  of  mus- 
cle in  a diagonal  direction,  is  lost  in  the  recto-vaginal  septum  about 
half  an  inch  from  the  anus. 

While  usually  in  women  this  portion  of  the  muscle  is  quite  small, 
in  some  instances  it  is  markedly  strong  and  hypertrophied,  as  may 
be  proved  by  careful  recto-vaginal  examination.  With  the  excep- 
tion of  this  bundle  of  fibres,  that  portion  arising  from  the  pubes, 
which,  as  we  have  said,  is  the  largest,  extends  as  one  continuous  strip 
of  muscular  tissue  from  its  origin  on  the  ramus  of  one  side  down 
alongside  the  vagina,  to  which  it  is  attached  by  strong  connective 
tissue  and  by  an  interweaving  with  some  of  the  longitudinal  mus- 
cular fibres  of  the  vagina  around  the  back  of  the  rectum  to  its  point 
of  attachment  on  the  ramus  of  the  other  side.  Some  of  its  fibres 
are  interwoven  with  the  longitudinal  fibres  of  the  rectum,  but,  as  in 
the  walls  of  the  vagina,  they  do  not  lose  their  identity.  This  band 
is  intimately  connected  with  the  sphincter  ani,  some  fibres  crossing 
or  interweaving  with  some  of  the  sphincter  fibres,  which  are  inserted 
into  the  dorsal  surface  of  the  coccyx.  As  the  muscle  spreads  out 
towards  the  coccyx  its  bundles  become  flatter  and  thinner.  It  hugs 
the  concavity  of  the  curve-end  of  the  rectum  and  supports  it  from 
below.  The  middle  portion  joins  its  fellow  by  aponeurosis  at  the 
point  of  the  coccyx.  The  smallest  and  posterior  portion  is  fixed  by 
tendinous  attachment  to  the  fourth  coccygeal  vertebra. 

The  functions  of  the  levator  are  primarily  to  aid  in  defecation. 
In  woman,  however,  it  has  other  functions.  It  draws  the  anus 
and  posterior  wall  of  the  vagina  towards  the  symphysis,  and  during 
coitus,  as  a vaginal  constrictor,  presses  the  penis  firmly  against  the 
os  tincse. 


THE  LEVATOR  ANI  AS  RELATED  TO  PARTURITION. 


673 


In  strength  it  varies  greatly,  it  being  found  strongest  in  women 
of  strong  muscular  build,  of  erotic  disposition,  with  wide  pelves, 
and  in  those  suffering  from  painful  lesions  around  the  vulva  and 
anus. 

By  careful  experiment  the  average  lifting  power  has  been  found 
to  be  ten  pounds,  while  in  some  it  is  as  high  as  twenty-seven  pounds. 
There  are  reported  instances  of  tonic  spasm  of  ihe  muscle  during 
copulation  so  strong  as  to  require  anaesthesia  for  the  release  of  the 
imprisoned  penis. 

This  abnormal  development  and  increased  strength  of  the  levator 
is  not  infrequently  called  upon  to  compensate  for  other  defects.  A 
woman  past  eighty  years,  while  ill  from  other  troubles,  complained 
of  piles.  Much  to  my  surprise  I found  a complete  laceration  of  the 
perinseum.  I had  known  her  for  fifteen  years  as  a remarkably  smart 
and  robust  old  lady.  She  had  borne  several  children,  and  I could 
not  learn  that  she  had  ever  suffered  from  uterine  trouble  or  inconti- 
nence of  faeces.  The  womb  was  certainly  then  in  normal  position. 
The  levator  was  very  strong,  and  so  contracted  as  to  draw  the  anus 
well  forwards  towards  the  symphysis,  thus  perfectly  compensating, 
as  far  as  support  to  the  vaginal  walls  and  womb  were  concerned,  for 
the  destroyed  perinseum;  and  what  seems  more  remarkable,  had 
so  closed  the  anus  that  the  loss  of  the  sphincter  had  caused  no  in- 
convenience. 

Not  long  since  I examined  a patient  with  perinseum  gone  to  the 
sphincter;  she  had  suffered  nothing  from  want  of  support  to  the 
organs  above.  As  in  the  former  case,  the  strong  levator  had  so 
drawn  the  anus  forwards  as  to  form  a substitute  for  the  perinseum. 
Whether  a rectal  polypus  has  been  a constant  whip  to  keep  the  lev- 
ator in  a state  of  contraction  cannot  be  said.  Only  lapse  of  time — - 
now  that  the  polypus  has  been  removed — can  answer,  which  it  will 
have  a chance  to  do,  since  she  can  see  no  necessity  for  having  the 
perinseum  restored. 

In  ordinary  cases  its  dystotic  power,  when  it  is  not  abnormally 
strong  from  hypertrophy,  may  not  seem  very  great. 

Physiological  relaxation,  paralysis  from  continued  tension  and 
from  compression  all  tend  to  reduce  its  opposing  power  to  the  mini- 
mum. A careful  comparison  of  the  levator,  reinforced,  as  it  is  by 
firm  fascise,  with  the  diaphragm,  will  show  that  its  average  resisting 
power  is  not  inconsiderable. 


43 


674 


world’s  homoeopathic  congress. 


As  before  stated,  however,  we  not  infrequently  find  the  levator 
greatly  strengthened  by  hypertrophy.  This  is  most  marked  in  the 
anterior  portion  that  has  its  origin  from  the  rami  of  the  pubes  and 
exerts  the  most  power  in  drawing  the  anus  and  vagina  forward 
towards  the  pubes.  The  hypertrophy  may,  however,  involve  the 
entire  muscle  or  only  independent  portions  of  or  bands  of  fibres. 

It  is  claimed  that  the  levator  ani  usually  becomes  hypertrophied 
during  pregnancy.  Painful  lesions  in  the  anus,  like  piles  and  fis- 
sures— which  are  so  frequent  a complication  of  pregnancy — tend  to 
keep  the  muscle  in  a state  of  active  contraction,  which  is  promotive 
of  hypertrophy.  This  condition  of  the  anus,  irritated  by  the  press- 
ure* from  the  approaching  part,  may  set  up  a tonic  contraction  of  the 
levator.  Not  infrequently  labor  progresses  naturally,  with  promise 
of  a speedy  delivery,  until  the  presenting  part  comes  in  contact  with 
the  floor  of  the  pelvis — in  other  words,  with  the  levator  ani.  Pain 
succeeds  pain,  each  causing  the  presenting  part  to  press  firmly  upon 
the  opposing  tissues;  but  in  the  interval  between  the  pains  it  recedes 
to  its  former  position,  no  advance  being  made.  The  muscles  of 
propulsion,  already  wearied  by  long-continued  effort,  meet  a fresh 
and  untried  opponent.  The  naturally  stronger  yields,  through 
fatigue,  to  the  weaker.  The  pains  lessen  in  force  and  frequency. 
Longer  delay  places  the  life  of  the  child  in  jeopardy,  and  the  hot, 
dry  vagina,  quick  pulse,  wearied  yet  anxious  face  of  the  mother  call 
loudly  for  her  relief.  Now,  or  even  before  this  extreme  condition 
has  been  reached,  the  very  short  forceps  (Hale’s)  are  most  useful. 
Being  small,  with  almost  no  shank  between  the  blade  and  handle, 
they  can  be  easily  adjusted  and  often  without  the  knowledge  of  the 
patient.  Then,  if  just  sufficient  traction  be  applied  to  prevent  the 
presenting  head  from  receding  in  the  intervals  between  the  pains, 
the  levator  is  kept  in  a state  of  continued  tension,  with  such  paralyz- 
ing effect  as  to  soon  cause  it  to  lose  its  power  of  resistance,  and  the 
delivery  is  accomplished  easily. 

If,  however,  hasty  delivery  be  demanded,  anaesthesia  should  be 
carried  to  the  surgical  degree,  in  order  to  produce  complete  relaxa- 
tion of  the  muscle  and  avoid  rupture. 

In  case  the  anus  be  sensitive  and  painful,  from  fissures  or  ulcers, 
complete  anaesthesia  is  of  vital  importance;  for, as  all  rectal  surgeons 
know,  putting  a sensitive  anus  on  stretch  will  arouse  violent  reflex 
muscular  action,  which  can  only  be  overcome  by  complete  anaesthe- 


THE  LEVATOR  ANI  A&  RELATED  TO  PARTURITION.  675 


sia.  If  this  precaution  be  not  observed,  the  levator,  being  in  a 
state  of  tonic  contraction,  delivery  will  most  likely  be  accomplished 
with  a rupture  of  the  perinseum  and  some  portion  of  the  levator  ani. 

A strong  and  contracting  levator  is  responsible  for  many  cases  of 
detention  of  the  after-coming  head.  The  body  having  been  deliv- 
ered, the  muscle  contracts  around  the  neck,  retaining  the  head,  to 
the  extreme  hazard  of  the  child. 

Budin  reports  a case.  The  body  was  delivered,  after  much  delay, 
by  the  aid  of  Ergot,  traction  and  expressio-foetus.  Forceps  finally 
delivered  the  head  without  lacerating  the  perinseum,  but  the  levator 
was  badly  torn.  No  sutures  wTere  used,  and  the  result  was  entire 
loss  of  power  in  the  levator  muscle. 

Cases  of  most  aggravated  obstruction  have  been  reported  as  the 
result  of  extreme  thickening  and  shortening  of  the  levator. 

Benicke  reports  a case  where  &uch  muscular  changes  had  taken 
place,  as  the  result  of  long-continued  vaginismus  and  contraction, 
that  forceps,  under  chloroform,  were  unavailing,  and  craniotomy 
was  resorted  to.  Cases  of  this  kind  must  be  rare. 

The  levator  may  present  abnormalities  in  the  shape  of  irregular 
thickening  of  the  muscles,  presenting  constrictions  like  tendinous 
bands. 

Revillout  speaks  of  a case  where  a ring  or  bridle  was  found  within 
the  vagina  which  prevented  the  application  of  forceps.  Believing 
the  obstruction  to  be  a band  of  cicatricial  tissue,  it  was  incised.  The 
autopsy  showed  that  it  was  the  levator.  She  had  suffered  from  ex- 
treme vaginismus. 

A case,  unique,  as  far  as  I can  learn,  occurred  in  my  practice. 

Mrs.  S , age  39;  primipara.  Just  within  the  vagina  was  one, 

and  a little  farther  up  a second  sharply-defined,  constricting  cord. 
They  were  like  two  puckering  strings,  firm  and  unyielding.  The 
vagina  seemed  gathered  in  folds  upon  them,  but  otherwise  normal 
in  texture  and  yielding.  Digital  examination  was  not  only  painful 
to  the  patient,  but  made  her  peculiarly  nervous.  The  constriction 
was  not  so  great  as  to  in  the  least  interfere  with  the  introduction  of 
the  finger,  but  even  slight  pressure  upon  those  constricting  bands 
was  unbearable.  Other  than  this,  labor  progressed  normally  until 
the  head  entered  the  pelvic  canal  and  began  to  press  upon  the  upper 
constricting  band,  when,  in  the  midst  of  a pain,  without  warning 
she  went  into  a violent  convulsion.  With  the  aid  of  ether  and  for. 


676 


WORLD  S HOMCEOPATHrC  CONGRESS. 


ceps  the  delivery  was  speedily  accomplished,  with  no  subsequent 
convulsions.  The  perinaeum  was  ruptured  to  the  anus,  the  irregular 
tear  extending  up  the  vagina  past  the  site  of  the  upper  ring.  Su- 
tures were  used,  but  how  near  the  repair  put  the  parts  in  a normal 
condition  I cannot  say,  never  having  her  under  my  care  since.  Some 
two  years  afterwards,  in  a distant  city,  she  was  delivered  of  a still- 
born child,  after  a hard  labor,  but  without  any  convulsions. 

Lesions  of  the  levator  are  of  frequent  occurrence,  and  are  often 
overlooked  at  the  time,  since  they  are  within  the  vaginal  canal,  and 
the  cutaneous  perinaeum  may  show  no  signs  of  injury,  or  the  lacera- 
tion may  extend  through  the  perinaeum  and  up  the  vaginal  canal. 
A careful  examination  will  show  that  beyond  the  perinaeum  the 
laceration  is  more  or  less  ragged  and  irregular  and  deflects  to  the 
right  or  left  of  the  median  line.  When  we  consider  how  the  levator 
is  reinforced  by  the  intervening  rectal  walls  and  the  peculiar  inter- 
weaving of  the  longitudinal  rectal  muscular  fibres  with  portions  of 
the  levator,  we  see  that  the  most  vulnerable  part  of  the  levator  must 
be  just  before  it  reaches  this  adjunct  of  strength. 

This  fact  makes  repair  less  liable  to  be  perfect,  as  the  deep  sulci 
so  often  found  on  one  or  other  latero-posterior  vaginal  wall  proves. 
In  fact,  except  the  band  of  fibres — unusually  small  and  unimport- 
ant— that  crosses  diagonally  the  larger  belly  of  the  levator  arising 
from  the  pubic  ramus,  it  is  anatomically  self-evident  that  the  levator 
will  not  be  torn  at  the  median  line.  The  torn  muscle  retracts,  and 
if  discovered  at  the  time  of  injury,  it  is  not  an  easy  matter  to  so 
close  the  wound  as  to  bring  the  ends  of  the  lacerated  muscle  in  per- 
fect adaptation,  which  certainly  should  be  done.  If  neglected,  we 
have  a pocket  for  the  collecting  of  septic  matter,  which  even  the 
free  use  of  the  vaginal  douche  may  not  remove.  If  .left  to  heal  by 
slow  granulation,  it  is  usually  with  a partial  or  complete  loss  of 
power  in  the  levator.  Sometimes  there  remains  a cicatrix  that  is 
specially  sensitive,  some  nerve  filament  being  so  incarcerated  in  it 
as  to  be  in  a constantly  sensitive  condition.  This  may  be  revealed 
to  the  patient  and  physician  only  by  the  educated  touch  of  the  ex- 
amining finger,  while  it  may  have  been  a nidus,  from  whence  had 
radiated  neurotic  and  other  troubles  for  months  and  years. 

Often,  we  believe,  there  is  a concealed  submucous  laceration.  There 
being  no  break  of  continuity  in  the  mucous  surface,  the  injury  is 
only  discovered  by  the  sulcus  caused  by  the  retracted  ends  of  mus- 
cles, and  by  the  impaired  function. 


THE  LEVATOR  ANI  AS  RELATED  TO  PARTURITION.  677 


Not  infrequently  in  suturing  a lacerated  perinseum  at  the  time  of 
accident  the  wound  is  not  brought  together  evenly  and  the  torn 
muscle  is  distorted  from  its  normal  line.  The  circumstances  attend- 
ing the  case  and  the  absence  of  efficient  assistants  makes  this  result, 
while  to  be  deplored,  in  a degree  excusable  as  far  as  the  medical 
attendant  is  concerned,  and  the  wonder  only  is,  that  the  results  are 
generally  so  good.  The  gynaecologist  must  often  come  in  and  undo 
what  has  been  imperfectly  done. 

Mrs. , primipara,  as  the  result  of  a tedious  and  difficult  deli- 

very, had  complete  rupture  of  the  perinaeum  and  a portion  of  the 
recto-vaginal  septum.  Stitches  were  immediately  inserted.  For  a 
few  months  there  was  a constant  sense  of  pulling  in  the  parts,  especi- 
ally in  walking  and  in  sitting  down  or  rising  from  a chair.  This 
she  came  to  notice  less  and  less.  Haemorrhoids  developed.  Defeca- 
tion was  somewhat  difficult  and  attended  by  discomfort  in  the  anus. 
At  the  end  of  ten  months  coitus  had  become  very  painful  and  was 
soon  unbearable.  Nervous  hysterical  symptoms  began  to  show 
themselves,  and  at  the  end  of  sixteen  months  from  the  date  of  deli- 
very, when  she  came  into  my  hands,  she  was  physically  and  mentally 
in  a most  miserable  condition. 

Physical  Examination. — Externally  the  perinjeum  seemed  fairly 
well  restored  with  the  exception  that  the  vaginal  commissure  was 
drawn  to  the  right  of  the  median  line.  Pressure  near  the  anus  and 
near  the  os  vagina  caused  a sharp  lancinating  pain.  Within  the 
vagina  the  perineal  wall  was  a hard  uneven  cicatrical  mass.  A line 
of  firm  tissue,  tensely  drawn,  extended  from  the  right  anterior  to  the 
left  posterior  wall  of  the  vagina,  and  was  there  incorporated  in  the 
cicatrix.  It  was  evidently  a portion  of  the  levator  ani,  that  in  the 
suturing  of  the  ragged  wound  had  become  misadjusted.  It  caused 
a partial  occlusion  of  the  vagina,  and  by  constant  traction  upon  the 
left  vaginal  wall  produced  a deviation  of  the  commissure  to  the 
right.  Pressure  upon  it  caused  a sharp  pain  to  extend  upwards  into 
the  pelvis  and  a sickening  feeling  in  the  epigastrium.  There  was  a 
stricture  of  the  anus,  the  anterior  wall  being  hard  cicatrical  tissue. 
There  was  subinvolution,  but  otherwise  the  uterus  was  in  a normal 
condition. 

Operation. — I dissected  out  the  vaginal  cicatrix,  thoroughly  releas- 
ing the  misadjusted  muscle.  Removed  sufficient  mucous  membrane 
so  that  when  the  raw  surfaces  were  coaptated  the  normal  wedge- 


678 


world’s  homoeopathic  congress. 


shaped  body  of  the  perinseum  would  be  restored.  The  mucous 
membranes  of  the  opposing  sides  were  united  with  a continuous  catgut 
suture,  and  the  denuded  surfaces  were  held  in  apposition  by  two 
deep  catgut  sutures  within  the  vagina,  and  one  silver  suture  intro- 
duced from  the  perineal  surface  and  encompassing  the  whole  field  of 
operation. 

The  anus  was  dilated,  the  cicatrix  removed  and  the  healthy 
mucous  membrane  dissected  up  like  a crescentic-shaped  pocket,  the 
deepest  portion  being  about  an  inch,  and  but  little  at  its  juncture 
with  the  integument  on  either  side  of  the  anus.  This  flap  of  mucous 
membrane  was  then  brought  down  over  the  site  of  the  removed 
cicatrix  and  sutured  to  the  integument.  The  result  has  proved 
satisfactory  to  patient  and  surgeon. 


A COMPARATIVE  STUDY  OF  OPERATIVE  PROCEDURES.  679 


A COMPARATIVE  STUDY  OF  THE  OPERATIVE  PRO- 
CEDURES APPLICABLE  TO  THE  COMMONER 
VARIETIES  AND  DEGREES  OF  PELVIC 
DEFORMITY . 

By  L.  L.  Danforth,  M.D.,  New  York  City. 


There  is  no  subject  in  the  whole  field  of  obstetrics  which  receives 
so  little  attention  in  our  Society  discussions  as  that  of  pelvic  deformi- 
ties. To  the  relative  infrequency  of  these  abnormalities  as  com- 
pared with  other  obstetrical  complications  may  be  attributed  the 
neglect  which  this  subject  receives.  Though  seldom  encountered 
in  practice,  we  are  not  justified  in  totally  neglecting  this  important 
branch  of  obstetrical  study. 

The  writer  has  endeavored  to  ascertain  the  frequency  of  pelvic 
deformity  in  lying-in  institutions  in  this  country,  wherever  statistics 
have  been  published,  and  as  a result  interesting  information  has  been 
obtained. 

In  a series  of  2127  cases  of  labor  in  the  out-patient  department  of 
the  Boston  Lying-in  Hospital,  Dr.  Edward  Reynolds*  found  22 
instances  of  pelvic  deformity,  and  in  100  cases  of  confinement  in  the 
wards  of  the  same  institution  five  cases  were  observed.  Dr.  James 
W.  McLane  reports  10  cases  in  the  first  100  cases  of  confinement  in 
the  Sloane  Maternity. 

In  3225  cases  of  confinement  attended  by  students  at  the  lying-in 
hospital  in  New  York  City,  during  the  first  three  years  of  its  exist- 
ence, in  only  one  instance  was  reduction  in  size  of  the  foetus  demanded 
on  account  of  a contracted  pelvis.  In  another,  premature  labor  was 
induced  on  account  of  a contraction  of  the  pelvis  in  all  its  diameters ; 
in  not  a single  instance  did  the  absolute  indication  for  Caesarean 
section  exist  from  any  cause.  Pelvimetry  is  systematically  employed 
by  the  students  of  this  school.  This  is  a remarkable  record,  and 


* Transactions , Am.  G^n.  Soc.,  1890. 


680 


WORLD  S HOMOEOPATHIC  CONGRESS. 


shows  a much  smaller  percentage  of  cases  of  pelvic  deformity  than 
is  generally  supposed  to  be  the  case.  Dr.  Edgar  states,  with  regard 
to  the  cases  (1154)  confined  during  the  first  two  years  in  their  lying- 
in  hospital,  in  not  a single  instance  did  a markedly  contracted  inlet 
exist.  He  does  not  say  that  there  were  no  cases  of  pelvic  contrac- 
tion to  the  minor  degrees,  and  it  is  not  assuming  too  much  to  sup- 
pose that  some  of  the  forcep  operations  and  cases  of  version  were 
performed  on  account  of  the  small  size  of  the  pelvis. 

In  250  cases  of  labor  in  private  and  consulting  practice  of  which 
the  writer  has  record,  there  were  three  cases  of  contracted  pelvis; 
one  simple  flat  pelvis  and  two  symmetrically  small  pelves.  The 
latter — the  justo-minor  pelvis — is  the  Variety  most  frequently  seen 
in  women  of  American  birth. 

Among  the  100  cases  in  the  wards  of  the  Boston  Hospital,  re- 
ferred to  in  Reynold’s  tables,  there  were  57  native  women  who  pre- 
sented one  case  of  pelvic  deformity,  and  that  of  a typical  justo-minor 
type,  the  percentage  of  1.75  per  cent,  being  almost  identical  with 
that  obtained  among  native  women  from  the  out-patient  department 
of  the  same  institution  and  the  obstetrical  department  of  the  Boston 
Dispensary,  which  was  1.6  per  cent.  In  contrast  to  this  the  remain- 
ing 43  foreign  women  yielded  four  examples  of  the  simple  flattened 
pelvis  (9.4  per  cent.)  and  no  justo-minor  pelvis. 

Among  Reynold’s  2127  women  of  all  classes,  10.3  per  cent,  pos- 
sessed contracted  pelves  of  one  variety  or  another.  Abroad,  the 
average  is  about  the  same.  Winckel  says:*  “After  all  pregnant 
and  parturient  women  were  carefully  examined  as  regards  their  pel- 
vic relations,  there  were  found,  among  1199  births,  115  women  with 
contracted  pelves  (9J  per  cent.),  a figure  which  coincides  exactly 
with  those  obtained  of  late  years  in  the  Werzburg  clinic  (8.10  per 
cent.),  and  approaches  closely  to  those  obtained  by  Michaelis  and 
Litzmann.” 

The  first  regular  pelvic  measurements  were  made  in  1840-1847 
by  Michaelis,  of  Kiel,  who  found  in  1000  parturients  131  cases  of 
narrow  pelvis  (10.3  per  cent.). 

Litzmann  (1848-1886)  found  in  1000  parturients  149  (10.4  per 
cent.).  Subsequent  observers  up  to  Winckel’s  time  found  a much 
smaller  number  of  cases,  but  the  difference  is  undoubtedly  due  to 


* Text-Book  of  Midwifery , j».  451. 


A COMPARATIVE  STUDY  OF  OPERATIVE  PROCEDURES.  681 


the  fact  that  more  than  half  the  cases  of  slight  narrowing  were  not 
recognized  because  they  produced  no  difficulty  in  labor.  Winckel 
concludes  that  “ we  shall  not  go  too  far  in  making  the  statement  that 
contraction  of  the  pelvis  is  present  in  10  to  15  per  cent,  of  all  par- 
turient women,  but  that  usually  only  about  5 per  cent,  are  recog- 
nized even  in  clinical  institutions  on  account  of  the  effects  upon 
labor.”  This  would  seem  to  be  about  the  frequency  in  this  country 
if  we  include  all  classes.  Women  of  American  birth  are  undoubt- 
edly less  frequently  the  subjects  of  pelvic  narrowing  than  those  of 
foreign  birth.  Furthermore,  it  may  safely  be  concluded  than  an 
American  birth  decreases  the  amount  of  pelvic  deformity  among  the 
children  of  foreign  parents. 

The  predominance  of  the  rachitic  types  of  deformed  pelves,  char- 
acterized by  irregularities  in  shape  of  the  wThole  pelvis  and  especially 
by  flattening  of  the  inlet  by  undue  projection  of  the  promontory 
among  women  of  the  lower  classes  born  abroad,  is  probably  due 
to  insufficient  nourishment  and  hard  work  before  or  during  pu- 
berty. 

The  symmetrically  small  pelvis,  due  to  simple  arrest  of  develop- 
ment at  puberty  (a  partial  persistence  of  the  infantile  type),  is  the 
variety  generally  met  with  in  women  of  American  birth  and 
lineage,  and  is  due,  as  might  be  expected,  to  the  peculiar  char- 
acter and  habits  of  American  women  and  nineteenth-century  civili- 
zation. 

In  the  practice  of  midwifery,  the  following  questions  are  nowand 
then  presented  for  solution : 

1.  Is  there  any  external  evidence  or  anything  in  the  progress  of  a 
labor  in  its  early  stage  which  will  enable  one  to  suspect  the  presence 
of  a pelvic  deformity  ? 

2.  What  constitutes  pelvic  narrowing,  and  how  are  we  to  deter- 
mine that  such  a condition  really  exists  as  well  as  the  variety  and 
degree  of  the  deformity? 

3.  Is  it  possible  to  ascertain,  before  labor  sets  in,  the  relation  of  the 
presenting  part  of  the  child  to  the  narrowest  diameter  of  the  pelvis 
through  which  it  must  pass  to  accomplish  delivery? 

4.  Can  we  define,  with  any  degree  of  certainty,  the  limitations  of 
the  different  operative  procedures  by  an  approximate  estimate  of  the 
extent  of  the  narrowing? 

I shall  endeavor  to  answer  these  questions  seriatim : 


682 


world’s  homoeopath ic  congress. 


1.  With  regard  to  the  significance  of  physical  peculiarities  in 
pointing  out  the  possible  existence  of  pelvic  deformity. 

While  narrow  straight  hips  and  short  limbs  may  not  prove  to  be 
indicative  of  diminished  transverse  and  oblique  diameters,  the  fact 
that  such  peculiarities  of  shape  coexist  should  not  be  overlooked. 
As  Spielgelberg  says,*  when  he  emphasizes  the  importance  of 
making  pelvic  measurements:  “ Still,  the  other  circumstances  de- 
serve that  full  weight  be  given  them,  and  even  if  they  never 
afford  more  than  certain  points  d’appui , suggestive,  to  a certain  ex- 
tent, of  the  direction  in  which  measurements  should  especially  be 
made,  they  nevertheless  assist  in  deciding  the  best  treatment  for 
special  cases.” 

An  unusually  short  person,  or  a tall,  slender  woman,  wfth  very 
narrow  hips,  or  lameness  due  to  diminished  length  of  one  leg; 
women  with  abnormal  curvature  of  the  spine,  or  undue  hollowness 
of  the  back,  which  is  usually  the  external  evidence  and  accompani- 
ment of  excessive  inclination  of  the  pelvis;  none  of  these  peculiari- 
ties should  escape  the  eye  of  the  careful  obstetrician.  They  may 
mean  nothing,  or  they  may  be  suggestive  of  more  serious  defects, 
the  detection  of  which,  by  more  extended  observation,  will  enable 
one  to  act  intelligently  at  the  time  of  labor,  and  thus  possibly 
save  a life  which,  without  such  preliminary  knowledge,  might  be 
sacrificed. 

The  life-history  of  a woman  with  a spinal  curvature  or  other  evi- 
dences of  defective  development  should  be  carefully  scrutinized  to 
ascertain  if  rachitis  existed  during  childhood. 

If  physical  peculiarities  do  not  exist,  or  have  been  overlooked, 
the  conditions  revealed  by  an  examination  at  the  onset  of  labor 
may  be  of  great  value  in  pointing  out  the  presence  of  contrac- 
tion. 

Failure  to  reach  the  presenting  part,  the  non-descent  of  the  head 
and  the  resulting  protrusion  of  the  elongated  bag  of  waters  under 
the  influence  of  the  uterine  contractions,  and  the  imperfect  adaptation 
of  the  head  to  the  lower  uterine  segment,  are  conditions  so  suggestive 
of  either  an  abnormal  presentation  or  a pelvic  contraction  that  a dis- 
criminating diagnosis  should  at  once  be  made. 

The  occurrence  of  constriction  or  retraction  rings  after  rupture  of 


* Text-Book  of  Midwifery,  vol.  xi.,  p.  30. 


A COMPARATIVE  STUDY  OF  OPERATIVE  PROCEDURES.  6 S3 


the  membranes,  without  advance  of  the  presenting  part,  is  evidence 
of  obstruction,  and  the  continuance  of  natural  labor  under  such 
circumstances  only  adds  to  the  difficulties  which  already  surround 
the  case. 

The  symmetrically  small  pelvis  (the  justo-minor  pelvis)  has 
scarcely  any  external  signs  by  which  we  may  detect  it  except,  per- 
haps, narrowness  of  the  hips  in  a woman  otherwise  of  normal  pro- 
portions, though  it  would  be  more  natural  to  suspect  its  existence 
in  a very  short  woman.  Rachitis,  which  causes  the  flat  pelvis,  or 
the  generally  contracted  flat  pelvis,  does  not  always  produce  pelvic 
deformity  in  proportion  to  the  intensity  of  the  disease  apparent  in 
other  parts  of  the  skeleton,  and  sometimes  it  produces  no  pelvic  de- 
formity whatever. 

A woman  with  a decided  spinal  curvature  may  have  a perfectly 
normal  or  even  a large  pelvis,  the  location  of  the  deviation  of  the 
bones  being  of  more  importance  than  the  degree  of  it.  Again,  a 
woman  may  have  a slight  degree  of  pelvic  deformity  and  yet  be  de- 
livered spontaneously  and  successfully,  especially  in  a first  labor,  the 
ability  or  failure  to  do  so  depending  upon  the  relation  which  the 
child  bears  to  the  contracted  portion  of  the  pelvis  through  which  it 
must  pass  in  order  to  be  delivered. 

2.  What  constitutes  pelvic  narrowing,  and  how  are  we  to  deter- 
mine that  such  a condition  exists,  as  well  as  the  variety  and  degree 
of  the  deformity  ? 

One  of  the  most  important  advances  in  the  teaching  of  practical 
midwifery  is  in  the  direction  of  systematic  examinations  of  the 
pelves  of  pregnant  women  by  means  of  the  pelvimeter,  the  tape,  and, 
most  important  of  all,  by  the  hand  of  the  examiner  within  the  pel- 
vic cavity. 

Every  physician  who  does  much  obstetrical  work  should  familiarize 
himself,  in  the  first  place,  with  the  shape  of  the  normal  pelvis  by 
examining  the  pelvic  cavity  carefully  with  regard  to  its  sacral  curve, 
depth  of  the  lateral  walls  and  of  the  symphysis  pubis,  the  inclina- 
tion of  the  pelvis  and  the  degree  of  projection  of  the  sacral  promon- 
tory. 

External  measurements  are  not  of  great  value,  because  we  cannot 
estimate  exactly  the  thickness  of  the  intervening  bones  or  of  the 
soft  parts.  Still,  conclusions  can  be  formed  which  will  enable  one 
to  determine  approximately  the  development  of  the  innominate 


684 


world’s  homoeopathic  congress. 


bones,  and  the  width  of  the  transverse  diameter  of  the  pelvic  inlet. 
The  same  remark  applies  with  equal  propriety  to  the  external  mea- 
surements of  the  conjugate  at  the  brim,  which  is  taken  from  the 
spinous  process  of  the  last  lumbar  vertebra,  to  the  upper  border  of 
the  symphysis,  and  should  measure  not  less  than  17.5  cm.  (or  seven 
inches)  in  the  living  subject. 

The  internal  method  with  the  left  hand  in  the  vagina,  is  the 
method  which  gives  most  accurate  information,  and  the  greater  the 
contraction  the  more  reliable  is  the  result.  This  method  is  practiced 
as  follows : With  the  fore-  and  middle  fingers  of  the  left  hand  in 

the  vagina  the  promontory  of  the  sacrum  is  touched.  Then  keeping 
the  middle  finger  on  the  promontory,  press  the  side  of  the  forefinger 
against  the  lower  edge  of  the  symphysis.  The  forefinger-nail  of  the 
right  hand  is  then  placed  where  the  examining  hand  is  touching  the 
symphysis.  Remove  the  two  hands  together  without  separating 
them,  so  that  the  finger-nail  may  accurately  mark  where  the  hand 
was  in  contact  with  the  symphysis.  An  assistant  then  with  a tape 
measure  or  rule,  measures  the  distance  between  the  tip  of  the  middle 
finger  and  the  place  where  the  side  of  the  hand  touched  the  lower 
edge  of  the  symphysis.  The  distance  is  the  diagonal  conjugate  and 
it  usually  measures  half  an  inch  more  than  the  true  conjugate  which, 
as  is  well  known,  is  four  inches. 

Now,  one  would  naturally  suppose  that  a contraction  of  the  con- 
jugate below  four  inches  must  exist  to  constitute  pelvic  deformity. 
Asa  matter  of  fact,  however,  the  conjugate  may  measure  four  inches, 
and  if  the  other  diameters  are  reduced  so  that  the  inlet  is  nearly 
round,  as  in  the  generally  small  pelvis  (the  justo-minor  type),  an 
obstacle  to  the  progress  of  labor  may  be  encountered  at  the  superior 
strait.  On  the  other  hand,  lessening  of  the  conjugate  at  the  brim 
to  three  and  three-quarter  inches  or  even  to  three  and  one-half  inches 
(Winckel)  as  in  the  simple  flat  pelvis  (the  other  diameters  being 
normal)  no  obstacle  to  deliver  will  occur,  and  the  deformity  may 
remain  unsuspected,  although  the  mechanism  of  labor  is  generally 
altered.  It  is  only  in  unfavorable  complications  such  as  would 
occur  with  a large  foetus  or  an  abnormal  presentation,  that  serious 
disturbance  of  labor  is  observed. 

In  consequence  of  these  peculiarities,  some  authors,  and  especially 
those  who  obtain  the  lowest  percentages,  recognize  as  abnormal  only 
those  cases  in  which  arrest  occurred  in  pelves  where  contractions 


A COMPARATIVE  STUDY  OF  OPERATIVE  PROCEDURES.  685 


were  three  and  one-half  inches  or  less.  While  those  who  find  deform- 
ity most  frequent  admit  to  their  tables  only  those  pelves  whose  con- 
jugates are  diminished  by  only  one-fifth  of  an  inch.  For  practical 
purposes  we  may  say  that  dangerous  contractions  exist  in  the  gener- 
ally small  pelvis,  though  the  conjugate  measures  full  four  inches, 
and  in  the  flattened  pelvis  with  ample  transverse  space  when  the 
conjugate  is  reduced  to  three  and  one-half  inches. 

The  difficulties  met  with  in  the  delivery  of  a child  through  a con- 
jugate of  four  inches  in  the  symmetrically  small  pelvis  may  be 
explained  by  the  fact  that  the  transverse  diameter  in  a pelvis  of  this 
variety,  is  no  longer,  and  may  not  be  so  long  as  the  antero-posterior; 
hence  diminution  of  the  oblique  diameter  and  greater  difficulty  in 
effecting  an  entrance  of  the  head  than  would  be  the  case  with  even 
a shorter  conjugate  and  more  transverse  space.  Besides  in  these 
cases  the  obstruction  to  labor  is  not  limited  to  the  superior  strait, 
but  continues  through  the  whole  pelvis.  The  mechanism  is  that  of 
early  and  complete  flexion,  with  occasionally  a delay  in  rotation 
from  decreased  inclination  of  the  inferior  pelvic  planes — and  the 
increase  in  the  length  of  the  pelvic  axis. 

These  remarks  apply  with  almost  equal  force  to  the  generally  con- 
tracted flat  pelvis  as  regards  the  obstacle  to  labor  at  the  superior  strait, 
since  internal  palpation  shows  the  transverse  space  at  the  brim  to  be 
diminished  almost  as  much  as  the  conjugate.  A generally  contracted 
flat  pelvis  with  an  antero-posterior  diameter  of  four  inches,  is  there- 
fore capable  of  giving  rise  to  as  much  difficulty  as  the  symmetrically 
small  pelvis  of  the  same  conjugate  diameter.  Normal  labor  is  pos- 
sible in  either  of  these  varieties  of  pelvis,  though  usually  assistance 
by  means  of  forceps  is  required.  The  characteristices  of  the  simple 
flat  pelvis  is  the  shortened  conjugate  diameter,  extreme  contraction 
being  uncommon,  the  length  of  the  conjugate  rarely  falling  below 
three  inches.  This  diameter  may  not  fall  below  three  and  three- 
quarter  inches,  and  when  diminished  to  this  slight  degree  only,  labor 
may  terminate  without  instrumental  assistance,  though  version  and 
forceps  are  alternative  operations  which  often  come  into  competition 
with  each  other. 

3.  The  duty  of  the  obstetrician  when  confronted  by  a contracted 
pelvis  is  to  form  as  accurate  an  idea  as  possible  of  the  type  and  measure- 
ments of  deformity  he  has  to  deal  with , and  at  the  same  time  determine 
approximately  the  size , shape , and  consistence  of  the  infantile  head. 


686 


world’s  homoeopathic  congress. 


If  the  gestation  lias  advanced  to  full  term,  we  know  what  the  aver- 
age measurements  of  the  foetal  head  are  at  this  time.  But  it  is  a 
matter  of  great  importance  to  know  in  the  particular  case  in  hand 
what  the  relation  of  the  head  is  to  the  pelvis  through  which  it  must 
pass.  Tables  have  been  compiled  which  give  the  approximate 
weight  of  the  child  at  different  periods  from  the  thirty-second  to  the 
fortieth  week,  with  the  appropriate  biparietal  diameter  of  the  foetal 
head  at  the  corresponding  periods,  as  well  as  the  diminished  conju- 
gate diameters  to  which  the  foetus  may  be  expected  to  adapt  itself 
at  these  times.  But  for  practical  purposes  such  tables  are  useless. 
~No  one  would  ever  be  able  to  recall  at  the  critical  moment  the  in- 
formation he  desired,  and  if  he  could  recall  it  the  chances  are  that 
the  knowledge  would  not  be  useful  in  solving  the  problem.  We 
may  determine  the  relative  measurements  of  the  pelvis  as  well  as  the 
relation  which  the  foetal  head  bears  to  the  pelvic  canal  at  its  con- 
stricted portion,  which  is  usually  the  conjugate  of  the  superior  strait, 
by  a very  simple  procedure.  This  manoeuvre  may  be  resorted  to 
during  gestation,  or  when  labor  has  begun  at  full  term. 

To  secure  this  information,  map  out  by  external  palpation  through 
the  abdominal  walls,  the  body  of  the  child  as  accurately  as  possible. 
In  the  hypogastric  region  we  search  for  the  neck  of  the  child, 
which  is  determined  by  the  depression  between  the  dorsal  surface 
of  the  trunk  and  the  region  of  the  occiput.  Then  the  head  of  the 
child  is  mapped  out  by  bimanual  examination,  and  to  prove  the 
correctness  of  the  diagnosis,  the  head  is  made  to  descend  slightly 
upon  the  examining  finger  within.  If  an  assistant  of  intelligence  is 
at  hand,  the  external  manipulation  may  be  conducted  by  him.  The 
head  of  the  child  is  then  made  to  descend  by  simultaneous  pressure 
upon  the  breech  and  occiput.  The  hand  within  the  vagina  then 
ascertains  whether  the  head  really  descends,  whether  it  passes  the 
promontory,  or  whether  rotation  occurs.  Where  serious  obstacles 
are  present  it  is  easy  to  prove  that  the  head  remains  with  the  greatest 
diameter  above  the  pelvic  brim,  and  even  bulges  out  the  region 
above  the  symphysis.  Such  a determination  of  the  relation  of  the 
head  of  the  pelvis  is  of  decided  importance  in  settling  the  time  for 
the  induction  of  premature  labor,  in  serious  cases  of  pelvic  deform- 
ity, especially  when  we  are  in  doubt  as  to  the  period  of  pregnancy. 
Labor  can  be  brought  on  when  the  head  can  be  pressed  into  the 
pelvis  no  further  than  the  vertex,  and  delivery  will  be  accomplished 


/ 


A COMPARATIVE  STUDY  OF  OPERATIVE  PROCEDURES.  687 


too  soon  if  the  head  is  pressed  into  the  pelvis  down  to,  or  slightly 
below  the  parietal  protuberances. 

In  case  of  an  obstacle  to  labor  at  the  superior  strait,  the  gestation 
having  advanced  to  full  term,  this  method  of  determining  the 
adaptability  of  the  foetal  head  to  the  pelvic  inlet  may  be  of  great 
service  and  enable  one  to  choose  between  two  or  more  competitive 
procedures.  No  great  force  is  necessary  to  secure  adaptation,  and  it 
need  not  be  continued  more  than  a moment  or  two.  The  lower 
uterine  segment  offers  no  obstacle  to  the  descent  of  the  head.  The 
only  difficulty  to  be  anticipated  would  occur  in  case  of  a woman 
with  fat  abdominal  walls  or  with  great  hypersesthesia  of  the  uterus. 
Anaesthesia  might  be  necessary.  This  method  can  never  supersede 
internal  measurements  by  palpation,  but  may  be  employed  in  con- 
junction with  them,  and  it  has  the  additional  merit  of  affording  a 
very  accurate  idea  of  the  relation  of  the  foetal  head  to  the  pelvic 
inlet. 

We  will  now  proceed  to  define  the  limitations  of  the  different 
procedures  called  for  in  pelvic  narrowing,  based  upon  comparative 
degrees  of  deformity  expressed  in  inches  at  the  conjugate  of  the 
superior  strait. 

It  is  obviously  impossible  to  construct  rigid  absolute  rules  for  the 
guidance  of  the  surgeon  in  cases  of  this  kind.  Other  factors  besides 
that  of  pelvic  contraction  have  to  be  taken  into  consideration,  and 
herein  the  personal  equation,  i.e.,  the  skill  and  experience  of  the 
operator  are  of  great  value  in  deciding  in  favor  of  one  procedure  or 
another. 

The  variety  of  the  deformity,  as  well  as  the  degree  of  contraction 
in  both  transverse  and  conjugate  diameters,  the  depth  of  the  sym- 
physis and  angle  of  inclination,  the  size  of  the  foetal  head,  the  con- 
dition of  the  child,  and  duration  of  labor  are  all  factors  of  such 
great  importance  that  neither  one  can  be  neglected  in  the  estimate 
of  the  procedure  which  it  is  desirable  to  adopt  to  effect  delivery.  In 
a Society  discussion,  or  in  a formal  essay,  we  can  venture  to  split 
hairs,  and  declare  that  this  or  that  operation  is  the  suitable  one  in  a 
certain  variety  of  deformity,  with  contraction  not  exceeding  a cer- 
tain degree.  But  at  the  bedside  all  this  is  changed.  It  is  results 
that  we  are  anxious  to  obtain — to  save  both  lives,  if  possible,  which, 
considering  the  means  at  our  command  at  the  present  day,  we  are 
not  to  be  excused  if  we  fail  in  securing. 


688 


world’s  homceopatiiic  congress. 


The  only  hope  we  have  of  ever  being  able  to  accomplish  such 
results  is  to  study  our  cases  in  advance.  Since  it  is  practically  im- 
possible for  two  men  to  agree  regarding  the  exact  length  of  the  true 
conjugate,  how  are  we  to  be  guided  by  a difference  of  J of  an  inch, 
as  to  whether  we  shall  elect  forceps,  version,  craniotomy,  symphy- 
seotomy, or  the  Caesarean  section.  These  are  the  most  difficult 
problems  that  can  ever  be  placed  before  any  man,  and  only  the 
highest  judgment,  based  on  the  most  thorough  examination,  under 
the  most  favorable  conditions,  can  hope  for  a satisfactory  answer  to 
these  questions. 

4.  Can  we  define , with  any  degree  of  certainty , the  limitations  of  the 
different  operative  'procedures  by  an  approximate  estimate  of  the  extent 
of  the  narrowing  f 

Under  this  head  we  have,  as  elective  operations,  forceps,  version, 
symphyseotomy,  craniotomy,  and  celiotomy  or  Csesarean  section. 
The  answer  to  the  above  questions  may  be  stated  in  five  propo- 
sitions. 

1.  Those  cases  in  which  the  deformity  is  limited  to  a shortening  of 
the  conjugate  at  the  brim,  and  docs  not  exceed  3J  inches.  In  simple 
flat  pelvis  contraction  of  the  conjugate  to  this  extent  mav  terminate 
in  normal  labor,  or  forceps  or  version  may  be  the  operations  of  elec- 
tion. When  all  the  diameters  are  reduced  to  the  length  of  the  con- 
jugate, as  in  the  justo-minor  pelvis,  four  inches  at  the  latter  point 
may  give  rise  to  considerable  delay  in  delivery  and  require  forceps, 
though  a natural  birth  of  a living  child  at  term  is  probable.  A 
conjugate  of  four  inches  in  the  generally  contracted  flat  pelvis  may 
also  cause  difficulty  in  the  birth  and  require  forceps  or  version. 

2.  Those  cases  in  which  the  diminution  of  the  conjugate  is  re- 
duced from  3f  inches  to  3J  inches,  though  a normal  labor  is  not 
impossible  with  a conjugate  of  3f  inches.  In  the  simple  flat  pelvis 
version  is  likely  to  be  required.  Playfair  says  forceps  are  applicable 
in  all  degrees  of  contraction  down  to  3J  inches  conjugate  of  brim, 
though  version  is  preferable  when  contraction  is  chiefly  in  the  ante- 
rior-posterior diameter,  with  abundance  of  room  at  the  sides  of  the 
pelvis  for  the  occiput  to  occupy  after  the  version.  Many  obstetri- 
cians believe  that  it  is  possible  to  deliver  a living  child  by  turning 
in  a pelvis  contracted  to  the  extent  of  2f  inches  in  the  conjugate 
diameter.  Playfair  inclines  to  this  belief.  Barnes  maintains  that, 
although  an  unusually  compressible  head  may  be  drawn  through  a 


A COMPARATIVE  STUDY  OF  OPERATIVE  PROCEDURES.  689 


pelvis  contracted  to  3 inches,  the  chance  of  the  child  being  born 
alive  under  such  circumstances  must  necessarily  be  small,  and  that 
from  3J  inches  to  the  normal  size  must  be  taken  as  the  proper  limits 
of  the  operation  of  version. 

A justo  minor  pelvis  with  a conjugate  of  3j  inches  may  be  ter- 
minated by  forceps.  Version  is  absolutely  contraindicated  in  pro- 
nounced cases  of  this  variety  (3J  inches  to  3 inches).  If  such  a 
case  is  seen  in  time,  the  induction  of  premature  labor,  after  viability, 
is  preferable  to  forceps  or  version  at  full  term.  Should  labor  have 
begun,  the  case  may  be  allowed  to  progress  until  nature  has  shown 
her  inability  to  cope  with  the  emergency.  Then  forceps,  or,  later, 
symphyseotomy,  or,  if  the  child  be  dead,  craniotomy,  may  be 
necessary. 

3.  In  all  cases,  without  regard  to  the  kind  of  deformity,  if  the 
birth  canal  is  not  obstructed  by  tumors,  cicatrices  or  other  insur- 
mountable obstacles  to  delivery,  when  the  conjugate  of  the  inlet  is 
reduced  from  3J  inches  (8  c.m.)  to  2-|  inches  (6t6q-  cm.),  symphyse- 
otomy seems,  according  to  the  latest  reports,  to  be  the  operation 
which  offers  the  best  chances  to  mother  and  child.  The  object  of 
separating  the  pubic  symphysis  (pubiotomy  or  symphyseotomy)  is 
to  increase,  by  the  artificial  separation  of  this  joint,  the  dimensions 
of  the  birth  canal.  Quoting  from  a recent  article  by  Dr.  H.  J. 
Garriguesj  he  says,*  “If  the  symphysis  pubis  is  cut  in  a woman 
lying  on  her  back,  with  outstretched  legs,  the  ends  of  the  bones 
separate  very  little — only  about  half  an  inch  ; but  if  the  joints  of 
the  hips  and  knees  are  bent,  the  distance  is  1J  to  1J  inches,  and  by 
pulling  on  the  iliac  bones  this  is  easily  increased  to  2J  inches,  with- 
out injury  to  the  sacro-iliac  articulations;  but  if  the  separation  is 
carried  as  far  as  3J  to  4 inches,  one  or  both  of  these  joints  are  torn 
open. 

“In  consequence  of  the  separation  of  the  pubic  bones,  a consid- 
erable change  takes  place  in  all  directions  of  the  pelvis,  whereby  it 
is  rendered  much  more  spacious  in  all  directions  or  planes  supposed 
to  be  laid  at  right  angles  through  the  axis.” 

As  a result  of  the  advantage  gained  by  the  increase  in  the  dimen- 
sions of  the  pelvis  by  the  performance  of  symphyseotomy,  the  pros- 
pect is  that  craniotomy  on  the  living  child  will  be  banished  from 
obstetrical  practice.  It  certainly  will  be  so  in  hospital  practice,  and 
it  should  and  will  be  so  in  private  practice  if  obstetricians  make 


* Medical  Record,  May  20,  1893,  p.  611. 
44 


690 


world’s  homoeopathic  congress. 


themselves  familiar  with  the  rationale  of  the  procedure  and  recog- 
nize the  advantages  to  be  derived  from  its  adoption. 

4.  In  a contraction  of  the  pelvis  less  than  2f  inches  (2-|  inches, 
or  6^0-  c.m.)  and  not  exceeding  2J  inches  (6^  c.ra.),  the  operation 
for  the  induction  of  premature  labor  soon  after  the  thirtieth  week  is 
the  operation  which  may  be  considered,  and,  like  the  operation  for 
the  induction  of  abortion  in  the  highest  degree  of  pelvic  contraction, 
is  to  be  compared  and  comes  into  competition  with  the  modern  ope- 
ration of  Caesarean  section.  Until  recently,  contractions  less  than 
2f  inches  in  the  justo-minor  pelvis  and  of  less  than  2J  inches  in  the 
simple  flat  pelvis,  placed  these  cases  under  the  ban  of  that  sacrificial 
procedure — abortion.  At  the  present  time  the  new  Caesarean  sec- 
tion, by  means  of  a more  perfect  technique,  asepsis,  and  the  more 
perfect  diagnosis  of  the  conditions  demanding  operation,  offers  to  the 
patient  a procedure  which  is  greatly  to  be  preferred,  in  view  of  its 
life-saving  features  to  both  mother  and  child.  Abortion  may  be 
avoided  and  premature  labor  is  unnecessary.  Caesarean  section 
seems  absolutely  indicated  in  any  pelvis  whose  diameters  are  below 
2-|  inches  conjugate  vera,  with  a living  child;  also  in  cancer  of  the 
cervix,  in  oblique  deformities  of  the  pelvis,  and  when  tumors  ob- 
struct the  vagina,  so  as  to  render  the  birth  of  a living  child  impos- 
sible. 

5.  Craniotomy,  since  the  revival  of  the  operation  of ’symphyse- 
otomy, has  a very  much  more  limited  field  of  applicabilty  than  for- 
merly, if  recent  impressions  prove  to  be  reliable. 

Upon  the  dead  foetus  it  is  certainly  justifiable  in  moderate  degrees 
of  pelvic  contraction,  in  mal presentations  and  positions,  deformities 
of  the  foetus,  and  in  cases  when  the  conjugate  vera  is  under  2f 
inches. 

Whether  craniotomy  upon  the  living  foetus  is  ever  justifiable  is  a 
question  which  men  of  large  experience  are  not  agreed  upon.  There 
will  probably  always  be  cases  in  which  it  is  the  only  practicable 
resource  left  open  to  the  operator.  As,  for  instance,  in  a case  of 
impacted  occipito-posterior  presentation,  or  a mento-posterior  face 
presentation  when  the  mother’s  condition,  as  indicated  by  the  tem- 
perature, pulse,  loss  of  strength  from  the  fruitless  and  prolonged 
efforts  at  delivery,  associated  with  dangerous  thinning  of  the  lower 
uterine  segment,  is  such  as  to  make  any  operative  procedure  danger- 
ous except  that  which  enables  us  to  deliver  by  the  speediest  and 
safest  means  possible — viz.,  craniotomy. 


RATIONAL  TREATMENT  OF  PUERPERAL  DISORDERS.  691 


THE  RATIONAL  TREATMENT  OF  CERTAIN  PUER- 
PERAL DISORDERS. 

By  George  B.  Peck,  M.D.,  Providence,  R.  L 


It  is  related  of  an  ambitious  but  pretentious  lawyer  that  during 
his  first  argument  before  the  Supreme  Bench  of  the  United  States, 
it  became  necessary  for  the  Chief  Justice  to  interrupt  him  with  the 
suggestion  that  “ This  court  maybe  presumed  to  know  something 
about  law  ! ” The  admonition  of  the  eminent  jurist  is  not  unheeded. 
I assume  that  he  who  takes  the  time  and  the  trouble  to  read  or  to 
listen  to  these  words  is  tolerably  familiar  with  the  present  teachings 
of  the  science  of  bacteriology,  the  present  state  of  development  of 
the  germ-theory. 

Bacilli  have  been  devoted  attendants  upon  the  human  race,  lo, 
these  unnumbered  ages.  We  made  their  acquaintance  but  yesterday. 
Not  too  late,  however,  for  they  will  continue  to  abide  with  us  a few 
centuries  longer.  It  is  for  us  simply  to  determine  upon  a proper 
style  of  deportment  toward  our  newly-discovered  companions. 

The  practical  relations  of  human  beings  to  such  tiny  yet  murder- 
ous associates  are  susceptible  of  a threefold  division  natural  at  once 
and  logical.  The  underlying  conditions  are:  1.  The  obnoxious 
microbes  outside  the  unbroken  covering,  cuticular  or  mucous,  of  a 
vigorous  healthy  body.  2.  Their  actual  storming  of  more  or  less 
accessible  breaches  in  the  vital  armor,  occasioned  by  violence  or  by 
physiological  processes.  3.  Their  establishment  of  camps  within 
the  human  frame.  Evidently,  the  functions  of  a physician  toward 
these  conditions  are  as  diverse  as  the  situations  indicated,  although 
in  any  given  instance  he  may  be  compelled  to  discharge  them  all. 
Concerning  the  bearing  of  a surgeon  toward  disease- germs,  I will 
not  presume  to  speak,  although  elsewhere  I have  intimated,  by  ref- 
erence to  unimpeachable  authority,  his  subjection  to  the  same  prin- 
ciples which  should  govern  his  brother. 

If  a physician  is  consulted  concerning  pertinent  matters  when 


692 


world’s  homoeopathic  congress. 


thoroughly  satisfied  none  of  these  little  creatures  have  discovered  an 
entrance  to  his  patron’s  body,  he  must  act  simply  as  a hygeist.  To 
the  performance  of  that  duty,  however,  he  should  bring  all  attain- 
able knowledge  of  the  resources  of  sanitary  science.  This  service 
has,  singularly  enough,  been  dubbed  by  some  “ preventive  medicine,” 
an  incongruous  and  absurd  appellation. 

Should  a doctor  succeed  in  catching  any  of  the  well-nigh  omni- 
present wanderers  in  an  attempt  to  scale  any  breach  opening  to  the 
citadel  of  life,  he  would  at  once  thoroughly,  though  gently , sweep 
thence  the  invading  hosts,  for,  as  was  shown  in  detail  one  year  ago, 
experience  and  bacteriology  alike  forbid  the  application  of  corrosive 
or  irritating  substances  to  raw  surfaces. 

If  aid  has  not  been  summoned  until  invasion  has  been  measura- 
bly accomplished,  the  attendant’s  duty  is  still  unmistakable.  Since 
the  chief  physiological  disturbances  and  anatomical  changes  (patho- 
logical conditions)  subsequent  to  the  lodgment  of  these  impalpable 
foes  within  the  human  frame  are  the  direct  result  not  of  themselves 
nor  yet  of  their  work,  but  of  the  efforts  of  the  organism  to  free 
itself  from  their  presence,  it  follows  as  naturally  and  as  inevitably 
as  does  the  day  the  night  that  th q proper  course  of  action  is  the  ad- 
ministration of  medicaments  which  shall  intensify  and  sustain  (re- 
inforce) the  exertions  of  the  affected  organism  in  .its  endeavors  to 
expel  the  intruders ; in  other  words,  the  dispensation  of  remedies 
capable  of  producing  corresponding  phenomena  when  given  to  the 
healthy  and  sound.  The  possession  of  such  property  by  any  sub- 
stance can  be  definitely  known,  of  course,  only  through  antecedent 
experiment. 

Parenthetically,  it  may  be  remarked  (a)  that  it  is  perfectly  proper 
to  speak  of  a person’s  being  threatened  with  any  one  of  many  of  the 
so-called  diseases.  Should  an  invading  host  be  routed  before  it  had 
deployed  its  columns,  before  it  had  clearly  manifested  its  character, 
any  assumption  consistent  with  the  apparent  phenomena  would  be 
legitimate.  (6)  The  inherent  possibility  of  overwhelming  the  enemy 
at  any  time  is  also  evident,  although  the  synchronous  destruction  of 
his  works  is  neither  claimed  nor  expected.  A reported  cure  at  any 
stage  of  any  case  of  an  infectious  disease  requires,  therefore,  no 
stronger  proof  than  other  commonplace  statements  of  alleged  facts. 

To  resume  : Since  the  laws  of  nature  are  general,  not  to  say  uni- 
versal, originating  not  in  human  formulation,  but  in  the  established 


RATIONAL  TREATMENT  OF  PUERPERAL  DISORDERS.  693 


constitution  of  things,  and  since  the  known  field  of  infectious  dis- 
eases is  broadening  with  marvellous  rapidity,  while  extreme  uncer- 
tainty attends  the  limitation  of  its  boundaries,  it  is  clear  that  with 
him  lies  the  burden  of  proof  who  dares  affirm  that  the  administra- 
tion to  the  sick  of  remedies  capable  of  producing  corresponding- 
phenomena  when  given  to  the  healthy,  is  not  the  proper  course  of 
action  in  all  curable  cases. 

Finally,  since  the  character  of  the  work  of  many  microbes  varies 
with  the  age,  sex  and  condition  of  their  victim,  and  since  autopsies 
frequently  reveal  their  unsuspected  presence  at  important  points, 
there  is  no  reason  to  expect  a parasitic  pathology  will  prove  a more 
reliable  guide  in  the  healing  art  than  have  been  the  humoral,  the 
methodic  and  the  pneumatic.  Hence  naught  remains  for  the  true 
physician  but  to  exemplify  the  singularly  significant  motto  of  this 
World’s  Congress,  and  day  by  day  to  treat 

“Not  Things,  but  Men.” 

Discussion. 

L.  C.  Grosvenor,  M.D. : Mr.  President , Ladies  and  Gentlemen . 
— If  there  is  an  evil  principle  in  this  world,  it  is  always  ready  to 
jump  on  us  when  we  are  down.  If  we  see  a boy  going  to  the  bad, 
we  say  that  is  all  I expected  of  him.  I knew  him  when  he  was  a 
little  fellow.  There  is  another  principle  always  ready  to  boost  us 
when  we  are  going  up.  Now,  these  two  principles  are  just  as  active 
in  our  physical  life  as  in  our  educational  life,  in  our  moral  life,  or 
anywhere  else,  when  we  are  in  high  health  or  when  we  are  in  dis- 
eased condition.  These  microbes  are  of  all  denominations.  They 
are  ready  to  jump  on  us  and  abuse  us.  When  we  are,  in  a general 
way,  in  fine  health,  they  pass  by  on  the  other  side  of  the  street  and 
take  off  their  hats  to  us.  This  is  one  of  the  inducements,  not  only 
to  us  as  doctors,  but  to  our  patients,  to  always  live  on  a high  physi- 
cal plane. 

Alonzo  Boothby,  M.D. : I could  not  say  anything  on  the  other 
matter  when  you  spoke  to  me,  but  when  I get  a chance  on  this  sub- 
ject, I always  take  advantage  of  it.  I believe  that  remedies  have  a 
great  deal  of  influence  on  septic  disease,  but  I would  not  say  that 
we  have  to  depend  upon  them  in  all  cases;  and  while  the  paper  has 
hardly  committed  the  writer  to  that  position,  yet  that  is  what  it 
leads  to,  or  what  has  it  led  to?  If  we  have  a perfect  condition  of 
things,  we  do  not  need  any  antiseptic,  but  we  do  need  the  aseptic 
principle  put  into  practice  in  every  case;  and  I presume  that  hardly 
anybody  here  would  think  of  attending  a case  of  confinement,  any 


694 


world’s  homoeopathic  congress. 


more  than  they  would  attempt  making  a surgical  operation,  without 
having  everything  clean  about  them.  If  you  have  -everything 
clean  and  a healthy  subject  to  deal  with,  I say  you  need  nothing 
more  than  that.  But  suppose  you  have  a diseased  vagina;  then 
are  you  not  going  to  use  your  antiseptics,  and  is  it  not  true  that 
a cut  surface  anywhere  will  bear  these  applications  with  perfect  im- 
munity? I think  that  those  who  use  them  speak  most  positively  in 
regard  to  them,  and  it  is  not  to  the  advantage  of  any  member  of 
this  Congress  to  suppose  that  they  will  do  harm,  because  the  one 
who  has  used  them  says  that  they  did  not  do  any  good  in  the  proper 
wray.  Some  one  spoke  of  using:  one  to  ten  thousand  of  the  bichlo- 
ride solution.  Now,  you  might  just  as  well  use  hot  water.  That 
is  what  you  get  when  you  use  such  an  antiseptic.  If  you  use  an 
antiseptic,  you  must  use  enough  of  it  and  use  it  long  enough  to  pro- 
duce some  action  on  microbes.  They  would  bear  that  solution  for 
two  or  three  minutes,  and  be  just  as  lively  as  ever.  Beside,  we  have 
not  to  adopt  the  germ-theory.  It  is  possible  that  it  is  the  poison 
accompanying  the  germ ; but  whether  it  is  the  one  or  the  other,  the 
effect  is  the  same. 

Dr.  Foster:  Mr.  Chairman , Ladies  and  Gentlemen . — I have 
nothing  to  add  to  what  has  been  said  already.  I might  give  you 
my  own  opinion  about  antisepsis  in  midwifery  and  asepsis,  and  I 
don’t  know  that  it  would  carry  any  particular  weight  with  this 
body.  I think  that  if  we  have  the  evidence  of  septic  infection 
present,  we  ought  to  use  antiseptic  measures  to  antidote  the  evil  and 
if  we  haven’t  any  evidence  whatever  that  there  is  any  such  thing 
wrong  wdth  the  patient,  then  we  ought  not  to  have  anything  to  do 
with  antisepsis  or  asepsis,  for  our  patient  is  aseptic  already.  One 
gentlemen  said,  what  I don’t  understand,  that  a solution  of  corro- 
sive sublimate  one  to  five  thousand  would  be  no  more  efficacious 
than  hot  water. 

Dr.  Boothby  : I beg  to  correct  that.  It  was  one  to  ten  thousand 
that  would  have  no  beneficial  effect. 

Dr.  Foster:  Well,  one  to  ten  thousand  has  sometimes  produced 
serious  symptoms.  One  to  five  thousand  has  caused  death,  and  that 
in  more  cases  than  one,  so  I don’t  think  corrosive  sublimate  is 
always  safe  even  when  made  in  as  high  a solution  as  one  to  ten 
thousand. 

R.  Ludlam,  M D. : I think  it  is  important  to  be  specific  in  what 
we  are  talking  about.  Two  or  three  have  the  same  opinion,  but 
they  haven’t  specified.  My  good  friend,  Dr.  Boothby,  thinks  that 
such  a weak  solution  as  one  to  ten  thousand  of  the  bichloride  would 
be  of  no  great  service  in  the  vagina.  My  good  friend,  Dr.  Foster, 
speaks  inferentially,  of  the  bichloride  upon  the  perinseum.  The  bi- 
chloride in  contact  with  the  perinseum  is  very  poisonous  in  a very 
weak  solution,  but  it  is  not  so  in  the  vagina,  unless  it  chances  to  get 


RATIONAL  TREATMENT  OF  PUERPERAL  DISORDERS.  695 


through  into  the  perinseum.  So  I submit  that  these  two  very  clever 
fellows  are  talking  about  two  things. 

C.  H.  Cogswell,  M.D.  : I don't  know  that  I dare  tackle  this 
subject.  I had  occasion  to  prepare  a paper  for  the  American  Insti- 
tute last  year,  but  it  is  very  seldom  that  I do.  I stated  in  my  paper 
then — I can  only  reitetate  the  statement  to-day — that  I have  no  use 
for  antiseptics  in  obstetrical  practice.  I have  never  seen  a time 
when  they  were  needed.  I know  of  a great  many  cases  that  have 
been  injured  by  the  use  of  them.  I reported  twenty  cases  last  year 
from  the  use  of  the  bichloride  (one  to  three  thousand)  in  labor.  I 
try  to  be  clean  and  keep  my  patients  clean  and  when  I have  done 
that  I believe  I have  done  all  that  the  good  Lord  asks  me  to  do. 

H.  W.  Robey,  M.D. : One  point,  I think,  would  profit  all  of  us 
to  ponder.  It  seems  to  me  that  the  Homoeopathic  profession  is 
gradually  and  surely  taking  ground  against  the  germ-theory  of  the 
origin  of  disease,  and  we,  I believe  the  majority  of  ns,  are  coming 
more  and  more  clearly  to  the  conclusion  that  it  is  merely  one  of  the 
passing  fancies  of  the  age — that  diseases  are  not,  as  a rule,  produced 
by  these  germs,  but  they  are  simply  the  accompaniments  of  disease; 
they  act  as  scavengers  of  the  system  to  throw  out  the  morbid  product 
of  disease  and  that  they  are  blessings  in  disguise  and  not  our  great 
enemies.  We  find  connected  with  all  the  products  of  decomposi- 
tion, both  in  the  animal  and  vegetable  kingdom,  certain  kinds  of 
scavengers  which  nature  seems  to  have  provided  iu  her  great  law  of 
conservation. 

Dr.  Sheldon  Leavitt  : I have  been  slow  to  put  myself  on 
record  with  regard  to  this  matter  of  antisepsis.  I have  been  unde- 
cided in  my  own  mind  just  what  course  it  is  best  to  pursue.  I spent 
some  six  weeks  with  Tate  in  Birmingham,  England,  and  I saw 
there  the  utter  disregard  for  these  things  which  he  manifested,  and 
at  the  same  time  the  excellent  results  which  he  obtained  in  a surgi- 
cal way.  In  regard  to  practice  of  an  obstetrician  I may  say  that  this 
is  an  important  matter.  I make  no  allusion  now  to  the  puerperal 
state  wherein  we  may  have  indications  of  pathological  conditions, 
but  I allude  to  parturition.  I always  wash  my  hands  thoroughly 
before  an  operation,  and  I usually  employ  no  antiseptics.  If  the 
nurse  asked  me  if  I wished  to  use  an  antiseptic  solution,  I would 
say  : “ Yes,  with  thanks."  If  nothing  is  said,  I do  not  use  it.  I 
am  particular  to  wash  my  hands  very  clean.  I carry  in  my  case  the 
bichloride  and  Carbolic  acid,  but  in  three  cases  out  of  four  I make 
no  use  of  them.  I have  in  my  private  practice  for  a number  of 
years  seen  no  evidence  of  septic  infection. 

My  practice  in  the  hospitals  is  different.  The  conditions  and  cir- 
cumstances and  surroundings  are  different,  and  I feel  called  upon  to 
exercise  still  greater  precaution.  Now,  I believe  that  we  ought  to 
exercise  unusual  care  in  the  hospital,  but  what  I have  been  alluding 


696 


world’s  homceopathic  congress. 


to,  in  my  remarks  just  made,  is  to  practice  of  a private  nature,  and 
you  have  my  modus  operand i in  these  cases. 

Dr.  Harvard:  I would  like  to  ask  one  question  of  Dr.  Leavitt. 
If  we,  as  physicians,  are  not  responsible  for  our  example,  and  if  we 
have  positive  opinions  upon  subjects  we  should  say  “ yes  ’’when 
we  mean  it,  and  if  we  think  it  is  not  necessary  say  “ no,  with 
thanks.” 

Dr.  Leavitt:  As  I said,  my  opinions  on  this  subject  are  not 
very  positive,  but  I am  giving  my  practice. 

j.  W.  Hingston,  M.D.,  North  Platte,  Neb. : All  who  have  yet 
spoken  have  been  from  the  cities,  and  their  practice  is  mostly  among 
the  better  classes.  They  have  a privilege,  to  a certain  extent,  of 
choosing  their  patients.  Now,  it  has  been  my  experience  to  be 
called  into  places  from  which  I would  gladly  have  staid  out — 
where  there  was  neither  fame  nor  name.  When  we  look  around  for 
a nurse,  we  find  one  of  the  same  class.  When  we  wish  to  give  in- 
st Junctions  as  to  the  work,  we  find  that,  no  matter  how  particular  we 
are,  our  words  are  entirely  neglected.  If  we  ask  for  a syringe,  it  is 
black  with  filth;  if  we  ask  for  a basin  to  wash  our  hands  in,  it  is 
one  used  in  the  kitchen.  So  that  it  is  often  a question  in  my  mind 
whether  we  should  do  anything  at  all  in  the  way  of  antisepsis. 

Phcebe  J.  B.  Waite,  M.D. : We  must  remember  that  there  are 
many  things  to  be  learned  from  experience,  and  from  the  experience 
of  those  who  have  gone  before.  The  fact  remains  that  notwith- 
standing all  the  antisepsis  that  we  are  talking  about  to-day,  our 
grandmothers  and  our  mothers  had  families  of  six  to  ten  and  even 
up  into  the  teens,  and  they  lived  and  the  children  lived,  and  the  doc- 
tors who  attended  them  had  never  seen  a fountain  syringe,  had  never 
heard  of  the  bichloride,  and  the  disgusting  smell  of  Carbolic  acid 
was  unknown  in  the  world.  I suppose  there  is  not  a gentleman  in 
this  room  who  does  not  believe  that  cleanliness  is  next  to  godliness. 
AThen  I began  the  practice  of  medicine  I understood  that.  I have 
had  no  case  of  septic  poisoning  and  have  used  no  Carbolic  acid  or 
bichloride.  Among  the  “ well-to-do”  I can  have  things  more  com- 
fortable, but  I dare  not  say  I have  had  any  better  success  than  among 
the  lower  classes. 

F.  B.  Righter,  M.D. : I am  very  desirous  of  hearing  the  end  of 
Dr.  Kingston’s  story,  and  I have  just  asked  him  if  he  was  troubled 
in  his  cases  with  peritonitis  and  other  septic  diseases,  and  he  says 
no.  Now  this  is  enough  to  shatter  the  rankest  bacteriologist.  I was 
in  hopes,  when  I came  here,  that  I would  gain  some  knowledge  as 
to  whether  this  World’s  Congress  believes  in  the  germ-theory  as  the 
cause  of  disease.  The  discussion  of  the  subject  by  the  essayist  wan- 
dered over  a large  territory.  I may  be  doing  him  an  injustice,  but 
he  seemed  to  me  to  treat  this  subject  with  something  like  levity.  I 
didn’t  catch  the  drift  of  his  paper;  however,  what  I did  get  of  it 


RATIONAL  TREATMENT  OF  PUERPERAL  DISORDERS.  697 


reminded  me  of  that  great  American  humorist  who,  when  he  an- 
nounced his  subject,  never  referred  to  it  again  during  the  whole 
lecture. 

In  regard  to  asepsis,  I,  with  Dr.  Hingston,  have  seen  many  cases 
which  occurred  where  the  conditions  were  as  bad  as  they  could  be, 
and  no  bad  results  occurred.  Now  that  may  be  due  to  our  atmos-' 
phere  and  our  climate.  I never  in  my  practice  of  obstetrics  use 
the  vaginal  douche  unless  there  is  some  special  call  for  it. 

F.  J.  Becker,  M.D. : I must  apologize  for  speaking  here,  but  I 
cannot  refrain  from  saying  something  in  the  face  of  these  remarks, 
which  seem  to  leave  the  impression  that  we,  as  physicians,  are  allow- 
ing ourselves  to  stand  in  the  face  of  the  facts  which  are  taught  us  by 
bacteriologists.  If  these  men  who  have  spoken  to-day  knew  what 
has  been  accomplished  in  German  hospitals  in  the  way  of  antisepsis, 
they  would  be  friends  of  antisepsis,  I am  a friend  of  asepsis,  but 
there  are  cases  in  which  antisepsis  must  be  practiced  in  order  to 
obtain  asepsis,  Take  the  germ  of  cholera  and  put  it  in  gelatine, 
and  the  germ  can  be  produced  and  reproduced.  The  fact  that  many 
persons  escape  septic  disease  is  no  argument  whatever  against  anti- 
sepsis. 

Martha  G.  Bipley,  M.D. : I should  say  that  the  practitioner 
who  comes  from  a case  of  erysipelas  has  no  business  in  the  obstetri- 
cal room. 

The  younger  men  and  women  may  learn  something  from  the  prac- 
tical experience  of  those  who  talk  to  them.  There  is  something  to 
be  said  for  the  country  practitioner  in  the  way  of  good  air,  which 
in  crowded  cities  we  don’t  get.  If  I could  choose  my  patients,  I 
would  have  their  surroundings  pleasant  and  the  best  of  nursing,  the 
best  of  care.  But  in  general  practice  we  must  do  the  best  we  can. 
I think  we  forget  that  an  obstetrical  case  is  not  necessarily  a patho- 
logical case;  that  it  is  physiological.  I live  in  a city  where  I pre- 
sume that  two-thirds  of  the  women  are  attended  by  midwives.  We 
have  a large  Scandinavian  element,  and  they  rarely  call  in  a physi- 
cian. They  take  no  antiseptic  precautions,  and  often  the  doctor’s 
business  is  to  stand  by  and  watch,  and  merely  help  when  it  is 
needed. 

Now,  in  the  maternity  hospital  of  which  I have  charge  there  are 
hundreds  of  women,  and  almost  up  into  the  thousands,  who  have 
been  confined  within  a few  years.  We  have  not  had  a single  case 
of  sepsis.  I treat  these  cases  according  to  common-sense — my  idea 
of  common-sense.  My  hands  are  cleaned,  the  nurse’s  hands  are 
cleaned — not  necessarily  with  bichloride,  although  we  have  it.  No 
antiseptic  treatment  is  used  at  all  unless  there  is  a bad  uterus.  Then 
we  cleanse  it.  Fifty  years  ago  it  was  better  for  a woman  to  be  con- 
fined in  a gutter  than  in  a hospital.  In  our  days  things  have 
changed.  It  is  better  for  a woman  to  be  confined  in  a hospital  than 


698 


world’s  homoeopathic  congkess. 


at  her  own  home.  Why  is  that?  Because  we  have  found  out  the 
close  relationship  between  the  puerperal  state  and  septic  disease. 

Dr.  Becker:  I am  inclined  to  look  at  the  case  somewhat  in  the 
manner  of  Dr.  Ripley.  Lying-in  is  a purely  physiological  case. 
We  have  heard  a great  deal  about  the  bright  side  of  obstetrical 
cases.  I have  had,  within  the  last  two  years,  two  cases  where  there 
was  trouble.  I found  it  was  not  due,  howevrer,  to  the  lack  of  anti- 
sepsis, but  in  both  cases  could  be  traced  to  taking  cold.  Now  we 
recognize  the  matter  of  a woman’s  keeping  warm  during  the  men- 
strual period.  We  know,  as  physicians,  the  serious  results  arising 
from  the  suppression  of  this  function,  and  I believe  if  we  were  as 
careful  to  keep  our  patients  warm  as  a great  many  are,  I do  not 
believe  we  would  have  one-half  of  the  bad  results  we  now  have  in 
practice. 

Dr.  Kin  yon  : I want  to  enter  a protest  against  one  point.  My 
friend  Dr.  Robey  makes  a statement  that  the  majority  of  the  Hom- 
oeopathic fraternity  do  not  believe  in  the  germ-theory  of  disease. 
If  this  is  true,  I feel  sorry  for  the  Homoeopathic  profession.  I sim- 
ply wanted  to  make  this  point,  when  somebody  objected,  and  said 
we  ought  not  to  go  from  a case  of  erysipelas  to  a case  of  confine- 
ment. Why  does  he  object  ? 

George  B.  Peck,  M.D. : I flattered  myself  that  the  members  of 
this  Institute  read  my  paper  carefully  at  their  homes,  and  if  they 
did,  they  found  that  I confined  myself  strictly  to  my  subject,  and 
furthermore,  have  said  all  there  is  to  be  said  on  that  subject.  I am 
well  satisfied  of  the  truth  of  the  germ-theory  of  disease.  I wish  it 
was  absolutely  demonstrated,  for  in  the  practical  working  of  the 
germ-theory  I find  the  strongest  proof  and  the  best  explanation  of 
the  cure  of  disease  I have  found  anywhere.  The  profession  as  a 
whole  believes  thoroughly  in  aseptic  precautions.  That  is  to  say,  at 
least  three-quarters,  as  was  indicated  by  the  statistics  which  I pre- 
sented last  year,  when  this  subject  of  the  germ-theory  came  up.  I 
object  to  the  use  of  corrosive  sublimate  on  chemical  grounds.  The 
instant  that  substance  comes  in  the  presence  of  liquid  albumen,  it 
forms  an  insoluble  precipitate.  That  being  the  case,  I have  no  use 
for  corrosive  sublimate  in  a vaginal  douche.  It  has  been  stated  that 
the  testimony  of  city  doctors  who  enjoy  select  practices  has  been 
given  here.  I am  a city  doctor  and  I defy  any  one,  unless  it  be 
some  one  who  has  practiced  in  the  neighborhood  of  Five  Points  in 
New  York,  to  have  a meaner  class  of  patients  than  I myself  have 
in  regard  to  one  class  of  them.  For  some  years  I have  been  city 
physician  simply  because  if  I resigned,  an  Allopath  would  be  ap- 
pointed in  my  place,  there  being  no  Homoeopath  in  the  district 
qualified,  and  second,  that  it  feeds  the  hospitals.  I have  been  in 
places  that  no  one  cares  to  go,  and  I never  lost  a case  or  had  any 
serious  trouble  or  any  germ -disease  among  those  people.  But  that 


RATIONAL  TREATMENT  OF  PUERPERAL  DISORDERS.  699 


does  not  shatter  at  all  my  belief  in  the  germ-theory.  Because  the 
people  I find  there  are  a class  who  enjoy  perfect  health,  and  I have 
no  cares  for  their  safety. 

The  matter  of  putting  pure  bacteria  into  the  perinseum  is  another 
proof  of  the  truth  of  bacteriology.  It  will  produce  natural  results. 
Its  excreta,  whatever  they  may  be,  depend  upon  the  individual,  and 
upon  the  species.  It  doesn’t  make  any  difference  whether  the  poison 
is  due  to  the  presence  of  bacteria  or  the  results  of  their  presence.  If 
we  use  disinfectants,  they  should  be  mild  and  unirritating,  and  of 
those  there  are  plenty. 


700 


world’s  homoeopathic  congress. 


THE  YEAR’S  PROGRESS  IN  OBSTETRICS. 

By  Sheldon  Leavitt,  M.D.,  Chicago,  III. 


For  several  years  progress  in  the  art  of  obstetrics  has  been 
mainly  along  surgical  lines,  until  so  much  operative  work  now  per- 
tains to  the  complete  practice  of  this  branch,  that  he  who  expects  to 
rely  upon  himself  in  the  hour  of  emergency  must  possess  surgical 
skill.  Moreover,  requirements  for  the  successful  practice  of  ob- 
stetrics are  daily  becoming  more  exacting.  Midwives  and  incompe- 
tents will  ultimately  be  driven  out  of  the  field  by  the  lash  of  public 
sentiment. 

Symphyseotomy. — The  old  operation  of  Sigault,  known  as  symphy- 
seotomy, which  had  quite  a run  in  the  latter  part  of  the  last  cen- 
tury, has  been  revived  in  this  our  day  by  the  Obstetric  School  of 
Naples,  and  thus  far  has  a good  record.  In  this  country  it  has  been 
employed  but  a few  times,  but  the  sentiment  of  accoucheurs  appears 
to  be  friendly  toward  it. 

It  is  only  occasionally  appropriate,  and  probably  far  less  fre- 
quently in  this  country,  and  especially  in  the  west,  than  in  the  more 
densely  settled  countries  of  Europe,  where  pauperism  is  more  preva- 
lent, and  the  people  are  harder  worked  and  more  poorly  fed. 

Ever  since  the  original  operation  of  Sigault  fell  into  desuetude, 
obstetricians  have  busied  themselves  in  efforts  to  devise  methods  for 
reducing  the  size  of  the  foetal  head  to  correspond  to  pelvic  dimen- 
sions, and  as  a result,  thousands  of  foetal  lives  have  been  sacrificed 
for  want  of  the  very  expedient  which  had  been  cast  aside. 

It  is  unnecessary  for  me  to  say  that  the  secret  of  our  success  with 
Sigault’s  operation  to-day  is  found  in  cleaner  methods  and  finer 
technique. 

For  some  years  Caesarean  section  has  been  the  standard  operation 
for  cases  in  which  the  antero-posterior  diameter  of  the  brim  was  re- 
duced as  low  as  2f  inches ; but  recently  a living  child  has  been  de- 
livered by  means  of  symphyseotomy  when  the  diameter  was  only 


701 


THE  YEAR?S  PROGRESS  IN  OBSTETRICS. 

2f  inches.  The  wonderful  improvement  in  obstetrical  results  which 
this  affords  is  at  once  apparent  when  we  consider  the  vast  difference 
in  point  of  mortality  between  the  two  operations,  Caesarean  section 
and  symphyseotomy.  JSTor  is  maternal  life  preserved  at  the  expense 
of  subsequent  misery,  for  according  to  the  reports  thus  far  made, 
there  are  no  disabling  effects  produced  in  the  woman  as  the  result  of 
temporary  disarticulation  of  the  pubic  bones. 

Still  we  are  to  recollect  that  the  operation  is  yet  on  trial,  and  should 
lay  corresponding  restraint  on  our  enthusiasm.  The  true  value  of  it 
can  better  be  told  in  a twelve-month. 

After  the  os  uteri  has  become  fully  dilated,  and  futile  attempts 
have  been  made  to  deliver  with  the  forceps,  or  as  soon  as  we  find 
that  the  foetal  head  is  unquestionably  so  decidedly  out  of  propor- 
tion to  the  size  of  the  pelvis  that  delivery  of  a living  child  cannot 
be  effected,  the  time  has  arrived  for  the  performance  of  symphy- 
seotomy. 

The  field  of  the  operation  is  prepared  in  the  usual  manner  (which 
preparation  should  include  shaving  the  mons  veneris  and  vulva), 
and  an  incision  is  made  about  two  inches  long  in  the  median  line, 
the  lower  limit  of  it  being  a point  just  above  the  clitoris.  A few 
fibres  of  the  rectus  muscle  are  separated  from  the  pubes  on  either 
side  of  the  median  line,  and  the  finger  is  passed  down  along  the 
posterior  surface  of  the  symphysis.  Using  the  finger  as  both  di- 
rector and  protector,  a curved  probe-pointed  bistoury  is  then  made 
to  sever  the  articular  soft  structures,  including  the  sub-pubic  liga- 
ment, great  care  being  exercised  to  avoid  wounding  the  other  struc- 
tures. The  articular  surfaces  are  gently  separated  a few  lines,  the 
wound  is  examined  for  bleeding  points,  these  being  secured  with  fine 
catgut,  temporary  gauze  packing  is  used  and  the  forceps  are  applied. 
Delivery  should  be  practiced  with  great  care,  and  during  traction 
effort  the  trochanters  should  be  supported  by  the  hands  of  an  assistant. 
After  delivery  of  the  placenta  the  gauze  is  removed,  the  control  of 
all  bleeding  assured,  the  articular  surfaces  are  brought  together  and 
held  by  silkworm-gut  sutures  through  the  fibrous  structures  along 
the  face  of  the  bones,  which  fall  within  easy  reach,  and  then  the  ex- 
ternal wound  is  closed.  In  exceptional  cases  it  may  be  wise  to 
practice  drainage  for  twenty-four  hours.  A tight  bandage  should 
be  applied  to  the  hips  and  firmly  secured.  The  recumbent  posture 
should  be  enforced  for  about  four  weeks. 


702 


world’s  homoeopathic  congress. 


The  Caesarean  Operation. — I am  not  aware  that  there  has  been 
any  improvement  worthy  of  mention  in  the  technique  of  theCsesarean 
operation  or  its  modification  during  the  past  year;  but  the  sentiment 
is  becoming  nearly  universal  that  the  operation  should  be  regarded 
as  elective  in  the  matter  of  time. 

Formerly,  the  custom  was  to  resort  to  surgical  interference  only 
after  labor  had  been  well  established,  and  that,  too,  even  in  cases 
wherein  delivery  per  vias  maturates  had  been  recognized  as  impos- 
sible. 

Without  pausing  here  to  note  the  objections  which  have  been  made 
to  early  interposition,  I may  be  allowed  to  emphasize  the  advantages 
arising  from  ante-partum  operation,  viz. : 

1.  A better  opportunity  for  deliberate  and  painstaking  preparation 
on  the  part  of  the  operator  is  afforded. 

2.  Daylight  can  be  assured. 

3.  The  patient  can  be  more  thoroughly  prepared. 

4.  The  vital  powers  of  the  woman  have  not  become  seriously  im- 
paired. 

In  view  of  the  bearing  of  exact  pelvic  and  cranial  measurements 
on  the  selection  of  the  most  suitable  operation  for  an  individual 
case,  I should  not  omit  to  direct  your  attention  to  the  demand  for 
more  frequent  use  of  the  pelvimeter  and  a careful  estimate  of 
cranial  dimensions,  which  the  introduction  of  symphyseotomy  has 
established. 

Sanger  vs.  Porro. — Caesarean  section,  pure  and  simple,  as  prac- 
ticed by  Sanger,  and  Csesarean  section  as  modified  by  Porro,  are  still 
rivals  for  surgical  favor.  In  Italy,  where  it  originated,  the  Porro 
operation  is  by  far  the  most  popular,  while  in  Germany  Sanger’s 
operation  is  in  greater  favor.  The  surgeons  of  this  country  have 
exhibited  a preference  for  the  latter  method,  though  some  of  the  best 
operators  are  outspoken  in  their  preference  for  the  former.  Dr. 
Robert  P.  Harris,  whose  statistics  are  most  elaborate  and  reliable, 
believes  that  Americans  have  good  reason  for  preferring  the  im- 
proved Caesarean  operation,  inasmuch  as  twelve  out  of  twenty-eight 
Porro  subjects,  up  to  the  present  time,  have  died,  against  five  out  of 
the  last  twenty-eight  delivered  under  the  other  method.  On  the 
other  hand,  aour  success,”  says  Dr.  Joseph  Price,  who  has  thus  far 
produced  the  best  statistics  of  personal  abdominal  work  which  the 
world  affords,  “ in  supra- vaginal  extra-peritoneal  hysterectomy  for 


THE  YEARNS  PROGRESS  IN  OBSTETRICS. 


703 


fibroids,  and  the  low  mortality  accompanying  the  operation  has 
assured  our  faith  in  the  Porro  operation.”  “ Hysterectomy  should 
be  performed,”  he  continues,  “ wherever  the  Caesarean  section  is 
necessary.”  Thus  the  controversy  goes  on,  but  out  of  the  din  and 
smoke  of  the  tumult  we  gather  indications  of  the  advantage  of  the 
Porro  over  the  Sanger  operation  for  the  use  of  the  average  surgeon 
and  gynaecologist  outside  of  hospital  walls.  It  is  more  easily  and 
expeditiously  performed,  and,  what  to  my  mind  commends  it  still 
more,  the  possibility  of  future  impregnation  is  prevented.  The  sen- 
timentality in  which  some  indulge,  and  the  amiability  which  would 
encourage  reproduction  by  such  women  of  weak,  deformed,  and 
usually  dependent  children,  should  be  discountenanced.  The  record 
which  Rosenburg  found  of  thirty -six  cases  wherein  Caesarean  section 
had  been  performed  from  two  to  five  times  on  the  same  woman,  is  to 
my  mind  deeply  revolting. 

As  in  the  case  of  supra- vaginal  hysterectomy  under  other  circum- 
stances, some  late  operators  have  treated  the  stump  according  to 
various  intra-abdominal  or  intra-pelvic,  if  not  strictly  intra-perito- 
neal,  methods,  but  the  ordinary  operator  will  still  prefer  to  fasten 
the  stump  at  the  abdominal  opening. 

Caesarean  Operations  vs.  Craniotomy. — The  accoucheur  who  pos- 
sesses surgical  skill  will  hereafter  reserve  his  perforator,  his  crani- 
otomy forceps,  and  his  cephalotribe  for  use  only  upon  the  dead  foetus, 
for,  with  the  child  still  living,  abdominal  section  and  symphyse- 
otomy are  the  operations  to  be  considered.  Upon  a dead  foetus,  in  a 
pelvis  measuring  in  excess  of  3 or  at  the  least  2J  inches,  such  instru- 
ments will  afford  occasional  aid,  but  not  elsewhere.  This  is  the  dic- 
tum of  late  obstetrical  authorities,  and  yet  I can  conceive  of  an 
occasional  case  in  the  experience  of  those  who  have  no  surgical  skill 
themselves  and  cannot  readily  summon  those  who  do  possess  it, 
wherein  an  exception  to  this  rule  may  properly  lie.  The  practitioner 
wrho  is  inexperienced  in  surgery  of  the  abdomen,  but  who  is  accus- 
tomed to  obstetrical  manipulation,  will  be  less  likely  to  do  serious 
harm  with  the  perforator  and  allied  instruments  than  with  the 
knife;  and  to  such  cases,  with  an  environment  decidedly  unfavor- 
able so  far  as  concerns  consultative  facilities,  rigid  rules  cannot  be 
applied. 

Ischio-Pubiotomy. — I should  not  fail  to  refer  to  a congener  of  sym- 
physeotomy known  as  Farabeuf’s  operation,  which  consists  of  section 


704 


world’s  homoeopath rc  congress. 


of  the  pelvis  at  a point  about  2 inches  to  the  right  or  left  of  the 
symphysis  pubis,  according  to  the  direction  of  the  pelvic  contraction. 
It  is  intended  for  cases  of  obliquely-contracted  pelvis,  wherein  sym- 
physeotomy wonld  be  comparatively  ineffectual.  The  most  recent 
example  of  this  operation,  of  which  I have  seen  a report,  is  from 
the  clinic  of  Prof.  Pinard,  of  Paris. 

In  order  to  make  the  result  of  this  operation  satisfactory,  as  it  ap- 
pears to  me,  the  greatest  care  will  be  requisite,  owing  to  the  presence, 
at  the  site  of  section  as  designated,  of  the  obturator  nerve  which 
supplies  adductor  muscles  of  the  thigh.  In  measurements  recently 
made  on  the  cadaver,  I find  that  the  point  of  exit  of  this  nerve,  at 
the  upper  and  inner  margin  of  the  obturator  foramen,  is  just  2 
inches  from  the  symphysis.  The  obturator  vessels  are  also  found 
at  the  same  point.  To  go  to  the  outer  side  of  this  opening  would 
materially  diminish  the  danger  of  section,  but  the  operator  must 
recollect  that  the  nerve  there  lies  close  to  the  lower  border  of  the 
horizontal  ramus  of  the  pubis.  If  section  is  made  at  a nearer  point 
the  body  of  the  pubis  alone  will  be  cut,  and,  owing  to  proximity  of 
this  line  of  incision  to  the  symphysis^  the  special  advantage  of  the 
operation  over  symphyseotomy  will  be  measurably  diminished.  The 
best  point  for  section  is  probably  about  2J  inches  from  the  symphy- 
sis. The  direction  of  the  section  will  be  downwards  and  somewhat 
inwards,  the  chain  saw  cutting  first  the  transverse  and  then  the  de- 
scending pujaic  rami.  Of  course,  the  obturator  nerve  can  be 
avoided  by  careful  adjustment  of  the  saw  about  the  transverse 
ramus. 

Pyrexia  in  the  Puerperium. — Advanced  notions  concerning  the 
treatment  of  puerperal  pyrexia  have  been  maintained  and  strength- 
ened. I have  frequently  seen  the  temperature  in  the  puerperium  run 
up  to  103°  and  104°  for  a few  hours  and  then  subside  under  the  in- 
fluence of  simple  remedies,  and  therefore  great  haste  in  the  matter  of 
operative  interference  is  by  me  discountenanced.  But  when  the 
temperature  is  disposed  to  remain  high,  or  when  there  is  a decided 
rigor  at  the  beginning  of  the  pyrexia,  with  no  explanation  traceable 
to  disturbance  distant  from  the  pelvis,  little  time  should  be  allotted 
to  the  expectant  plan  of  treatment.  First  of  all,  let  the  vagina  be 
washed  out  with  a gentle  stream  of  hot  boiled  water.  If  the  symp- 
toms do  not  improve  within  a few  hours,  or  if  the  temperature  is 
only  temporarily  lessened,  the  uterus  should  be  carefully  washed  out 


THE  YEAR’S  PROGRESS  IN  OBSTETRICS. 


705 


with  plain  boiled  water,  ample  provision  being  made  for  the  return  of 
the  fluid.  Then  seizing  the  cervix  with  a pair  of  bullet  forceps  and 
drawing  it  downwards  until  it  is  within  easy  reach,  the  uterine  cavity 
should  be  wiped  out  repeatedly  with  pledgets  of  absorbent  cotton  or 
iodoform  gauze.  If  this  should  fail  to  give  more  than  temporary 
relief,  the  organ  should  be  curetted  and  packed  with  either  iodoform 
or  sterilized  gauze,  the  end  of  the  strip  being  allowed  to  trail  into 
the  vagina  for  drainage  purposes.  If  up  to  this  point  the  manipu- 
lation has  been  done  with  due  regard  to  asepsis,  the  packing  may 
safely  be  left  twenty-four  hours,  and  subsequently  renewed  if  re- 
quired. It  may  be  unnecessary  to  say  that  all  this  manipulation 
would  better  be  left  undone  unless  it  be  done  with  strict  regard  to 
perfect  cleanliness.  A thoroughly  clean  vulva  and  vagina  and 
uterus  are  absolutely  essential,  and  the  fingers  of  the  operator,  the 
instruments,  and  the  packing  material  must  be  above  suspicion. 

If  at  the  end  of  twenty-four  hours  after  packing  the  temperature 
does  not  approach  normal,  and  the  other  symptoms  do  not  evince 
corresponding  improvement,  we  are  left  to  infer  that  the  cause  of  the 
disturbance,  while  originally  within  the  tract  which  has  been  thus 
treated,  has  now  located  itself  within  the  lymphatics,  the  veins,  the 
tubes,  or  has  invaded  the  peritoneal  cavity.  When  this  is  true  some 
practice  laparotomy  without  delay,  but,  in  view  of  the  results  of  such 
operations,  as  shown  by  reliable  statistics,  I would  still  withhold  my 
hand  for  a season,  meanwhile  hoping  to  obtain  from  our  deep-acting 
remedies  results  unlooked  for  by  Old-School  practitioners.  This 
relegates  laparotomy,  in  such  cases,  to  the  place  of  a dernier  res- 
sort. 

Episiotomy. — I am  convinced,  from  what  I have  seen  and  heard, 
that  the  operation  of  episiotomy  is  far  more  commonly  used  than 
formerly.  About  three  or  four  years  ago  I appealed  to  several  of 
our  prominent  obstetrical  practitioners  for  their  experience  with  the 
operation,  and  was  surprised  to  find  how  few  had  become  familiar 
with  it  in  a clinical  way.  At  that  time  I had  resorted  to  it  a few 
times,  but  of  late  I have  had  rather  frequent  recourse  to  it. 

Whereas  it  was  my  former  custom  to  make  several  small  in- 
cisions on  either  side  of  the  vulva,  I now  make  but  one  on  each 
side,  and  that  of  sufficient  depth  to  give  the  needed  circumference. 
The  authors  who  mention  the  subject  at  all  usually  advise  that  the 
incisions  be  made  with  a knife,  and  that  we  leave  the  integument  in- 

45 


706 


world’s  homceopathic  congress. 


tact  or  nearly  so ; but  this  is  not  my  practice.  When  the  perinseum 
is  bulging,  and  the  vulvar  circle  is  tense,  with  every  certainty  of 
laceration,  I slip  the  scissors  under  the  thin  margin  and  cut  outwards 
and  backwards  from  a half  to  three-quarters  of  an  inch.  By  this 
means  the  vulvar  circumference  is  greatly  augmented  and  the'peri- 
nseum  is  saved.  After  delivery  of  the  secundines  I put  two  or  three 
catgut  sutures  into  each  wound,  and  the  result  is  usually  a perfect 
vulva.  I confess  to  a partiality  for  this  operation,  and  have  yet 
to  meet  the  case  wherein  I have  had  occasion  to  regret  my  resort 
to  it. 

Immediate  Repair  of  Parturient  Lacerations. — The  demand  for 
immediate  attention  to  lacerations  involving  the  vulva  and  vagina  is 
becoming  more  imperative,  while  some  teach  and  practice  immediate 
suturing  of  even  cervical  rents.  Surely  the  time  is  ripe  for  declar- 
ing that  the  accoucheur  who  fails  to  suture  vulvar  rents  is  guilty  of 
gross  neglect.  Nor  should  one  be  allowed  to  escape  censure  under 
the  plea  that  anything  short  of  an  extensive  laceration  is  not  reck- 
oned by  him  as  a laceration. 

Suture  of  such  wounds  must  be  thorough,  since  otherwise  the 
operation  will  prove  unsatisfactory. 

Asepsis. — Essential  progress  is  being  made  by  the  great  body  of 
obstetric  practitioners  in  the  direction  of  thorough  cleanliness  in 
midwifery  practice,  but  there  is  still  much  room  for  reform  in  this 
direction.  The  slackness  of  many  accoucheurs  is  truly  appalling. 
Filthy  instruments  and  filthy  fingers  appear  to  be  the  rule  rather 
than  the  exception.  Both  students  and  practitioners  need  education 
along  this  line. 

Discussion. 

L.  C.  Grosvenor,  M.D. : I don’t  know,  Mr.  President,  that  I 
have  anything  to  say  to  this  able  paper.  I have  enjoyed  it  in- 
tensely. It  is  as  full  of  meat  as  a nut,  and  I am  very  glad  to  see 
our  Homoeopathic  obstetricians  coming  clear  to  the  front  on  these 
very  important  subjects. 

Martha  G.  Ripley,  M.D. : I was  very  much  pleased  with  the 
paper,  and  doubt  if  I shall  be  able  to  add  anything  to  it.  I wish 
to  say  that  within  a year  or  two  I have  had  what  I consider  a very 
important  method  of  using  the  forceps.  I have  never  seen  it  men- 
tioned in  any  work — in  fact,  it  is  directly  in  opposition  to  the  rules 
that  were  given  me  for  the  use  of  forceps.  In  my  obstetrical  box  I 
carry  two  sizes  of  forceps,  the  medium  and  the  short,  the  very  small. 


THE  YEARNS  PROGRESS  IN  OBSTETRICS. 


707 


I have  those  small  forceps  with  me  at  every  case,  and  in  cases  where 
I fear  a laceration  of  the  perinseum  when  the  head  bulges  on  the 
perineum,  when  I come  to  that  point  I stretch  it.  If  I fear 
that  the  outlet  is  not  sufficiently  large,  and  I judge  it  impossible  for 
the  head  to  pass,  then  I take  my  scissors  and  make  the  last  opera- 
tion spoken  of,  on  each  side.  When  there  is  any  pain  and  the  liga- 
ments are  stretched,  I make  a cut  on  each  side  from  a quarter  to  a 
half  an  inch,  as  I think  best,  putting  in  fingers  as  they  are  needed. 
That  is  very  much  better  than  a laceration  of  the  perinseum.  I like 
that  operation  very  much  in  case  I fear  there  is  to  be  a laceration. 
Now,  to  avoid  a laceration,  I have  worked  over  the  perineum  and 
stretched  it  and  dilated  it  as  much  as  possible ; then  when  there  is 
no  pain,  I put  in  my  small  forceps.  If  a pain  comes,  I stop.  I 
work  when  there  is  no  pain,  when  every  part  is  relaxed.  I can 
get  then  the  best  results.  I have  tried  it  in  hundreds  of  cases,  and 
I can  avoid  a laceration  of  the  perinseum  many  times;  and  if  I de- 
livered with  the  forceps  when  there  was  pain,  I would  get  laceration. 
I will  say  this : the  patients  are  not  frightened  by  the  word  forceps. 
I say  to  them,  “I  have  a little  pair  of  spoons  here  that  will  help. 
I will  shorten  the  operation.”  I think  mine  are  the  Higbee  forceps 
— the  smallest  size  you  can  find. 

It  has  been  said  that  you  can  use  large  forceps  as  well.  I want 
to  say  that  sometimes  I can  get  along  better  without  any  forceps ; 
but  when  you  depend  upon  delivering  without  the  pain  and  expul- 
sive efforts  of  nature,  you  have  got  to  use  a little  force.  Sometimes 
I get  along  without  using  any  forceps.  You  cannot  use  force  with- 
out pain. 

Dr.  Hingston  : Almost  the  last  words  of  one  of  the  doctors  was 
that  he  believed  that  it  was  almost  a rule,  rather  than  the  exception, 
that  obstetrical  cases  were  attended  without  any  care  as  to  asepsis. 
Now,  in  my  discussion  of  the  paper  before  this  one,  I rather  sup- 
posed that  the  people  here  thought  that  I was  one  of  that  class,  and 
I don’t  believe  I look  like  a very  dirty  man.  I am  heartily  in 
concord  with  the  opinion  that  the  greatest  aseptic  condition  should 
be  adhered  to ; and  when  I remarked  that  I thought  it  was  perhaps 
better  to  stay  out  of  the  vagina  than  to  go  into  it  under  certain  cir- 
cumstances, I don’t  want  to  be  understood  that  that  was  my  method. 
On  the  contrary,  if  I had  had  time  to  finish,  I would  have  said  that 
after  I go  away  from  my  cases,  I insist  that  the  nurse  shall  leave 
them  alone — keep  out  of  that  domain.  I permit  none  of  these  an- 
tiseptic washings  that  we  have  here  recommended  in  the  journals 
and  elsewhere,  to  be  carried  out  every  day  or  twice  a day.  On  the 
contrary,  I believe  that  if  we  do  not  have  trained  nurses,  we  had 
better  keep  the  nurse  away  from  that  domain.  Let  us  make  the 
vagina  as  aseptic  as  possible.  Let  us  be  as  cleanly  as  possible. 
These  are  my  views  on  this  subject,  and  I was  glad  that  this  paper 


708 


world’s  homoeopathic  congress. 


came  up  after  the  other  one,  because  I felt  that  I was  misunder- 
stood. 

H.  E.  Beebe,  M.D. : The  measures  recommended  are  all  very 
good,  but  I think  it  is  quite  well  proven  that  of  later  years  lacera- 
tion of  the  perinseum  is  more  frequent  when  the  shoulders  are  passed 
than  when  the  head  is  passed. 

Sheldon  Leavitt,  M.D.,  in  closing  the  discussion,  said  : I have 
nothing  of  importance  to  add,  though  I might  say  a few  words  with 
regard  to  the  use  of  the  forceps  as  mentioned,  more  especially  by 
Dr.  Ripley.  These  short  forceps — these  very  short  forceps — are  a 
convenience,  to  say  the  least.  The  use  of  emollients,  as  mentioned 
by  Dr.  Ripley,  is  an  excellent  practice;  but  we  must  give  what 
Graves  demanded — the  tincture  of  time,  in  which  the  perinseum 
may  accommodate  itself  to  the  size  of  the  foetal  head.  But  the  cases 
of  which  I spoke,  in  which  episiotomy  is  desirable,  are  those  in 
which  we  have  given  the  time,  and  the  vulvar  opening  is  hard  and 
unyielding,  and  the  head  out  of  proportion  to  it.  Under  these  cir- 
cumstances, where  laceration  is  received,  from  the  experience  which 
we  have  had,  we  may  introduce  the  scissors  and  make  the  incision 
to  which  I have  alluded. 


PUERPERAL  FEVER. 


709 


PUERPERAL  FEVER. 

By  J.  B.  Gregg  Custis,  M.D.,  Washington,  D.  C. 

Each  journal  that  has  been  placed  upon  our  desk  during  the  last 
six  months  has  told  us  of  the  World’s  Homoeopathic  Congress,  and 
now  we  stand  before  this  body  of  representative  men,  and  are  re- 
minded that  the  eyes  of  the  physicians  of  the  world  are  upon  us, 
and  that  they  are  asking  why  we  Homoeopathists  are  given  this 
special  auxiliary  Congress.  The  anfewer  must  come  from  us,  and  if 
we  fail  to  express  here  our  distinctive  opinions,  and  to  show,  with 
reason,  what  we  do  as  a distinctive  school,  we  can  no  longer  lay 
claim  to  distinctive  rights  and  privileges. 

Our  school  has  added  so  much  that  is  original  to  human  knowl- 
edge, that  we  can  by  right  appropriate  whatever  is  of  value  to  sci- 
ence wherever  found,  and  by  virtue  of  our  law,  can  cast  off  and  dis- 
card whatever  is  worthless  in  the  realm  of  therapeutics,  the  science 
in  which  we  lead. 

With  this  introduction,  we  wish  to  call  attention  to  puerperal 
fever,  a disease  of  especial  interest  to  us  as  obstetricians,  not  only 
because  of  its  reputed  fatality,  but  also  because  of  its  various  setiology. 
The  physician  who  masters  the  history,  cause,  progress  and  results 
of  this  disease,  has  a general  knowledge  sufficient  for,  and  is  equal 
to  the  discussion  of  any  febrile  disorder.  This  statement  is  not 
surprising,  when  as  an  accepted  definition,  we  state  that  puerperal 
fever  is  any  continued  fever  occurring  in  connection  with  child- 
birth. 

The  history,  briefly  given,  is  first  traditional,  Rachel's  death  being 
attributed  to  that  cause.  Hippocrates  describes  isolated  cases.  In 
fact  there  is  no  doubt  that  the  disease  has  made  its  ravages  during 
all  ages,  though  it  was  not  recognized  as  a positive  epidemic  fever 
until  lying-in  institutions  were  established.  After  their  establish- 
ment, when  records  wrere  more  compjete,  we  have  it  appearing  in 
epidemic  form,  always  with  some  years  intervening,  and  travelling 


710 


world's  homoeopathic  congress. 


over  the  world,  thus:  In  1750,  in  Lyons;  in  1760,  in  London;  in 
1765,  in  Copenhagen;  in  1767,  in  Dublin  ; in  1770,  in  Germany, etc. 

During  these  epidemics  it  raged  with  such  intensity  that  the  death- 
rate  rose  in  Vienna,  as  late  as  1842,  to  almost  16  per  cent,  of  the 
women  confined.  The  points  to  be  noticed  here  are,  that  the  dis- 
ease occurred  in  the  form  of  an  epidemic,  as  well  as  a sporadic  dis- 
ease. An  old  writer  from  whom  we  have  learned  much,  divided 
diseases  into  sporadic  and  epidemic.  According  to  that  writer,  spo- 
radic diseases  are  those  engendered  by  meteoric  or  telluric  agencies, 
to  the  morbific  influence  of  which  only  a few  persons  are  susceptible 
at  a time.  Next  to  this  class  come  the  epidemic  diseases,  which 
attack  many  persons  at  the  same  time.  They  arise  from  the  same 
cause,  and  individual  cases  resemble  each  other.  These  diseases 
usually  become  infectious  when  they  pervade  crowded  districts. 

The  disease  in  question  in  #its  manifestations,  falls  under  these 
definitions,  the  author  referred  to  is  our  revered  Hahnemann,  and 
there  is  between  the  lines  of  these  definitions  all  that  our  scientists 
of  to-day  have  developed. 

In  1847,  Semmel weiss  observed  that  in  the  wards  in  Vienna 
where  the  physicians  attended,  the  more  fever  cases  occurred,  and 
that  the  mortality  was  greatest,  while  in  those  wards  attended  by 
midwives  the  mortality  was  comparatively  small.  In  the  first 
wards,  medical  students  were  allowed  to  examine  the  patients  re- 
gardless of  their  previous  occupation,  whether  in  the  dissecting  room 
or  in  the  surgical  ward.  As  a result  of  these  observations  Semrael- 
weiss  advanced  the  doctrine  that  puerperal  fever  was  the  result  of 
the  introduction  of  a poison  from  an  external  source. 

Simpson  and  others  in  1850  claimed  and  proved  to  the  satisfaction 
of  many,  that  this  fever  was  identical  with  surgical  fever. 

Note  here  that  the  physicians  and  medical  students  were  important 
factors  in  the  propagation  and  spread  of  the  disease,  and  also  that  it 
did  then,  as  it  does  now,  come  from  the  introduction  into  the  system 
of  decomposing  animal  matter.  These  statements  in  brief  give  the 
history  of  the  disease  under  discussion. 

Time  will  not  allow  us  to  do  more  than  announce  our  conclusion 
as  to  the  setiology  of  puerperal  fever. 

1.  We  believe  that  there  is  sufficient  evidence  for  believing  that 
it  does  occur  in  the  form  of  an  epidemic.  When  in  this  form  it  is 
contagious  and  infectious,  and  that  it  should  be  placed  among  the 


PUERPERAL  FEYER. 


711 


miasmatic  contagious  diseases.  This  is  the  disease  of  which  Noeg- 
garath  isolated  the  germ.  This  germ  may  enter  the  body  through 
the  lungs,  stomach  or  vaginal  tract,  it  may  be  introduced  prior  to* 
confinement  and  lay  dormant,  not  developing  till  after  delivery. 

We  are  all  justified  in  being  guided  by  our  experience,  and  in 
forming  our  conclusions  in  accordance  therewith,  and  we  must  not 
ignore  evidence  from  reliable  sources.  We  believe  that  we  have 
seen  a specific  form  of  puerperal  fever. 

We  know  that  each  year  many  of  us  have  cases  of  cholera-mor- 
bus, cholerine,  or  severe  diarrhoea,  which  present  the  symptoms  of 
cholera.  Some  of  these  are  fatal,  and  there  is  no  way  of  distinguish- 
ing by  symptoms  between  our  cases  and  those  of  true  cholera  ex- 
cepting that  they  are  single,  and  that  they  do  not  appear  in  epidemic 
form.  True,  the  microscope  gives  us  a test,  but  how  many  of  us 
use  it,  or  can  use  it?  We  believe  that  cholera  does  occur  in  the 
form  of  an  epidemic,  individual  cases  presenting  the  same  symptoms, 
and  that  under  these  circumstances  it  is  infectious  and  contagious. 
Few  of  us  have  had  personal  experience  with,  epidemic  cholera. 
Because  many  have  not  had  experience  with  puerperal  fever  in  epi- 
demic form,  there  is  no  reason  to  deny  its  existence  in  the  face  of  the 
history  we  have. 

This  form  of  puerperal  fever  is  contagious  in  the  highest  degree. 
~No  physician  should  take  other  eases  of  labor  while  in  attendance 
upon  a case  of  puerperal  fever  of  this  variety. 

2.  Physicians,  students,  midwives  or  nurses  can  infect  our  patients 
and  so  cause  puerperal  fever.  When  so  infected  it  is  by  reason  of 
the  introduction  of  decaying  animal  matter,  or  the  ptomaines  pro- 
duced during  the  progress  of  another  diseased  condition. 

Pregnancy  presents  a physiological  condition  which  tends  to  hy- 
pertrophy. The  puerperal  state  is  a physiological  condition  tending 
to  atrophy. 

After  labor  as  the  result  of  hemorrhage,  shock,  more  or  less 
laceration  and  traumatism,  the  patient’s  vitality  is  at  the  lowest  ebb. 
Consequently  they  are  especially  susceptible  to  disease,  and  the 
patient  is  in  a peculiar  state,  which  peculiarity,  we  can  hardly  de- 
scribe. She  is  exposed  to  the  above  described  dangers.  It  is 
rational  also  on  evidence,  to  assume  that  germs  which  would  under 
other  circumstances  be  harmless,  are  now  poisonous,  so  that  the 
danger  from  infection  by  her  attendants  is  greater  than  under  any 


712 


world’s  homoeopathic  congress. 


other  circumstances  when  the  physician  is  called  upon  for  assist- 
ance. 

» Any  interference  with  the  physiological  condition  of  atrophy  may 
cause  an  auto-infection.  This  is  especially  true  when  traumatism  is 
introduced  as  a factor.  When,  under  any  circumstances,  traumatic 
influences  arrest  circulation  completely  or  is  of  such  a character  or 
extent  to  render  its  return  impossible,  we  have  fever,  the  danger  of 
which  depends  upon  the  extent  of  the  injury.  Ordinarily  the  in- 
flammatory condition  remains  at  the  seat  of  the  injury,  but  when  in 
connection  with  labor  it  interferes  with  the  process  of  atrophy,  we 
have  as  a result,  a continued  fever. 

3.  Evidence  that  we  cannot  dispute  teaches  that  there  is  an  inti- 
mate relation  between  many  cases  of  puerperal  fever  and  the  zymotic 
diseases;  diphtheria,  erysipelas,  and  so  forth.  Personally  we  have 
been  able  to  distinctly  trace  three  cases  directly  to  diphtheria.  One 
case  which  occurred  this  winter,  a patient  who  was  nearing  her  con- 
finement period,  left  her  home  because  of  the  presence  of  a case  of 
diphtheria.  Ten  days  after  she  was  delivered,  and  in  thirty  hours 
after  delivery,  puerperal  fever  was  announced  by  the  initial  chill. 
Her  attending  physician  had  not  seen  the  diphtheria  case.  Our  in- 
ference is  that  the  poison  lay  dormant  in  her  system  until  after  de- 
livery. 

We  do  not  consider  cases  belonging  to  the  last  two  cases  conta- 
gious in  the  strict  sense  of  the  word,  and  the  physician  using  especial 
care  need  not  give  up  his  obstetrical  practice,  because  he  is  unfortu- 
nate enough  to  have  one  patient  so  affected. 

The  symptoms  as  observed  by  us,  and  of  the  disease  as  it  has  ap- 
peared among  us  are  as  follows  : 

The  first  is  a chill  of  short  duration,  occurring  from  thirty  to  forty- 
eight  hours  after  delivery,  followed  by  a fever  of  great  intensity. 
The  chills  return  at  irregular  intervals,  though  the  fever  never  leaves 
entirely.  The  temperature  in  true  puerperal  fever  describes  a curve 
of  about  forty-eight  hours  in  length,  the  fever  rising  the  first  half 
and  declining  the  second. 

The  patient  may  or  may  not  present  any  spots  of  local  tenderness, 
though  there  is  generally  some  intolerance  of  touch  over  the  whole 
abdomen ; single  spots  of  tenderness  are  more  frequently  found  in  the 
ovarian  region. 

The  patient  soon  reaches  a typhoid  condition  as  regards  tongue 


PUERPERAL  FEVER. 


713 


and  bowels,  though  puerperal  fever  is  generally  accompanied  by 
profuse  sweating,  and  there  is  but  little  delirium.  These  symptoms 
are  constant  regardless  of  temperature,  which  frequently  reaches 
10IJ  to  105,  on  the  first  and  third  days.  There  is  usually  diarrhoea 
after  the  fifth  day,  the  stools  being  profuse,  yellow  and  gushing,* 
often  uncontrollable. 

The  lochial  discharge  is  not  immediately  affected,  but  gradually 
diminishes,  and  is  not  especially  foetid.  The  milk  either  does  not 
make  its  appearance,  or  the  breasts  make  but  a feeble  effort  to  es- 
tablish their  function. 

The  duration  of  the  fever  under  the  most  favorable  circumstances 
is  seven  days,  reaching  its  greatest  intensity  on  the  fifth,  but  if  the 
temperature  reaches  98J  on  the  morning  of  the  seventh  day  it  will 
return  during  the  following  week;  in  fact  we  have  seen  it  return  on 
each  seventh  day  for  several  weeks  after  convalescence  was  fully  es- 
tablished. 

We  base  our  diagnosis  on  the  peculiar  curve  marked  on  the  tem- 
perature chart,  the  condition  of  the  lochia,  the  non-appearance  of  the 
milk,  and  the  absence  of  any  localized  inflammation.  It  is  neces- 
sary to  differentiate  from  malarial  fever  with  its  twenty-four  hour 
curve  and  previous  history,  also  from  the  fact  that  malarial  fever 
diminishes  the  milk  but  does  not  destroy  it;  from  fever  and  chill  from 
suppression  of  lochial  discharges,  by  the  difference  in  the  head 
symptoms,  which  disappear  with  the  return  of  the  discharge;  from 
retro-mastitis  by  its  later  onset  and  the  local  symptoms;  from  septi- 
caemia the  result  of  retained  fragments  of  placenta,  by  the  knowledge 
on  the  part  of  the  physician  that  the  placenta  was  complete  when 
expelled,  and  the  foetor  of  the  lochia.  Remember  that  this  condi- 
tion (septicaemia)  is  first  one  of  local  inflammation;  true  the  system 
may  become  poisoned,  but  that  is  secondary.  Puerperal  fever  is  a 
constitutional  fever,  the  poison  being  introduced  directly  into  the 
system ; the  other  is  local  and  the  patient’s  life  is  often  saved  by  the 
formation  of  an  abscess.  We  may  also  have  pyaemia,  the  result  of 
the  absorption  of  the  discharge  of  an  old  abscess.  The  history  and 
later  development  of  the  symptoms  will  allow  us  to  differentiate. 

As  to  the  prognosis,  it  is  always  grave,  though  in  view  of  the 
possibilities  of  our  owu  materia  medica  we  need  fear  it  no  more  than 
we  would  a case  of  scarlet  fever  in  a non-puerperal  patient.  I say 
scarlet  fever  because  I know  of  no  condition  so  like  it  in  range  of 

O 


714 


world’s  homoeopathic  congress. 


temperature  and  course  even  to  the  desquamation  which  sometimes 
follows  puerperal  fever. 

History  and  aetiology  are  the  same  in  all  schools;  preventive 
medicine  should  be.  In  the  case  of  many  diseases  our  school  offers 
more  than  any  other. 

Recalling  the  part  the  physician  plays  as  a cause,  what  course 
should  he  follow  as  to  prophylaxis?  One  word  covers  all  his  duty, 
to  our  mind : Cleanliness.  Cleanliness  of  the  patient’s  person, 
cleanliness  on  the  part  of  the  physician  and  nurse,  cleanliness  of  in- 
struments. Everything  that  comes  in  contact  with  the  patient  must 
be  in  as  perfect  an  aseptic  condition  as  possible.  No  normal  dis- 
charge from  uterus  or  vagina  before,  during,  or  after  labor  contains 
any  noxious  bacteria.  Our  friends  of  the  antiseptic  school  insist 
that  we  shall  use  the  douche  before  labor,  and  in  labor  long  continued 
use  it  during  its  progress,  and  are  certain  of  the  necessity  for  the  use 
of  the  antiseptic  douche  after  labor. 

The  definition  of  the  term  “ Homoeopathic  Obstetrician,”  like  that 
of  all  others,  is  to  assist  women  during  the  lying-in  period,  the 
essence  of  the  definition  being  in  the  word  “ assist.”  If  he  has 
followed  the  above  instructions  he  can,  during  the  lying-in  period, 
assist  without  fear  of  causing  injury  or  that  he  has  introduced  any 
poison. 

Let  me  call  attention  here  to  the  fact  that  there  is  as  much  danger 
in  his  placing  too  much  reliance  upon  the  supposed  antiseptic  prop- 
erties of  drugs  commonly  in  use,  as  there  is  danger  in  the  drugs 
themselves  to  the  patient.  The  natural  logical  conclusion  of  the 
teaching  of  the  antiseptic  enthusiast  is  that  the  physician  can 
attend  more  than  one  case  of  puerperal  fever  if  he  only  uses  suf- 
ficient antiseptic  solution.  That  he  may  attend  cases  of  erysipelas, 
even  take  part  in  post-mortem  examinations,  without  danger  to  his 
obstetrical  patients,  provided  he  uses  sufficient  antiseptic  solu- 
tion. We  see  in  this  the  greatest  danger,  and  would  caution 
teachers  not  to  give  too  great  liberty  to  their  students  by  expatiat- 
ing too  strongly  upon  the  wonderful  power  of  this  or  that  favorite 
solution. 

There  is  no  analogy  in  nature  justifying  the  course  as  taught  in 
most  of  our  colleges.  We,  after  much  searching,  fail  to  find  any 
record  of  puerperal  fever  among  animals  excepting  when  operations 
have  been  performed  ; the  terrible  doctor  again  the  cause. 


PUERPERAL  FEVER. 


715 


And  should  poison  have  been  introduced,  what  then?  Its  course 
through  the  system  has  been  so  rapid  that  its  toxic  effect  is  shown 
by  the  chill,  the  high  temperature,  etc.,  while  local  manifestation  of 
the  disease  is  still  insignificant,  so  that  we  cannot  hope  by  any  locally 
applied  remedies  to  modify  its  effects.  After  the  germ  has  once 
penetrated  the  tissues,  we  soon  have  constitutional  fever,  in  which 
the  local  organs  are  but  slightly  implicated.  But,  doctor,  look  at 
the  records.  True,  since  the  introduction  of  the  antiseptic  treatment 
the  disease  has  been  reduced  to  a minimum,  but  the  prohibition  of 
examination  by  the  students  without  preparation  was  stopped  at  the 
same  time;  so  was  the  isolation  of  patients  commenced;  so  was  care 
on  the  part  of  the  attendant  physician  as  to  habits  first  commenced. 
We  claim  that  there  is  certainly  no  analogy  in  nature  for  the  use  of 
the  douche  and  no  argument  further  than  that  puerperal  fever  di- 
minished after  their  introduction.  The  women  of  the  present  day 
have  not  improved  in  their  “ getting  up”  by  these  means,  and, 
further,  I believe  that  the  use  of  the  douche  interferes  with  nature’s 
methods  of  repairing  the  injuries  of  child-birth.  It  weakens  the 
tissues,  and  unless  something  has  been  left  behind  by  the  carelessness 
of  the  physician  there  is  nothing  that  nature  has  not  fully  provided 
for.  Again,  the  douche  is  advocated  to  stop  the  absorption  of  pos- 
sibly present  poisons.  The  same  power  of  absorption  is  present  to 
pick  up  the  drug,  and  how  any  Homoeopathist  who  certainly 
believes  in  the  sixth  potency  can  use  any  antiseptic  solutions  and 
still  expect  clear-cut  indications  for  his  remedies,  we  don’t  under- 
stand. 

The  oft-repeated  example  of  the  savage  and  of  the  hard-working 
woman  is  a reproach  on  the  obstetrician  more  than  a sign  of  weak- 
ness on  the  part  of  his  patients.  Let  us  be  prepared  to  meet  dis- 
eased conditions  when  they  come,  but  not  cause  them,  and  if  our 
conscience  is  clear  that  we  have  not  introduced  poison  by  lack  of 
care,  we  need  not  follow  any  of  the  fashions  of  the  day.  The  young 
doctor  is  taught,  should  he  use  the  latest  antiseptics  and  lose  his  pa- 
tient, that  it  was  the  visitation  of  Providence,  and  no  fault  of  his. 
But  if  his  patient  should  die  under  other  circumstances  he  is  cul- 
pable. Away  with  such  nonsense,  and  especially  by  those  who  have 
at  their  command  remedies  which,  when  used  under  our  law,  in  ac- 
cordance with  the  teachings  of  our  materia  raedica,  which  seems  at 
times  to  have  been  written  by  inspiration,  are  far  more  certain  as 


716 


world’s  homoeopathic  congress. 


microbe  killers  than  any  of  the  coal-tar  products,  and  the  danger 
of  introducing  disease  by  the  obstetrician  is  far  less  than  of  pro- 
ducing disease  by  Corrosive  sublimate  added,  to  the  hydrant  water 
of  the  day.  That  cases  have  died  from  mercurial  poison  is  just  as 
certain  as  that  puerperal  fever  has  claimed  its  victims. 

Fortunately,  as  Homoeopath ists,  our  treatment  does  not  depend 
upon  aetiology,  and  whatever  may  be  our  opinion  as  to  that,  there  is 
no  reason  for  hesitation  as  to  treatment.  As  the  result  of  experi- 
ence, we  see  no  greater  reason  to  fear  the  result  in  this  disease  than 
in  any  other  severe  sickness. 

What,  I am  asked,  are  the  remedies?  First  of  all,  Rhus;  I 
never  saw  a case  where  it  was  not  called  for  sooner  or  later.  So 
constant  has  been  this  experience  that  I anticipate  the  condition  by 
giving  it  in  the  absence  of  other  directly  indicated  remedies,  or  when 
the  temperature  remains  stationary,  not  improving  under  previously 
prescribed  remedies.  I need  not  before  this  body  recount  the  symp- 
toms, but  will  add  the  warning  that  you  need  not  wait  for  looseness 
of  the  bowels  4o  appear  before  prescribing  Rhus,  as  has  been  recom- 
mended in  many  cases  of  typhoid  fever.  Among  other  remedies,  of 
course,  we  have  Aconite  for  the  characteristic  fear  of  death  and  rest- 
lessness; Bryonia,  when  the  abdominal  tenderness  is  marked,  but 
this  is  rarely  the  case;  Hyoscyamus  for  the  involuntary  discharge  of 
urine  and  stools;  Belladonna  when  the  head  symptoms  predominate; 
Arsenicum  for  its  characteristic  pulse  and  stomach  condition.  The 
use  of  Kali  carb.  has  been  verified  for  the  yellow,  gushing  stools 
which  so  frequently  present  themselves  about  the  fifth  day.  Should 
the  lochial  discharge  become  offensive,  it  can  easily  be  corrected  by 
carefully-selected  remedies,  most  likely  Carbo  animalis.  We  will 
state  here  that  if  there  is  reason  to  believe  that  there  are  retained 
membranes  or  placenta  left  in  the  uterus,  the  curette  is  indicated. 
If  spots  of  tenderness  appear  on  the  left  side,  Lachesis  will  help  ; 
if  on  the  right,  Lycopodium.  We  have  known  the  pain  to  disap- 
pear, not  to  return,  in  a very  few  hours  after  the  administration 
of  these  remedies.  Frequent  sponge  baths  are  advised,  their  fre- 
quency and  temperature  depending  upon  the  height  of  the  tempera- 
ture of  the  patient.  The  free  use  of  stimulants,  in  the  form  of  milk 
punch  or  brandy  and  water,  and,  if  nausea  is  present,  champagne. 
These  indications  are  the  result  of  experience.  I can  imagine  some 
one  saying  that  we  should  not  have  had  so  much  experience  had  the 


PUERPERAL  FEVER. 


717 


doctor  followed  the  antiseptic  methods;  he  would  not  have  seen  so 
much  puerperal  fever.  Let  me  say,  for  the  gentlemen’s  satisfaction, 
that  most  of  the  cases  which  I have  seen  have  been  in  consultation 
with  other  physicians,  and  that  he  has  never  had  but  one  case  of  the 
disease  in  his  own  practice  at  one  time.  Again,  the  methods  which 
he  has  used  have  been  uniformly  crowned  with  success. 

In  conclusion,  we  will  again  repeat  that  we  give  this  as  our  experi- 
ence with  puerperal  fever,  believing  that  it  shows  that  it  is  possible  to 
treat  this  disease  successfully  by  strictly  Homoeopathic  medicines  after 
the  manner  taught  by  our  founder;  that  if  it  is  followed,  the  patients 
will  be  able  to  return  sooner  to  a life  of  usefulness,  and,  as  a school, 
we  have  given  the  patient  the  advantage  of  the  beneficence  of  our 
laws.  Physicians  may  ask,  Why  should  we  not  avail  ourselves  of 
the  methods  generally  recommended?  Because  if  you  fail  to  take 
advantage  of  the  possibilities  of  the  law,  and  to  give  your  patient 
the  advantage  of  the  quickest,  safest  and  most  pleasant  methods  of 
cure,  you  are  not  true  to  your  patient,  not  true  to  yourself,  and  can 
give  no  reason  for  belonging  to  a school  with  a distinctive  name,  or 
to  one  which  has  a special  auxiliary  congress. 


718 


world’s  homoeopathic  congress. 


PUERPERAL  ECLAMPSIA. 

By  L.  C.  Grosvenor,  M.D.,  Chicago,  III. 


Happily  both  for  the  doctor  and  his  patients  this  disease  is  of  rare 
occurrence. 

It  is  a violent  convulsion,  epileptiform  in  character,  followed  by 
coma,  occurring  during  the  latter  months  of  gestation,  and  during 
and  after  labor.  Although  it  is  a condition  of  great  peril  to  both 
mother  and  child  much  can  be  done  in  the  way  of  prevention,  allevia- 
tion, and  cure. 

Many  are  the  causes  which  in  the  past  have  been  assigned  for  this 
malady  but  later  research  narrows  them  down  to  two  or  three.  All 
causes  sooner  or  later  refer  to  a functional  or  pathological  derange- 
ment of  the  kidneys.  Is  it  pressure  of  the  gravid  uterus  upon  these 
organs  ? 

Is  it  pressure  of  the  gravid  uterus  upon  the  solar  plexus,  thus 
interfering  with  the  renal  nerve-supply?  For  the  renal  plexus  re- 
ceives a large  part  of  its  nerve  fibres  from  the  solar  plexus. 

Is  it  some  peculiar  position  of  the  foetus  in  utero  ? 

Is  it  the  non-elimination  of  the  uric  acid — thus  constituting 
uraemia?  Is  it  albuminuria?  The  fact  that  albumen  is  so  constant 
a factor  would  lead  us  to  think  so.  For  fifty  years  albumen  has 
been  associated  with  this  disease  as  its  cause  and  has  been  so  at- 
tributed by  many  noted  authors. 

But  the  other  fact  that  eclampsia  occurs  in  cases  where  little  or  no 
albumen  is  present  makes  us  look  for  still  other  causes. 

I think  we  shall  find  them,  as  my  friend  Dr.  Tooker  once  sug- 
gested, in  the  peculiar  nervous  tendency  of  certain  expectant  women. 

Some  have  attributed  it  to  anaemia,  especially  cerebral  anaemia ; 
but  the  gestating  woman  is  a good  feeder,  and  if  eclampsia  occurred 
where  long  nausea  and  vomiting  had  been  of  daily  occurrence,  and 
the  system  been  depleted,  we  might  then  regard  it  as  a cause. 

That  renal  insufficiency  through  pressure  upon  these  organs  may 
be  the  cause  receives  color  from  the  fact  that  eclampsia  occurs  in 


PUERPERAL  ECLAMPSIA. 


719 


male  and  twin  pregnancies  and  in  persons  of  contracted  pelvis.  The 
male  child  being  on  an  average  larger  than  the  female,  for  in  one 
hundred  cases  each  of  consecutive  male  and  of  consecutive  female 
births  I found  a difference  in  weight  in  favor  of  the  male  of  from 
one-quarter  to  one-third  of  a pound  on  the  average. 

That  it  occurs  in  primiparse  and  especially  in  elderly  primiparse 
is  evidence  in  the  same  direction,  for  the  first  distension  of  the  abdo- 
men causes  more  resistance  and  pressure — and  when  these  abdominal 
parietes  have  settled  down  to  mature  life  without  distension,  as  in 
the  elderly  primi parse,  the  resistance  is  still  greater. 

That  these  attacks  are  due  to  pressure,  in  part  at  least,  is  sup- 
ported by  the  fact  that  prompt  delivery  of  the  child — thus  removing 
this  pressure — prevents,  in  so  large  a number  of  cases,  a recurrence 
of  the  convulsions. 

If  we  are  correct  in  the  premise  that  pressure  is  a prime  cause 
then  we  can  deduce  our  prophylactic  hints. 

Hints. 

1.  Easy  habits  of  dress,  discarding  the  corset  and  the  bands  about 
the  waist,  thus  relieving  the  tension  here. 

2.  A semi-prone  position  in  sleep,  the  abdomen  resting  upon  the 
couch  and  not  upon  the  kidneys. 

3.  Daily  massage  of  the  abdominal  parietes  using  warm  sweet  oil 
in  the  process. 

4.  In  the  rare  cases  where  peripheral  irritation  causes  the  convul- 
sions— remove  as  far  as  possible  all  sources  of  irritation.  These  with 
a proper  affiliation  of  remedies  like  Arsenicum  and  Apis  will  pre- 
vent the  final  trouble  in  a large  majority  of  cases. 

Symptoms. 

Among  the  first  symptoms  noticed  are — a puffiness  under  the  eyes 
— specks  or  cobwebs  before  the  eyes — sounds  in  the  ears,  swelling  of 
the  feet,  ankles  and  also  of  the  wrists. 

These  symptoms  should  lead  to  an  immediate  examination  of  the 
urine  and  if  we  find  albumen  present  in  any  considerable  quantities, 
we  should  immediately  commence  our  preventive  treatment.  Our 
armamentarium  is  full,  complete,  and  effective  to  combat  this  state 
of  things. 

My  friend,  Dr.  Tooker,  the  eminent  professor  and  author,  once 


720 


world’s  homoeopathic  congress. 


met  me  and  said  he  had  a case  which  promised  convulsions  at  labor, 
having  all  the  symptoms  which  precede  eclampsia.  He  urged  me 
to  respond  promptly  if  I were  called  to  his  aid.  A proper  affilia- 
tion, however,  of  the  remedies  in  his  skillful  hands  prevented,  and 
he  told  me  later  that  she  passed  through  the  ordeal  of  labor  safely. 

Perhaps  no  agent  is  so  valuable  at  the  time  of  the  convulsions  as 
chloroform  wisely  administered.  It  has  held  many  a case  in  check 
while  the  true  remedium  was  doing  its  curative  work. 

Perhaps  Bell,  and  Opium  are  the  most  commonly  indicated 
remedies. 

It  seems  strange  that  two  remedies  so  diametrically  opposed  to 
each  other  should  be  so  happily  and  uniformly  efficient  in  this  dis- 
ease. 

Some  Consultation  Cases. 

Dr.  S.  N.  Snider  called  me  in  a case  of  eclampsia.  He  had  de- 
livered the  case  and  hoped  that  this  would  terminate  the  convulsions 
as  it  so  frequently  does — but  they  continued,  and  were  of  a violent 
and  alarming  character.  Chloroform  held  them  in  check  while  the 
Bell,  was  doing  its  work.  This  case  made  a good  recovery. 

Prof.  Tooker  called  me  in  another  case  which  was  sprung  upon 
him  without  his  previous  knowledge  of  the  threatening. 

The  lady  was  in  a series  of  frequently  recurring  convulsions  when 
I arrived.  It  was  a primipara  past  thirty  years,  with  a breech 
presentation,  the  breech  having  been  for  some  time  impacted  in  the 
straits. 

Some  convulsions  occurred  after  the  delivery,  but  under  Dr. 
Tooker’s  skillful  handling  of  the  remedies  she  made  a full  though 
tardy  recovery.  Later  she  moved  west,  had  another  child,  and  died 
of  puerperal  convulsions. 

Some  months  ago  I was  hastily  summoned  to  an  adjoining  State. 
Here  I found  a lady,  37  years  old,  seven  months  along  in  her  first 
pregnancy,  and  having  had  frequent  convulsions  for  some  weeks. 

There  was  evident  and  increasing  harm  to  the  sensorium  from  the 
long  continued  strain.  After  getting  a history  of  the  case,  I ad- 
vised an  immediate  termination  of  the  gestation  as  the  only  course 
offering  any  hope  of  relief.  In  this  view  the  two  physicians  in 
charge  and  also  the  family  acquiesced.  At  11.30  P.M.  I commenced 
by  dilating  the  os,  using,  first,  an  index-finger  and  then  two  index- 


PUERPERAL  ECLAMPSIA. 


721 


fingers  back  to  back.  Soon  I had  sufficient  dilation  for  the  applica- 
tion of  the  forceps.  The  labor  terminated  successfully  in  three  and 
a half  hours. 

The  lady  had  no  more  convulsions,  regained  consciousness,  and 
the  doctors  in  charge  wrote  me  three  days  later  that  they  had  strong 
hopes  of  her  recovery.  She  died  about  two  weeks  later,  as  I after- 
wards learned.  And  right  here  let  me  say  that  if  this  renal  disturb- 
ance is  from  pressure  of  the  gravid  uterus,  we  have  a right  to  ex- 
pect relief  when  that  pressure  is  removed  ; but  if  the  convulsions 
ari&e  from  an  old  Bright’s  disease,  the  prognosis  is  very  doubtful. 

My  Own  Cases. 

In  my  own  practice  I have  had  but  four  cases  with  two  deaths  in 
thirty  years — a practice  covering  between  three  and  four  thousand 
cases.  The  statistics  and  authors  would  lead  us  to  expect  one  in 
b)ut  five  hundred  cases,  but  my  experience  has  been  much  less. 

I think  that  by  early  recognition  of  the  danger  and  a proper  use 
of  our  Homoeopathic  remedies,  I have  been  able  to  prevent  several 
cases. 

1.  My  first  one  occurred  about  twenty  years  ago,  in  the  case  of 
Mrs.  H.,  a primipara. 

The  convulsions  recurred  every  thirty  minutes.  After  the  second 
I sent  for  Hr.  S.  P.  Hedges  in  counsel.  He  being  out,  the  messenger 
brought  Dr.  M.  The  lady  was  delivered  with  instruments,  when 
the  convulsions  ceased,  not  to  return,  and  she  made  a good  recovery. 
The  convulsions  did  not  return  at  subsequent  labors.  She  is  at  the 
head  of  a beautiful  family  to-day. 

2.  Mrs.  S.,  from  another  city,  was  placed  under  my  care,  expect- 
ing to  be  confined  in  six  weeks.  She  was  a primipara,  nearly  30 
years  old.  Her  eyes  were  puffy;  her  hands  and  limbs  were  swollen  ; 
there  were  specks  before  the  eyes ; also  sounds  in  the  ears,  occasional 
vertigo,  and  frequent  micturition. 

Asking  the  husband  to  call  at  my  office,  I had  an  opportunity  to 
tell  him  of  the  danger,  and  that  he  must  be  prepared  for  trouble, 
explaining  to  him  as  definitely  as  possible  what  the  dangers  were. 
When  within  two  weeks  of  her  expectation,  I was  hastily  sum- 
moned to  find  her  in  convulsions  of  the  worst  type.  They  continued 
at  frequent  intervals  for  about  eight  hours,  when,  with  a violent 

46 


722 


world’s  homoeopathic  congress. 

cqnvulsion,  the  trouble  ended  in  death.  She  was  unconscious  from 
the  time  she  was  taken,  never  rallying  a moment. 

My  nephew,  A.  Grosvenor  Thome,  assisted  me  in  caring  for  the 
case. 

3.  I was  called  to  Mrs.  P.,  aged  33  years,  who  had  lost  all  her 
children  a year  previously  with  diphtheria.  She  had  it  in  a severe 
form  herself,  losing  some  features  of  her  face  by  blood-poisoning,  as 
her  doctors  affirmed.  This  diphtheria  probably  left  a kidney  dis- 
ease, which  fatally  complicated  her  gestation,  for  when  about  eight 
months  along  she  was  taken  with  eclampsia,  and  died  in  a convul- 
sion the  next  day.  My  son,  Dr.  Lorenzo  N.  Grosvenor,  was  with 
me  in  the  case. 

Whether  this  case  should  be  regarded  purely  as  a case  of  puer- 
peral eclampsia  or  as  a sequela  of  diphtheria  is  a question. 

4.  Mrs.  S.,  December,  1892,  a German,  primipara,  large  and 
strong,  and  24  years  old.  When  the  confinement  engagement  was 
made  there  was  some  indication  of  kidney  trouble,  but  the  family, 
being  poor,  objected  to  what  they  called  unnecessary  visits. 

I was  called  about  7 in  the  evening,  but  found  her  only  skirmish- 
ing, and  went  to  another  labor  case.  At  12  I left  my  case  and  saw 
her  again,  this  time  leaving  my  assistant,  Dr.  Wallace  F.  Grosvenor, 
in  charge  till  I should  complete  the  other  case. 

Towards  morning  she  became  tired,  fretful,  and  nervous.  At  6 
a.m.  she  had  a severe  convulsion,  and  they  occurred  hourly  till  8 
a.m.  My  son  gave  chloroform  immediately,  and  held  the  case  well 
in  hand  till  8 a.m.,  when  I applied  the  forceps  at  the  superior  strait 
and  labor  was  terminated  in  about  thirty  minutes.  Convulsions  fol- 
lowed at  9 a.m.,  12.30  and  5 p.m.,  and  during  the  evening  she  had 
three  more,  the  Bell,  and  the  chloroform  holding  them  in  check  some- 
what. 

I then  prescribed  rectal  suppositories,  each  containing 

Ex.  bell.,  . . 1 grain. 

Morphia  sulph., ^ grain. 

To  be  placed  every  three  or  four  hours. 

She  had  two  very  nervous  and  sleepless  days,  when  she  commenced 
to  gain,  and  made  a rapid  and  perfect  recovery,  being  up  and  about 
her  house  in  two  weeks.  The  child  was  a female;  weight,  ten  and 
a half  pounds;  strong  and  healthy. 


PUERPERAL  INSANITY. 


723 


PTJERPEEAL  INSANITY. 


By  M.  B.  Youngman,  M.D.,  Atlantic  City,  N.  J. 


Puerperal  insanity  is  commonly  divided  into  three  varieties: 

1..  Insanity  of  pregnancy,  appearing  during  the  term  of  gestation. 

2.  Puerperal  insanity  proper,  occurring  soon  after  delivery;  and 

3..  Insanity  of  lactation,  occurring  during  or  after  the  continu- 
ance of  prolonged  lactation. 

In  my  belief,  the  first  and  last  of  these  varieties  should  not  be 
classed  as  puerperal,  as  they  are  usually  due  to  some  cause  other 
than  the  puerperal  state,  which  latter  stands  in  the  relation  of  pre- 
cipitating cause  only.  There  is  an  inherited  predisposition,  neurotic 
or  hysterical  foundation,  syphilitic  taint,  or  an  exhausted  devitalized 
state,  and  the  puerperal  state  is  no  more  an  setiological  factor  than 
an)r  non-puerperic  cause  of  exhaustion,  mental  or  physical. 

The  second  variety,  or  puerperal  insanity  proper,  occurs  more  or 
less  suddenly  after  a recent  accouchement,  and  is  a septic  condition. 
It  is  almost  always  maniacal  in  type,  especially  if  accompanied  with 
much  elevation  of  temperature  and  the  other  symptoms  of  septic 
intoxication,  while  those  cases  (decidedly  in  the  minority)  which 
take  on  the  melancholic  type  are  the  outgrowth  of  a less  active  in- 
volvement of  the  system  with  the  septic  poison  and  accompanied  by 
the  usual  symptoms  of  asthenia.  In  the  cases  of  pure  puerperal 
insanity  that  have  come  under  my  personal  observation  there  has 
been  no  doubt  of  the  septic  origin  of  the  disease,  as  evidenced  by 
the  condition  of  the  sexual  organs,  the  veins,  the  breasts,  the  devel- 
opment and  course  of  the  symptoms,  the  reading  of  the  thermome- 
ter and  the  other  evidences  of  septic  absorption. 

The  two  following  cases  will  illustrate  the  two  types : 

Mrs.  N. ; set.  30 ; multipara;  nervo-sanguine  temperament;  de- 
livered with  forceps  after  a tedious  labor;  did  well  until  the  fifth 
day,  the  night  following  which  she  was  restless  and  did  not  sleep ; 
temperature  on  sixth  day,  101°.  Became  possessed  with  the  delusion 


724  world’s  homceopathic  congress. 

that  another  child  had  been  substituted  for  her  own  by  the  nurse, 
with  collusion  on  the  part  of  the  attending  physician,  upon  the  en- 
trance of  whom  into  her  room  she  would  develop  paroxysms  of  in- 
tense excitement,  although  toward  the  nurse  she  maintained  a tone 
of  imploring  entreaty,  as  though  she  might  in  this  way  iuduce  her 
to  restore,  through  pity,  her  own  babe.  Examination  showed  a 
diphtheritic  inflammation  of  the  vagina;  the  womb  was  enlarged 
somewhat  and  not  particularly  tender,  but  much  pain  along  the 
course  of  the  saphena  veins  in  the  thigh  was  complained  of. 

Her  temperature  for  a period  of  four  weeks  was  often  up  to 
103.5°  and  was  rarely  below  100°,  at  which  times  of  depression 
there  was  distinct  sweating,  once  or  twice  profuse.  She  made  good 
recovery,  at  the  end  of  three  months,  under  antiseptic  treatment  and 
the  indicated  remedy. 

Case  II. — Mrs.  K. ; set.  35;  multipara;  was  seen  by  me,  with  a 
brother  practitioner.  On  the  sixth  day,  after  an  easy  and  natural 
labor,  she  complained  of  chilliness,  aching  in  the  back  of  head, 
limbs  and  lumbar  region  ; temperature  100.5°  ; milk  rather  scanty, 
and  patient  much  depressed  thereat,  fearing  that  she  could  not  suf- 
ficiently nourish  her  child.  This  fear  became  so  fixed  that  in  a few 
days  she  talked  of  it  to  any  one  who  would  listen  to  her.  She  be- 
came dejected,  lachrymose  and  despondent,  declaring  that  God  was 
punishing  her  by  depriving  her  of  her  milk  for  her  babe,  because 
she  had  not  desired  it,  and  had  striven  in  the  early  months  of  her 
pregnancy  to  procure  miscarriage.  During  a period  of  three  weeks 
her  temperature  ranged  from  97.5°  to  101°,  no  regularity  in  the 
remissions.  She  perspired  much,  and  there  was  an  unwholesome 
and  sickly  odor  about  her  person.  Examination  showed  slight 
laceration  of  the  cervix  and  perinseum,  a single  stitch  having  been 
taken  in  the  latter  at  the  time  of  delivery.  There  was  an  offensive 
lochia,  not  profuse  in  quantity.  She  became  very  morose,  refused 
food,  expressed  a desire  to  die,  and  needed  to  be  watched  constantly 
that  she  did  not  execute  the  threats  of  suicide  which  she  constantly 
made.  She  made  recovery  after  persistent  treatment,  consisting  of 
antiseptic  measures  at  first,  the  indicated  remedy,  enforced  feeding, 
with  careful  nursing. 

Both  of  these  cases  were  clearly  septic  in  their  origin.  There 
was  no  albumin  in  the  urine  of  either;  there  was  a history  of  in- 
sanity in  the  family  of  the  first  patient.  In  fifteen  years’  experience 


PUERPERAL  INSANITY. 


• 725 


I have  seen  eight  cases  in  the  acute  or  early  stage,  either  my  own  or 
in  the  practice  of  friends,  that,  in  my  estimation,  were  septic.  I 
have  seen  a number  of  others  brought  to  Atlantic  City  for  the  ben- 
efit of  climate,  most  of  them,  of  course,  several  weeks  or  months 
after  delivery,  and  many  of  them,  in  my  belief,  not  puerperal  at  all, 
but  in  whom  the  puerperal  state  had  been  a precipitating  cause. 

It  follows  from  this  : 

1.  That  true  puerperal  insanity  is  septic  or  ptomanic  in  its  origin. 

2.  That  the  prognosis  based  upon  this  belief  and  the  following 
out  antiseptic  measures  is  much  more  favorable  than  ordinarily  laid 
down ; and 

3.  That  prophylaxis  is  of  the  utmost  importance. 

As  to  treatment,  I advise  quiet,  rest  and  freedom  from  care,  ab- 
solute cleanliness  of  the  person  of  the  patient,  the  intra-vaginal  use  of 

R.  Hydrogen  peroxide, f.  oz.  j. 

Aqua,  therm., O.  j.  or  stronger. 

M. 

The  use  of  Creolin,  Hydrarg.  bi-chlor.,  1-10,000,  Permanganate 
of  potash  solution,  or  simple  hot  boiled  water,  etc. 

If  undoubted  indications  existed  of  uterine  involvement  I would 
not  hesitate  to  make  use  of  the  intra-uterine  douche,  with  any  of 
these,  particularly  the  peroxide  of  Hydrogen,  and  as  a last  resort, 
but  not  hopelessly  late,  the  inter-uterine  curette. 

I advise  careful  and  persistent  feeding,  forced  feeding,  and  not  of 
liquids,  which  in  this  condition  as  in  other  states  of  insanity  is  of 
little  avail,  a half  pound  of  solid  food  being  of  more  value  than 
many  quarts  of  liquid  nourishment.  As  to  remedies,  we  have  many 
valuable  ones,  and  while  each  case  will  require  careful  study,  com- 
parison and  selection,  I may  be  pardoned  for  calling  attention  to  a 
few  of  those  perhaps  not  so  well  known,  that  I have  found  of 
value. 

Hyosciamine. — Hyoscine  hydrobromate.  These  have  been  of 
much  value  in  the  manaiacal  form,  in  substance  and  in  potency,  and 
of  particular  value  in  many  cases  in  procuring  sleep,  working  ad- 
mirably in  a case  where  Morphia  and  Chloral  had  failed  utterly  in 
the  hands  of  an  Old-School  friend. 

Valeriana. — Mother-tincture  in  water.  This  is  particularly  in- 
dicated in  excitable,  hysterical  cases. 


726 


world’s  homoeopathic  congress. 

Scutelaria. — This  drug  is  indicated  in  the  melancholic  variety  with 
marked  depression,  nervous  exhaustion,  apathy,  and  characterized  by 
frequent  changing  of  the  phase  of  the  symptoms. 

Monotropia  uniflor. — This  remedy  is  of  essential  value  in  cases 
exhibiting  great  erethism  accompanied  by  disturbances  of  the  sym- 
pathetic nervous  system,  as  dyspnoea,  rapid,  vacillating  pulse-rate, 
vaso-motor  disturbance,  etc. 

Ammon,  c. — One  of  the  best  remedies  in  the  maniacal  type,  to  be 
thought  of  also  if  the  case  should  present  any  albuminuric  compli- 
cations, or  uraemic  phenomena. 

Of  course,  it  is  of  little  use  for  me  to  speak  here  of  the  value  and 
indications  of  such  well-known  remedial  agents  as  Bell.,  Stram., 
Lachesis,  Arsenic,  Aurum,  Phosphorus,  Ignatia,  Stannum,  Zinc, 
Sulphur,  etc.  Very  few  cases  could  be  successfully  treated  without 
their  use. 

To  summarize  then,  the  treatment  that  I would  recommend, 
would  be: 

Asepsis  (prophylaxsis). 

Antisepsis. 

Forced  feeding. 

The  indicated  remedy. 

Hygiene. 

Discussion. 

L.  C.  Grosvenoe,  MJ). : I want  to  say  a word- to- this  last  paper. 
I want  to  say  just  a word  in  regard  to  feeding.  A.  few  years  ago, 
one  of  our  professional  brothers  sent  for  me  and  I went  there  to 
assist.  The  patient  believed  everybody  was  trying  to  poison  her. 
We  gave  her  oyster  broth,  milk,  soups — in  fact  we  gave  her  good 
square  meals  every  day,  but  the  third  morning  she  looked  up  when 
we  were  making  preparation  for  her  meal  and  she  said::  “ Well,  I 
believe  I will  take  my  breakfast  in  the  old  way  this  morning.”  I 
speak  of  this  to  emphasize  what  the  doctor  said  in  his  paper. 

Dr.  Yeomans:  In  reference  to  puerperal  insanity  I cannot 
quite  agree  with  the  doctor  that  it  is  the  result  of  sepsis  always.  It 
brings  one  case  to  my  mind  where  one  patient  for  four  successive 
times,  became  insane  about  the  third  month...  She  came  under  my 
care  during  the  third  time.  I think  I was  able  to  ameliorate  her 
condition  very  materially,  but  she  had  little  confidence  in  woman 
doctors,  and  especially  in  Homoeopathic  woman  doctors,  and  through 
a combination  of  influences,  my  patient  was  wrested  from  my  hands. 
Her  child  was  neglected  as  all. of  her  children*  were:  For  the  want 

of  a mother’s  care  they  had  died  in  early  infancy,  and  she  was 


PUERPERAL  INSANITY. 


727 


moved  to  an  asylum,  and  what  became  of  the  woman  I don’t  know, 
but  there  was  no  septic  influence  so  far  as  I was  able  to  detect.  I 
could  detect  no  uterine  lesions.  There  seemed  to  be  some  influence 
affecting  the  nerve  centres  that  I could’nt  really  explain. 

Dr.  Custis  : I don’t  know  that  I have  anything  further  to  say 
except  to  mention  that  during  the  past  winter  I had  a very  peculiar 
experience.  I had  a case  where  traumatism  was  the  cause  of  a 
fever,  and  the  first  thing  I knew  I was  in  the  case  without  knowing 
it  until  I got  in  the  room,  and  the  case  was  so  urgent  that  my  atten- 
tion was  demanded.  Then  there  was  another  case  that  I referred 
to  in  the  paper,  of  diphtheria.  Accidentally,  without  anybody’s 
fault  at  all,  that  infected  room  was  used  for  a confinement  case  before 
the  first  patient  had  been  out  of  it  five  days.  So  I came  to  the  con- 
clusion that  in  this  disease  we  have  one  that  is  contagious  in  the 
highest  degree;  that  the  disease  can  be  contracted  through  the 
larynx,  stomach  or  any  other  organ,  and  that  it  is  almost  impossible 
for  a physician  in  attendance  upon  such  a case  to  rid  himself  of  the 
poison  while  th,us  coming  from  other  cases. 

Dr.  Dinsmore:  Dr.  Grosvenor  did  not  mention — at  least  I did 
not  hear  him  mention — Veratrum  viride.  Some  regard  this  drug 
as  the  remedy  to  control  the  high  degree  of  fever.  I will  just  say, 
in  regard  to  puerperal  fever,  that  I was  unfortunate  enough,  a few 
years  ago,  to  have  five  such  cases  inside  of  ten  days,  and  that  after 
that  siege  was  over  I did  not  attend  any  more  for  a long  time.  After 
that  I did  not  see  a case  that  I thought  was  carried  directly  by  the 
physician. 

Dr.  Yeomans:  I have  had  quite  a number  of  cases  of  puerperal 
eclampsia,  and  I just  want  to-  say  that  I have  had  excellent  results 
with  Hyoscyamine,  and  when  I hear  this  subject  spoken  of,  that 
remedy  always  comes  to  my  mind,  and  I find  it  an  almost  invalua- 
ble medicine. 

Dr.  Grosvenor:  In  a Homoeopathic  convention  from  all  the 
United  States  and  Canada  and  the  West,  it  seems  like  a work  of 
supererogation  to  speak  of  remedies,  and  I only  alluded  to  the  pro- 
phylactic management. 

Dr.  Youngman  : Mr.  Chairman,  in  closing  the  paper,  I can  only 
answer  Dr.  Yeomans,  of  Iowa.  I think  the  case  she  refers  to  as 
occurring  three  or  four  times,  was  one  of  those  that  I speak  of.  I 
don’t  believe  much  in  puerperal  insanity.  I think  it  is  insanity 
incurred  from  some  other  cause,  or  some  excitement,  or  from  a pre- 
disposing cause. 


728 


world’s  homceopathic  congress. 


SOME  OF  THE  DISEASES  PREVENTING  AND 
COMPLICATING  PREGNANCY. 

By  Henry  C.  Aldrich,  M.D.,  Minneapolis,  Minn. 


Sterility. — DeSinety,  Treub,  Furbinger,  et  a/.,  attribute  50  per 
cent,  of  unproductive  marriages  to  the  husbands,  saying  that  ster- 
ility in  the  male  is  more  often  the  cause  of  barren  marriages  than  is 
generally  supposed. 

This  cause  of  sterility  I pass  by,  as  also  sterility  due  to  mechani- 
cal obstruction,  incomplete  ovulation  and  the  numerous  other  causes 
of  this  condition,  too  manifold  for  mere  enumeration,  to  consider 
obesity  as  a causative  agent  in  this  condition.  I need  not  say  that 
the  advocates  for  surgical  interference  for  the  relief  of  this  condition 
are  legion.  Sims  makes  the  assertion  that  sterility  can  be  cured  by 
surgical  means  only.  That,  of  course,  is  Allopathic  arguing  pure 
and  simple.  Cases  requiring  surgical  interference  do  arise,  but  any 
treatment  which  raises  the  nutrition  of  the  entire  organism,  improves 
the  blood-formation,  and  favors  the  resorption  of  pathological  pro- 
ducts in  the  sexual  organs,  is  to  be  regarded  as  the  indicated  remedy. 

Published  statements  are  my  authority  for  saying  that  excellent 
results  have  followed  the  administration  of  drugs,  nevertheless;  and 
in  complete  defiance  of  all  therapeutic  measures,  a certain  percentage 
of  women  remain  barren ; for  with  the  more  occult  causes  of  ster- 
ility we  remain,  as  yet,  unacquainted,  consequently  they  cannot  all 
be  reached  with  any  kind  of  treatment  whatever. 

The  following  case  I report  somew’hat  in  detail.  Whilst  not  an 
exceptional  case  at  all,  it  bears  directly  upon  the  subject  under  con- 
sideration, and  possesses,  it  seems  to  me,  some  decidedly  interesting 
features.  My  object  in  selecting  this  particular  one  is  to  call  atten- 
tion, if  possible,  to  a condition  not  sufficiently  considered.  Mrs.  J., 
set.  26,  married  about  two  years  and  a half,  appealed  to  my  knowl- 
edge for  a reason  as  to  why  she  remained  childless.  The  lady  was 
carrying  an  excess  of  flesh,  being  under  the  medium  height,  and 


DISEASES  PREVENTING  AND  COMPLICATING  PREGNANCY.  729 


weighing  186  pounds,  but  appeared  to  be  in  good  health  ; family 
and  previous  history  all  that  could  be  desired.  Examination  showed 
none  of  the  common  causes  of  sterility;  neither,  so  far  as  I could 
ascertain,  was  the  husband  responsible  for  this  unproductive  condi- 
tion of  affairs.  Some  previous  experiences  of  my  own,  with  the 
added  testimony  of  other  and  able  men,  was  my  reason  for  charging 
this  condition  of  things  to  the  excess  of  flesh,  this,  by  the  husband, 
being  laughingly  charged  to  excess  of  laziness. 

We  all,  undoubtedly,  are  familiar  with  that  peculiar  disease  of 
the  blood-corpuscles  which,  whilst  producing  flesh,  relaxes  at  the 
same  time  the  muscular  force;  acting  also,  I believe,  upon  the  mus- 
cular fibres  of  the  uterus  and  upon  the  ovaries,  inducing  not  only 
serious  menstrual  disorders  but  sterility.  McKee,  Philbert,  and 
others  give  several  instances  of  sterility  chargeable  to  obesity,  the 
women  in  question  having  been  married  several  years  without  bear- 
ing children,  and  all  became  mothers  after  losing  a portion  of  their 
flesh.  If  any  other  argument  were  needed  in  support  of  this  theory 
we  might  turn  to  the  quadrupeds,  where  we  find’the  poorest  breeders 
amono;  the  fleshiest  animals.  Fournei  has  a very  able  treatise  on 
“ The  Effects  of  Obesity  on  the  Menstrual  Functions  and  Partu- 
rition.” Without  having  had  any  actual  case  of  this  description  to 
deal  with,  he  inclines  very  strongly  towards  the  belief  that  obesity 
favors  sterility.  In  the  treatment  of  the  case  before  mentioned,  the  pa- 
tient was  subjected  to  a daily  massage  of  the  entire  body,  with  a 
special  pelvic  massage  three  times  a week.  This,  in  the  main,  consists 
in  elevating  the  uterus  as  high  as  possible  with  the  finger  in  the 
vagina,  ending  with  a quick  and  decided  vibratory  motion.  The  diet 
received  particular  attention,  as  at  this  time  there  was  a slight  gastric 
ailment.  The  indicated  remedy,  Thuja,  was  given  in  the  minimum 
dose.  At  the  end  of  three  months  almost  thirty  pounds  of  flesh  was 
gone,  a considerable  reduction.  As  an  experiment,  I recommended 
coitus  in  the  knee-elbow  position,  advising  that  the  lady  remain  quiet 
as  long  as  possible  after  coition,  with  thighs  well  flexed.  She  became 
enciente}  but  miscarried  at  eight  weeks.  There  was,  comparatively 
speaking,  but  little  pain  and  not  much  subsequent  haemorrhage. 
She  made  a rapid  recovery.  Since  then  a living  child  has  been  born 
to  them. 

I believe  I am  safe  in  saying  that  this  result  would  hardly  have 
obtained  were  it  not  for  the  prophylactic  measures  adopted. 


730 


WOKLD’s  HOMCEOrATHIC  CONGRESS. 


At  the  end  of  the  first  two  months  the  patient  was  attacked  with 
haemorrhage.  A similar  occurrence  took  place  at  irregular  intervals 
during  the  following  five  months,  the  quantity  of  blood  lost  being 
much  greater  than  that  at  the  normal  menstrual  period. 

For  the  greater  part  of  the  last  five  months  she  kept  her  bed,  at  the 
end  of  which  time  the  tendency  of  the  uterus  to  empty  itself  could  be 
resisted  no  longer.  A seven  months’  child  was  born,  and  is  to-day 
doing  well. 

Pseudo- cyesis,  cerebral  pregnancy , phantom  pregnancy  (whatever 
name  we  may  call  it  by)  is  a disease  which  must  come  under  the 
head  of  those  “complicating  pregnancy.”  Mrs.  M.,  a lady,  married 
two  or  three  years,  set.  29.  Previous  history  good,  always  enjoying 
perfect  health.  •When  I first  saw  the  lady  in  question  she  was  a per- 
fect picture  of  health,  and,  according  to  appearances  and  her  own 
statements,  about  seven  months  pregnant.  I made  no  examination. 
This  appeared  to  be  a thorougly  intelligent  woman,  and,  according  to 
her  own  statement,  there  was  cessation  of  the  menses.  There  cer- 
tainly was  an  enlargement  of  the  abdomen  and  breasts,  a milky  secre- 
tion, and  the  lady  was  sure  that  she  felt  foetal  movement.  On  Feb- 
ruary 28th  of  the  present  year  I was  called  to  attend  her  in  labor. 
Examination  showed  that  no  pregnancy  existed.  So  far  as  I could 
ascertain  there  was  no  assignable  origin  for  this  condition  other  than 
nervous  influences,  the  phenomena  being  purely  muscular  distension 
of  the  abdomen. 

May  ham  reports  a case  of  a woman  73  years  old,  claiming  to  be 
pregnant;  he  also  claims  that  subsequently  she  was  delivered  of  a 
child  ; this  is  an  Allopathic  report,  however,  of  which  we  will  take 
a Homoeopathic  dose.  Haultain  reports  three  cases  of  cerebral 
pregnancy.  In  the  first,  he  says  no  cause  whatever  was  to  be  found ; 
in  the  second,  there  was  cancer  of  the  uterus  ; in  the  third,  there  was 
a small  fibroid  growth  in  the  anterior  uterine  wall.  Hauck  reports 
a case  where  the  vomiting,  peristalsis,  and  flatus,  caused  by  alco- 
holism were  supposed  to  be  caused  by  the  pregnant  state.  Such 
cases  are  uncommon,  but  they  emphasize  the  importance  of  making 
a thorough  examination,  in  all  cases  where  positive  information  is 
desired  of  the  existence  or  non-existence  of  pregnancy. 

Hyperemesis  Gravidarum. — An  animated  discussion,  held  recently 
between  two  celebrated  Allopaths  of  Stuttgart  and  Leipsic,  has 
served  to  awaken  a renewed  interest  in  this  subject,  without  in  the 


DISEASES  PREVENTING  AND  COMPLICATING  PREGNANCY,  731 


least  adding  anything  new  to  our  stock  of  knowledge  regarding  its 
aetiology.  Notwithstanding  the  frequency  of  the  vomiting  of  preg- 
nancy, its  very  distressing  character  in  many  instances,  and  its  immi- 
nent danger,  we  find  but  very  few  contributions  of  any  value,  to 
either  the  aetiology  of  the  disorder  or  its  therapeutics.  I do  not 
expect  to  add  anything  specially  new  myself,  but  it  does  seem  to  me 
that  our  knowledge  of  the  vomiting  of  pregnancy,  is  to  say  the 
least,  in  a most  contradictory  state.  Some  physicians  look  upon  it 
as  a trifling  matter,  others  as  a thing  to  be  endured,  and  some  — 
these  are  in  the  right  too — view  even  the  mildest  cases  with  gravity. 
Even  in  the  mildest  cases  of  morning  sickness  there  is  a constant 
drain  upon  the  nervous  system,  putting  the  sufferer  into  a condition, 
in  which  she  is  very  much  less  able  to  endure  parturition  than  she 
would  otherwise  have  been. 

Dr.  Harrison  Mettler  says:  u After  careful  inquiry  I find  that 
women  who  suffer  from  much  morning  sickness  have  as  a rule, 
tedious  or  otherwise  troublesome  labors.  I have  observed  in  multi- 
parse that  at  one  time  they  will  have  much  nausea  and  vomiting 
followed  by  a difficult  labor,  while  at  another  time  they  will  be 
quite  free  from  the  vomiting,  and  will  pass  through  the  succeeding 
labor  with  comparative  ease.”  I must  say  my  observations  make 
me  agree  with  Dr.  Mettler  entirely  ; when  one  thinks  how  rapidly 
the  mildest  of  cases  assume  pernicious  forms,  indifference  is  cer- 
tainly no  longer  to  be  excused.  There  is  a voluminous  literature 
upon  this  subject,  and  many  and  varied  are  the  setiological  reasons 
given  for  this  very  variable  affection,  a large  majority  of  writers 
coinciding  in  the  opinion  that  “ many  causes  operate  together,”  to 
produce  what  we  are  pleased  to  designate  the  “ vomiting  of  preg- 
nancy.” I believe  myself  that  in  a large  percentage  of  cases,  this 
pernicious  vomiting  is  simply  the  result  of  a reflex  neurosis.  Un- 
doubtedly uterine  displacements  frequently  cause  vomiting ; but 
when  this  is  so,  and  the  displaced  organ  is  raised  by  packing  the 
vagina  with  aseptic  wool,  the  vomiting  ceases. 

Lillie  reports  a number  of  cases,  where  obstinate  vomiting  was 
caused  by  a retroflexed  uterus,  and  restoration  of  the  organ  caused 
a cessation  of  the  disorder.  Bezugloff  having  a persistent  case  of 
morning  sickness,  introduced  a bougie  into  the  uterus,  the  intention 
being  to  produce  abortion  ; the  immediate  result  was  a stoppage  of 
the  vomiting,  and  the  pregnancy  went  on  to  full  term. 


. 732 


world’s  homoeopathic  congress. 

In  the  case  just  cited,  I must  say  that  I believe  it  was  the  fright, 
caused  by  the  thought  of  abortion  being  performed,  more  than  the 
effects  of  introducing’ the  bougie,  which  operated  so  successfully;  I 
say  now,  as  I said  before,  I believe  that  the  pre-eminent'  cause  of 
this  kind  of  sickness  must  be  looked  for  in  the  nervous  system. 
Flint  speaks  of  this  form  of  sickness  as  being  decidedly  neurotic  in 
its  origin,  and  cites  a number  of  cases  of  a chronic  variety  of  dys- 
pepsia frequently  occurring  in  young  girls.  I had  one  such  case 
come  under  my  personal  care.  There  was  a persistent  morning 
sickness,  with  this  young  lady,  and  a disagreeable  nausea  whenever 
food  was  taken  ; this  patient  was  at  some  distance  from  her  home,  in 
a boarding  school,  and  she  will  probably  never  know  that  the  lady 
principal  entertained  very  grave  thoughts  at  one  time  in  regard  to 
her  virtue.  It  certainly  was  very  difficult  to  differentiate  between 
this  and  the  vomiting  of  pregnancy  ; it  was,  however,  simply  due  to 
a vitiated  nervous  system.  My  theory  is  supported  by  Alt,  who 
records  a number  of  such  cases;  I cite  one  only,  the  case  being  that 
of  a highly  hysterical  woman,  six  months  pregnant,  suffering  from 
the  gravest  vomiting,  and  anxious  that  miscarriage  be  induced.  She 
was  making  preparations  for  entering  the  hospital  for  this  purpose, 
when  one  of  her  children  was  seized  with  pneumonia.  The  anxiety 
felt  over  the  child,  forced  all  thought  of  self  from  the  mother’s 
mind  ; from  that  moment  the  vomiting  ceased  and  she  remained  well 
until  the  termination  of  pregnancy. — Munchener  Medicinische  Woch- 
enchrift. 

Whilst  saying  that  I believe  this  disease  to  be  in  the  majority  of 
cases  of  purely  nervous  origin,  I would  not  imply  thereby  that  it  is 
not  to  be  feared,  far  from  it ; if  neglected,  we  know  how  likely  it  is 
to  pass  quickly  beyond  treatment  and  our  patient  succumb  from 
sheer  exhaustion. 

In  the  treatment  cited  such  as  insertion  of  bougies,  dilation  of 
the  os,  pelvic  massage,  etc.,  I believe  it  is  merely  the  “ doing  some- 
thing,” no  matter  much  what  it  is,  so  long  as  you  have  gained  the 
confidence  of  your  patient,  that  does  good.  We  have  seen  how  sud- 
denly hyperemesis  will  cease  if  the  patient  be  alarmed  ; it  may  be, 
has  often  been,  and  will  be  again,  cured  by  a process  akin  to  sugges- 
tion. Kattenback  had  a case  where  the  patient,  a primipara,  was 
seized  with  an  incorrigible  vomiting.  It  was  suggested  to  her  that 
her  stomach  contained  some  lumps  of  unwholesome  material  and 


DISEASES  PREVENTING  AND  COMPLICATING  PREGNANCY.  733 


their  removal  would  cure  her.  Some  milk  was  given  her,  and  the 
stomach  ceremoniously  washed  out.  Its  contents  bore  no  indica- 
tions of  either  over-acidky  or  abnormal  ferment.  She  was  informed 
that  she  was  all  right  and  the  vomiting  would  not  return ; neither 
did  it,  and  she  was  safely  delivered  at  term. 

There  is  a familiar  and  now  well-known  phenomena,  by  which 
these  neurotics  can  be  influenced;  I speak  of  hypnotism  ; it  is  due  to 
purely  subjective  conditions. 

There  is  an  identity  of  the  hypnotic  susceptibility  with  the  condi- 
tion of  hysteria,  and  it  is  along  these  lines  that  we  can  work.  Just 
as  many  times  as  I have  tried  this  method  of  treatment,  for  these 
cases  of  excessive  vomiting,  just  so  many  times  has  it  given  me 
gratifying  results. 

The  patient  can  be  put  to  sleep  by  bi-ocular  pressure,  and  the 
idea  of  cure  suggested;  the  operation  may  have  to  be  repeated  sev- 
eral times,  at  intervals  of  a day  or  so,  but  you  will  be  rewarded  by 
the  cessation  of  the  vomiting,  often  with  but  one  suggestion.  Where 
the  patient  is  not  easily  controlled  by  means  of  the  bi-ocular  pressure, 
Luy’s  revolving  mirror  is  a never  failing  resource. 


REPORT 


OF  THE 

SECTION  IN  CLINICAL  MEDICINE. 


Chicago,  Friday,  June  2,  1893. 

The  Section  in  Clinical  Medicine  of  the  World’s  Congress  of 
Homoeopathic  Physicians  and  Surgeons  assembled  in  the  Hall  of 
Washington,  and  was  called  to  order  at  3 o’clock  p.m.,  by  Charles 
Gratehell,  M.D.,  of  Ann  Arbor,  Mich.,  the  Chairman  of  the  Section. 

As  the  first  business  in  order,  the  chairman  delivered  his  opening 
address,  entitled  : 

“Recent  Discoveries  in  the  treatment  of  Disease  by  the  Use  of 
Disease  Products,  and  their  Relation  to  Homoeopathy.” 

J.  Montfort  Schley,  M D.,  of  New  York,  N.  Y.,  read  a paper 
entitled  “ A Plea  for  Early  Operation  in  Pleurisy  with  Effusion.” 
It  was  discussed  by  Drs.  Oscar  Le  Seure,  of  Detroit,  Mich.;  J.  W. 
Dowling,  of  New  York,  N.  Y.  (whose  remarks  were  read  by  Dr. 
IT.  W.  Westover);  A.  A.  Whipple,  of  Quincy,  111.;  W.  H.  Burt, 
of  Chicago,  111.;  E.  R.  Eggleston,  of  Cleveland,  O.,  and  by  Dr. 
Schley,  the  author  of  the  paper. 

Then  followed  a paper  on  “ The  Prophylaxis  of  Cholera,”  by  Dr. 
B.  N.  Banerjee,  of  Calcutta,  India. 

“Cholera — Its  Curative  Treatment,”  a paper  by  Dr.  P.  C.  Ma- 
jumdar,  of  Calcutta,  India,  was  read  by  its  author.  It  was  discussed 
by  Drs.  W.  J.  Hawks,  of  Chicago,  111.,  and  J.  H.  Henry,  of  Mont- 
gomery, Ala. 

The  Chairman  then  announced  a paper  by  Conrad  Wesselhoeft, 
M.D.,  of  Boston,  Mass,  entitled  “ Some  Observations  on  Neurasthe- 
nia and  its  Treatment.”  He  stated  that  the  essayist  had  been  under 
the  necessity  of  returning  to  his  home  before  the  time  fixed  for  the 
meeting  of  the  section,  and  that  therefore  the  paper  would  be  read 
by  Dr.  J.  C.  Wood  instead.  Dr.  Wood  read  the  paper  and  dis- 
cussed it. 


REPORT  OF  SECTION  IN  CLINICAL  MEDICINE. 


735 


“ Bright’s  Disease,”  a paper  by  Dr.  P.  Jousset,  of  Paris,  France 
(translated  by  Dr.  Clifford  Mitchell,  of  Chicago,  111.),  was  presented 
by  title,  with  a discussion  by  Dr.  Geo.  M.  Dillow,  of  New  York, 
N.  Y. 

“The  Scientific  Clinician”  was  the  title  of  a paper  by  J.  P.  Suth- 
erland, M.D.,  of  Boston,  Mass.  It  was  presented  by  title,  together 
with  a written  discussion  of  the  subject  by  Dr.  George  B.  Peck,  of 
Providence,  R.  I. 

The  following  were  also  presented  by  their  titles  without  reading : 

“ Biliousness,”  by  F.  H.  Orme,  M.D.,  of  Atlanta,  Ga. 

“ The  Curative  Action  of  Homoeopathic  Remedies  in  Cases  of 
Organic  Disease  of  the  Heart,”  by  John  H.  Clarke,  M.D.,  of  Lon- 
don, England. 

“Moist  Heat  as  a Therapeutic  Agent,”  by  W.  A.  Edmunds,  M.D., 
of  St.  Louis,  Mo. 

“The  Study  of  Homoeopathy  as  a Distinct  and  Commanding  De- 
partment of  Medicine,”  by  John  C.  Morgan,  M.D.,  of  Philadel- 
phia, Pa. 

“ The  Homoeopathic  Treatment  of  Tabes  and  Pseudo-Tabes,”  by 
Alexander  Villers,  M.D.,  of  Dresden,  Saxony. 

The  meeting  of  the  section  was  then,  on  motion,  adjourned. 


736 


world’s  homoeopath rc  congress. 


INAUGURAL  ADDRESS  IN  CLINICAL  MEDICINE. 

Recent  Discoveries  in  the  Treatment  of  Disease  by  the 
Use  of  Disease-Products,  a^d  their  Relations 
to  Homoeopathy. 

By  Charles  Gatchell,  M.D,  Ann  Arbor,  Mich.,  Chairman. 


The  century  now  drawing  to  a close  will  pass  into  history  as  an 
era  of  wonderful  advance.  Never  before  has  there  been  such  cease- 
less activity,  such  painstaking  investigation  in  man’s  efforts  to  dis- 
cover and  to  control  the  forces  of  nature.  Medicine  shares  in  this 
spirit  of  discovery,  and  in  the  world  of  therapeutics  the  present  is  a 
period  of  great  unrest. 

In  the  Homoeopathic  school  this  activity  is  displayed  not  so  much 
in  the  addition  of  new  therapeutic  agents  to  our  already  extensive  list, 
as  it  is  in  a movement  to  systematize  our  present  records  of  drug  path- 
ogenesy,  to  expunge  that  which  is  faulty,  and  to  place  what  remains 

• in  a shape  to  be  efficiently  used.  Faith  in  Homoeopathic  methods 
was  never  stronger  than  it  is  to-day.  It  is  this  very  faith  that  in- 
spires the  demand  that  the  source  of  our  therapeutics  shall  be  reli- 
able and  authoritative.  To  this  end  effort  is  directed. 

On  the  other  hand,  in  the  dominant  school  little  confidence  is 
shown  in  prevailing  methods  of  treatment.  New  remedies  are 
being  eagerly  sought,  only  to  have  brief  title,  to  be  as  quickly 
abandoned. 

This,  also,  is  in  keeping  with  the  spirit  of  the  day.  Every  new 

• method  of  treatment  that  is  introduced  is  submitted  to  test  by  thou- 
sands of  experimenters.  If  wanting  in  merit,  it  is  soon  rejected. 

It  is  investigation  of  the  nature  indicated  that  gave  to  the  medi- 
cal world  the  synthetic  antipyretics,  which  for  a time  enjoyed  high 
favor.  At  last  it  was  found  that  antipyrine  has  no  power  to  control 
or  to  inhibit  the  heat-making  process — it  only  promotes  heat  elimi- 
nation. The  salicylates  have  no  specific  action  in  rheumatism — they 


INAUGURAL  ADDRESS  IN  CLINICAL  MEDICINE. 


737 


only  obtund  pain.  With  the  fall  of  these  two  drugs  from  their 
temporary  pedestal,  less  faith  is  reposed  in  the  class  of  remedies  to 
which  they  belong. 

But  investigators  are  not  idle.  Efforts,  however,  have  taken  an- 
other direction.  After  the  lapse  of  a hundred  years  the  medical 
world  has  turned  its  attention  anew  to  methods  closely  allied  to  that 
discovered  by  Jenner,  the  treatment  of  disease  by  agents  which  are 
the  products  of  disease.  Inspired  by  the  demonstrated  success  of 
Pasteur  in  the  preventive  treatment  of  rabies,  experimenters  are  in- 
dustriously working  in  this  promising  field.  Necessarily,  experi- 
ments are  confined  almost  entirely  to  the  lower  animals,  but  the  re- 
sults obtained  are,  in  many  cases,  definite,  and  give  promise  that  man 
may  yet  be  made  the  beneficiary.  In  the  lower  animals  infectious 
diseases,  artificially  produced,  that  usually  end  fatally,  may  be  led  to 
a favorable  termination  by  the  injection  of  micro-organisms  derived 
from  other  and  similar  infectious  diseases,  or  even  by  the  injection 
of  the  micro-organisms  of  the  same  disease. 

Again,  it  has  been  found  that  immunity  to  certain  diseases  may  be 
conferred  on  animals  by  the  injection  of  micro-organisms  or  their 
products — a state  of  immunity  without  which  the  animal  would 
perish  when  attacked  by  the  original  disease.  The  injection  of  the 
blood-serum  taken  from  an  animal  already  in  a state  of  immunity 
has  been  found  to  prevent  the  fatal  effects  of  certain  toxines  when  in- 
troduced into  the  system  of  the  susceptible  animal.  A number  of 
cases  have  been  reported  of  recovery  from  tetanus  after  the  injection 
of  Antitoxin,  a substance  obtained  from  the  blood  of  dogs  artificially 
rendered  immune  to  the  infection  of  tetanus. 

From  knowledge  gained  by  experiments  of  this  class,  it  is  prob- 
able that  new  and  valuable  methods  for  the  prevention  and  cure  of 
disease  will  be  developed.  The  results  already  attained  are  striking 
and  significant.  They  are  in  line  with  the  work  accomplished  by 
Jenner  and  Pasteur. 

Of  new  therapeutic  methods  none  surpasses  in  interest  that  intro-, 
duced  by  Murray,  of  England — the  treatment  of  myxoedema  by  the 
administration  to  the  patient  of  Thyroid  extract.  It  having  been 
conclusively  shown  by  Mr.  Victor  Horsley,  in  1884,  that  myxoedema 
is  due  to  loss  of  function  of  the  thyroid  gland,  Murray  conceived 
the  idea  of  treating  the  condition  by  the  injection  of  Thyroid  ex- 
tract. In  October,  1891,  he  reported  his  first  case,  which  gave  very 

47 


738 


world’s  homceopatfiic  congress. 


satisfactory  results.  Since  that  time  Murray  and  others  have  treated 
altogether  a large  number  of  cases,  and  it  is  now  possible  to  form 
some  estimate  of  the  value  of  the  treatment. 

The  method  pursued,  as  first  devised  by  Murray,  was  to  inject 
subcutaneously  a Thyroid  extract,  made  by  macerating  the  recently 
removed  thyroid  gland  of  the  sheep,  which  is  then  treated  with 
Glycerine  and  a weak  Carbolic  acid  solution.  A dose,  consisting  of 
from  ten  to  twenty-five  minims  of  this  extract,  is  slowly  injected 
beneath  the  skin.  But,  since  the  hypodermatic  injections  are  some- 
times followed  by  abscess,  Dr.  Hector  Mackenzie,  in  October,  1892, 
adopted  a modification  of  Murray’s  treatment,  which  consists  of 
feeding  to  the  patient  the  extract,  or  even  the  gland  itself.  It  is 
found  that  the  results  obtained  are  fully  as  satisfactory  as  those  fol- 
lowing the  use  of  the  subcutaneous  injection  of  the  extract.  To  the 
present  time  the  gland  has  been  used  in  four  different  forms — as  an 
extract,  a powder  prepared  by  desiccation  of  the  extract,  the  raw 
gland,  and,  most  remarkable  of  all,  the  gland  after  having  been 
fried.  Thus  it  would  seem  that  the  active  principle  contained  in  the 
gland  is  not  destroyed  even  by  heat.  Used  in  any  one  of  the  forms 
named,  the  remedy  seems  to  be  equally  efficacious. 

As  a result  of  this  method  of  treatment,  many  cases  of  com- 
plete recovery  from  myxoedema  have  been  reported  by  competent 
clinicians. 

The  time  required  in  order  to  bring  about  a cure  varies  in  dif- 
ferent cases  from  several  weeks  to  several  months  or  a year.  At  the 
end  of  the  period  all  signs  of  the  disease  have  disappeared  ; the 
oedema  subsides,  the  face  and  hands  become  natural  in  size,  the  speech 
is  restored,  the  spirits  brighten,  the  temperature  rises  to  normal,  the 
skin  becomes  soft,  smooth,  and  moist,  and,  most  conspicuous  of  all, 
the  previously  bare  scalp  becomes  covered  with  a heavy  growth  of 
hair.  In  a word,  all  lesions  and  symptoms  of  the  malady  disappear, 
and  the  patient  is  restored  to  perfect  health. 

The  size  of  the  dose  of  the  gland  or  its  extract,  it  is  found,  must 
be  carefully  regulated  in  order  to  obtain  the  best  results.  An  exces- 
sive dose  produces  cardiac  irregularity,  syncopal  attacks,  and  can 
even  cause  death.  But,  administered  with  the  care  that  would  be 
given  to  any  other  agent,  it  is  safe  and  efficacious. 

It  may  be  announced  that  a specific  for  a heretofore  incurable 
chronic  disease  has  been  found.  There  is  but  one  qualification  that 


INAUGURAL  ADDRESS  IN  CLINICAL  MEDICINE. 


739 


must  be  made,  but  that  is  a serious  one — the  recovery  is  not  perma- 
nent unless  the  treatment  is  continued  throughout  the  lifetime  of  the 
patient. 

But,  notwithstanding  this  one  disadvantage — the  necessity  for  the 
continued  use  of  the  remedy — Murray’s  method  of  treatment  of 
myxoedema  may  be  said  to  be  a great  therapeutic  triumph. 

The  mode  of  action  of  the  Thyroid  extract  in  the  disease  in 
question  would  seem  to  be  not  difficult  to  understand.  It  has  been 
pretty  conclusively  shown,  by  the  researches  of  Mr.  Victor  Horsley, 
that  the  thyroid  gland  plays  an  important  part  in  keeping  the  blood 
in  normal  condition  and  in  maintaining  the  natural  metabolism  of 
the  tissues.  The  thyroid  gland  thus  imparts  to  the  blood  some  ele- 
ment or  principle  that  neutralizes  the  tendency  to  the  peculiar  de- 
generation of  tissue  that  occurs  in  the  diseased  condition  known  as 
myxodema,  and  it  is  shown  that  this  same  element  or  principle  can 
remove  the  degeneration  after  it  has  once  occurred.  The  Thyroid 
extract  and  the  gland,  when  ingested,  evidently  supplies  to  the  blood 
the  principle  that  is  wanting  by  reason  of  loss  of  function  of  the 
gland  in  the  victim  of  the  disease. 

It  might  be  a satisfaction  to  be  able  to  find  some  Homoeopathic 
relation  of  the  remedy  to  the  disease  in  this  instance.  But  this  can 
* hardly  be  done.  On  the  contrary,  it  seems  to  be  an  instance  of  the 
revival  of  an  ancient  practice  under  more  scientific  auspices,  the 
treatment  of  conditions  depending  on  damaged  organs  by  the  ad- 
ministration of  such  organs  or  their  secretions.  The  method  under 
consideration,  therefore,  is  a marked  example  of  the  treatment  of 
disease  according  to  isopathy.  The  term  isopathy  is  applied  to  two 
distinct  practices.  One  of  these,  and  the  one  applicable  in  the 
present  instance,  is  “ the  theory  of  curing  a diseased  organ  by  the 
use  of  the  analogous  organ  of  a healthy  animal.” 

Hence,  we  must  conclude  that  the  treatment  of  myxodema  by  the 
use  of  Thyroid  extract  is  the  practice  of  isopathy. 

There  is  another  therapeutic  agent,  of  comparatively  recent  intro- 
duction, belonging  to  the  class  of  those  which  are  the  product  of 
disease  action  that  is  well  worthy  of  consideration  at  this  time.  Fol- 
lowing the  lead  of  Pasteur,  investigation  in  this  field  is  now  very 
active,  and  renewed  attention  is  being  given  to  the  agent  indicated. 

I refer  to  that  which  has  been  isolated  and  presented  to  the  profes- 
sion by  Koch — Parataloid  or  Tuberculin.  Notwithstanding  the 


740 


world’s  homoeopathic  congress. 


premature  announcement  of  the  alleged  virtues  of  Tuberculin  and 
the  extravagant  claims  made  in  its  favor,  there  is  now  evidence  that 
would  seem  to  indicate  that  it  will  yet  prove  to  be  a remedy  of  great 
value.  If  this  be  true,  it  will  have  a definite  place  in  the  Homoeo- 
pathic Pharmacopoeia.  It  is  for  the  purpose  of  reviewing  what  has 
already  been  done  in  this  direction  that  the  subject  is  now  brought 
to  your  attention. 

The  substance  under  consideration — Tuberculin — is,  probably,  the 
most  powerful  agent  ever  introduced  into  medicine.  In  describing 
its  action,  Hime  says:  “It  is  a tremendously  powerful  substance. 
An  ordinary  injection  represents  0.001  mgr.  of  the  liquid.  This 
contains  only  about  the  1-1000  part  of  active  material,  or  about  the 
fifteen  millionth  part  of  a grain.  Yet  this  infinitesimal  fraction  can 
set  the  whole  body  of  a man  weighing  two  hundred  pounds  in  such 
a state  of  change  that  the  whole  is  raised  to  a temperature  of  104° 
or  105°  F.  The  weight  of  the  mass  thus  affected  is  infinitely  greater 
than  that  of  the  active  agent,  the  exact  proportion  being  about  1- 
98,000,000,000. 

No  other  substance  known  to  medicine  will,  in  so  small  a quan- 
tity, produce  such  profound  effects.  Atropine,  Aconitine,  Glonoin, 
and  even  the  snake-poisons,  in  like  minute  quantity,  would  produce 
no  perceptible  systemic  disturbances. 

Tuberculin  is  a glycerine  extract  of  a pure  culture  of  the  bacillus 
tuberculosis.  And  yet  it  appears  that  it  is  not  identical  with  any 
ptomaine  produced  in  the  organism  by  the  bacilli  in  the  process  of 
disease.  Its  exact  character  is  not  defined.  The  active  principle 
seems  to  be  closely  allied  to  proteid  bodies.  That  it  does  not  belong 
to  the  group  of  so-called  Tox-albumins  is  indicated  by  the  fact  that 
it  resists  high  temperatures  and  can  be  readily  dialyzed.  A precipi- 
tate is  obtained  by  the  use  of  60  per  cent,  alcohol,  which  gives  a 
snow-white  mass  that  is  almost  pure  Tuberculin. 

This  new  remedy  possesses  one  property  that  adds  much  to  its 
interest.  The  universal  testimony  is  that  it  has  an  elective  affinity 
for  tuberculous  tissue.  Koch  says  : “ There  is  a general  consensus 
of  opinion  that  the  remedy  has  a specific  effect  on  tuberculous  tis- 
sue.” To  this  may  be  added  the  testimony  of  Virchow,  who  says : 
“ It  acts  in  a remarkably  selective  way.”  Virchow  further  re- 
marks : “ Evidence  of  its  specific  power  is  found  in  the  marked  in- 


/ 


INAUGURAL  ADDRESS  IN  CLINICAL  MEDICINE.  741 

dications  of  inflammatory  action  around  ulcerated  areas  and  in  con- 
tiguous lymphatic  glands.” 

In  order  to  assign  this  powerful  agent,  Tuberculin,  to  its  proper 
place  in  the  Homoeopathic  Materia  Medica — if  it  is  entitled  to  any 
such  place — two  things  must  be  determined  : first,  the  nature  of  its 
pathogenetic  effects  upon  the  healthy ; and  second,  its  curative  ac- 
tion when  applied  according  to  the  indications  of  these  pathogenetic 
effects. 

Unfortunately,  there  have  been  no  systematic  “ provings”  of  Tu- 
berculin, and  we  must,  for  the  present,  depend  upon  the  records  fur- 
nished by  a few  experiments.  It  will  be  seen,  however,  on  exami- 
nation of  these  records,  that  the  pathological  effects  of  Tuberculin 
are  more  or  less  constant  and  uniform. 

In  the  subject  of  tuberculosis,  the  injection  of  a small  quantity  of 
Tuberculin  is  followed  by  a most  profound  disturbance  of  the  system. 
There  is  great  and  rapid  rise  of  temperature,  and,  as  set  forth  by 
Virchow,  increased  destruction  of  tubercular  tissue,  with  its  absorp- 
tion and  dissemination  throughout  the  body.  This  is  accompanied 
by  great  aggravation  of  the  disease  from  which  the  patient  already 
suffers.  But  it  is  the  effect  of  the  remedy  in  the  healthy  subject  that 
we  are  interested  in  inquiring  into.  Koch  relates  the  results  of  such 
experiments.  The  first  subject  was  Dr.  Kitisato,  who,  June  24th, 
received  an  injection  of  two  milligrammes.  Four  hours  after  the 
injection  an  attack  of  coughing  came  on,  which  continued  for  three 
hours.  Five  hours  later,  or  eight  hours  after  the  injection,  the  tem- 
perature was  affected,  and  gradually  rose  from  97.7°  to  100.94°  F. 
The  pulse  rose  from  72  to  92,  and  these  symptoms  were  attended  by 
headache,  languor,  and  perspiration. 

Dr.  A.  Wasserman  received,  June  25th,  an  injection  of  3 milli- 
grammes. In  the  course  of  eleven  hours  his  temperature  rose  from 
98.06  degrees  to  101.66  degrees  F.,  and  his  pulse  from  80  to  92. 

Dr.  H.  Mass  received,  July  13th,  an  injection  of  4 milligrammes. 
In  the  course  of  the  twelve  hours  his  temperature  rose  from  98.6 
degrees  to  102.0  degrees,  and  his  pulse  from  72  to  100.  He  had 
slight  rigors,  a feeling  of  heat,  perspiration  and  vomiting. 

Dr.  P.  Guttman,  July  28th,  received  an  injection  of  8 milli- 
grammes. Within  eight  hours  his  temperature  rose  from  97.7  de- 
grees to  102.56  degrees  F.  The  pulse  rose  from  78  to  135.  This 
was  accompanied  by  rigors,  heat  and  sweating. 


742 


WORLD  S HOMOEOPATHIC  CONGRESS. 


From  these  records  it  may  be  seen  that  the  pathogenetic  effects  of 
tuberculin  are  as  constant  and  uniform  as  are  those  of  arsenic,  opium 
or  other  drugs  with  known  specific  action. 

The  character  of  its  effects  may  be  thus  summarized : 

After  a period  of  about  eight  hours  from  the  time  of  the  injection, 
the  reaction  begins.  First,  there  is  lowering  of  temperature,  fol- 
lowed by  a rise,  reaching  its  maximum  in  about  twelve  hours. 
Other  constitutional  symptoms  are:  chilliness  or  rigors,  headache, 
pain  in  the  back  or  through  the  body,  nausea,  vomiting,  prostra- 
tion. Another  noteworthy  symptom  is  that  there  is  a short,  dry 
cough,  even  in  provings  on  healthy  subjects,  those  whose  lungs  are 
sound. 

Those  symptoms  subside  after  twenty-four  or  forty-eight  hours. 
Provings  have  not  as  yet  gone  beyond  the  point  here  indicated.  If 
pushed  further,  the  indications  are  that  it  would  produce  most  pro- 
found disturbance  and  even  endanger  life. 

Let  us  now  examine  the  records  of  the  use  that  has  been  made  of 
tuberculin  by  Homoeopathic  physicians. 

Reports  of  cases  treated  have  been  made  by  Drasche,  of  Austria ; 
Furbringer,  of  Germany;  Jousset,  of  Paris;  Burnett,  of  England, 
and  Arnulphy,  of  Chicago. 

Drasche  treated  fourteen  cases,  six  of  which  were  improved  and 
eight  aggravated.  Furbringer  treated  forty  cases,  three  of  which 
were  cured  and  fifteen  ameliorated. 

Dr.  Arnulphy’s  cases  are  of  exceedingly  great  interest,  both  be- 
cause of  the  favorable  results  attained  and  because  they  include 
cases  of  acute  tuberculosis. 

The  first  case  Dr.  Arnulphy  reports  is  of  a young  woman,  26 
years  of  age.  For  six  or  seven  months  there  had  been  slight  symp- 
toms of  pulmonary  trouble,  consisting  of  dry  cough  and  emaciation. 
Suddenly  her  symptoms  became  acute,  and  the  disease  made  rapid 
progress.  She  showed  great  weakness,  pallor,  great  emaciation  and 
almost  incessant  cough,  rapid  breathing,  temperature  of  105  degrees 
F.,  profuse  perspiration  at  night  and  abundant  diarrhoea.  Oyer  the 
right  lung  the  respiratory  sounds  were  obscure.  The  left  lung  was 
much  affected ; at  the  apex  there  were  moist  rales,  surrounded  by  a 
zone  of  sub-crepitant  rales;  at  the  base,  bronchial  bubbling  rales. 
The  diagnosis  was  acute  tuberculosis  and  the  prognosis  grave,  if  not 
fatal. 


INAUGURAL  ADDRESS  IN  CLINICAL  MEDICINE. 


743 


Tuberculin  was  prescribed.  From  the  first  dose  the  cough  abated, 
the  breathing  became  easier,  and  in  a few  days  the  patient’s  condi- 
tion had  so  much  improved  in  all  respects  that  she  was  pronounced 
to  be  out  of  danger.  Two  weeks  later  she  was  out,  and  shortly 
after  left  her  home  in  Chicago  and  made  a journey  to  the  far  west. 
The  woman  is  still  living. 

Dr.  Arnulphy  reports  four  other  cases,  all  of  acute  phthisis,  which 
were  treated  successfully,  most  of  which  are  as  remarkable  as  the 
one  already  detailed. 

As  a result  of  his  experience,  Dr.  Arnulphy  remarks:  Judging 
by  the  success  achieved,  I am  justified  in  saying  that  the  proper  field 
for  the  activity  of  tuberculin  is  acute  tuberculosis — precisely  those 
cases  which  Koch  and  his  followers  persistently,  and,  from  their 
standpoint,  consistently  refused  to  treat  with  the  lymph,  on  account 
of  the  reaction  that  they  dreaded.” 

Burnett,  of  England,  reports  a number  of  cases  cured  ; but  his 
records  are  so  wanting  in  scientific  precision  that  it  is  impossible  to 
give  a satisfactory  summary  of  the  results. 

The  question  of  great  interest  is : Is  the  action  of  tuberculin  in 
the  cure  of  tuberculosis  Isopathic,  or  is  it  Homoeopathic  ? 

In  order  to  answer  this,  it  is  necessary  again  to  define  the  term. 

Isopathy  may  be  said  to  be  “ The  treatment  of  disease  by  one  or 
more  of  its  own  products.” 

One  lexicographer,  in  illustrating  this  definition,  says  : “ Thus, 
smallpox  should  be  treated  by  the  administration  internally  of  the 
various  excretions.” 

If  Koch’s  tuberculin  has  a curative  action  in  tuberculosis — as  would 
now  seem  to  be  established  from  the  experience  of  those  Homoeo- 
pathic physicians  who  have  already  reported  on  the  subject — it  fol- 
lows that  the  action  is  isopathic , if  the  tuberculin  of  Kocli  is  a product 
of  the  diseased  process  lcnown  and  recognized  as  tuberculosis. 

Let  us  see  if  this  be  true,  Koch’s  tuberculin  is  a preparation 
made  from  a pure  culture  of  the  bacillus  tuberculosis.  The  bacilli 
used  may  be  removed  two,  three  or  even  one  hundred  generations 
from  the  original.  A glycerine  extract  of  the  medium  of  culture  is 
made;  this  is  filtered  through  plaster-of-Paris,  and  from  this  an 
alcoholic  precipitate  is  obtained,  which,  in  attenuation,  is  the  med- 
icinal preparation  employed  in  the  treatment  of  disease. 

That  the  preparation  thus  obtained  is  not  a product  of  disease  is 


744 


world’s  homoeopathic  congress. 


evident.  It  is  a product’of  the  artificial  cultivation  of  a certain 
bacillus,  which  may  be  removed  a hundred  generations — yes,  a 
thousand,  an  indefinite  number  of  generations  from  the  original. 
It  is  not  a product  of  disease;  it  is  a product  of  the  test-tube. 

But  if  the  product  thus  obtained  were  identical  with  the  ptomaine 
produced  in  the  lungs  or  other  organs  in  disease,  we  could  not  then 
deny  the  isopathic  relation  of  the  remedy  to  the  disease.  But  the 
evidence  furnished  by  the  pathogenetic  action  of  tuberculin  does  not 
support  this  view.  Burnett  truthfully  says : “If  you  alter  some- 
what two  things  that  are  identical,  then  the  identity  becomes  simi- 
larity.” 

If  the  ptomaine  produced  in  the  system  of  the  tuberculous  pa- 
tient were  identical  with  that  produced  by  the  culture  process  fol- 
lowed by  Koch,  a minute  quantity  of  it  would  speedily  overwhelm 
the  system.  This  does  not  occur.  It  is  safe  to  say  that  the  amount 
of  the  ptomaine  produced  in  the  system  of  the  victim  of  tubercu- 
losis is  almost  without  limit.  If  this  product  were  identical  in 
nature  with  the  tuberculin  of  Koch,  tuberculosis  would,  in  every 
case,  be  one  of  the  most  rapidly  fatal  of  all  diseases ; the  duration 
of  the  attack  in  every  case  would  be  but  a few  days,  instead  of  weeks 
and  months  and  years,  according  to  its  present  history. 

Of  the  artificial  product,  tuberculin,  the  0.001  mgr.  will  produce 
the  most  profound  effects  upon  the  system,  in  a few  hours  raising  the 
temperature  from  normal  to  104  degrees  or  105  degrees  F.  In  the 
systems  of  those  already  affected  by  tuberculosis,  its  effects  are  even 
more  disastrous.  Now,  if  the  product  of  the  disease  process  and  of 
the  culture  process  were  identical,  then  the  effects  of  the  two  should 
not  differ  in  any  respect  whatever.  The  evidence  adduced,  there- 
fore, supports  the  conclusion  that  the  action  of  Koch’s  tuberculin  in 
the  cure  of  tuberculosis  is  not  Isopathic,  but,  on  the  contrary,  that 
it  is  Homoeopathic. 

Jousset  says  : “ Homoeopathists  only  will  be  able  to  make  intelli- 
gent use  of  tuberculin.  We  know  that  it  is  a powerful  agent  that 
has  a specific  action  in  tuberculous  affections.  We  know  why  it  is 
useful  in  phthisis;  it  is  because,  administered  in  a large  dose,  it 
aggravates  in  phthisis.  This  is  because  the  remedy  is  Homoeopathic 
to  the  diseased  condition ; that  is  to  say,  it  is  a remedy  that  will 
cure  a diseased  condition  similar  to  that  which  it  produces  in  the 
healthy  subject.  And  since  it  is  a Homoeopathic  remedy,  we  know 


INAUGURAL  ADDRESS  IN  CLINfCAL  MEDICINE. 


745 


it  must  be  indicated  by  the  totality  of  the  lesions  and  the  symptoms. 
Consequently,  in  order  to  complete  its  pathogenesy  it  is  necessary 
to  know  in  what  class  of  cases  of  phthisis  it  is  indicated  and  in  what 
it  is  not.” 

If  the  view  that  I have  here  set  forth  is  correct,  then  the  conclu- 
sion is  warranted  that  the  action  of  tuberculin  as  a remedy  for  tu- 
berculosis is  not  an  example  of  Isopathy.  On  the  contrary,  the 
evidence  at  hand  would  seem  to  indicate  that  its  action  is  distinctly 
Homoeopathic.  This  being  granted,  then  it  must  be  accepted  as 
true  that  Koch’s  important  discovery  is  but  another  illustration  of 
the  law  of  similars,  and  a notable  demonstration  of  the  power  of 
infinitesimals  in  the  cure  of  disease. 


746 


world’s  homoeopathic  congress. 


A PLEA  FOB  EARLY  OPERATION  IN  PLEURISY 
WITH  EFFUSION 

By  J.  Montfort  Schley,  M.D.,  New  York,  N.  Y. 


Two  articles  appearing  recently — the  one  by  Dr.  Barrs,  in  the 
British  Medical  Journal , dealing  more  especially  with  the  dire  results 
of  pleuritic  effusion,  the  other  by  Dr.  Lindsay,  in  the  Lancet , touch- 
ing more  on  the  advisability  of  early  interference  in  such  cases — 
have  brought  out  very  suggestive  points  for  us  to  consider. 

It  is,  however,  with  some  hesitation  that  I have  undertaken  to 
direct  the  attention  of  this  Society  to  so  familiar  and  well  nigh 
hackneyed  a subject  as  pleural  effusion  and  empyema.  I feel  some- 
what at  ease,  though,  in  doing  so,  because  the  disease  in  question, 
however  familiar,  possesses  an  exceptional  clinical  interest,  and  be- 
cause there  are  many  points  in  its  ultimate  pathology,  perhaps  aeti- 
ology— and  more  especially  its  treatment — around  which  much  con- 
troversy has  raged  and  is  still  raging.  It  is  out  of  the  question  to 
handle  exhaustively  so  vast  a subject  as  pleural  effusion  and  empy- 
ema. I will  therefore  limit  my  remarks. 

There  can  be  no  doubt,  in  my  opinion,  that  there  is  a strong  and 
growing  tendency  to  employ . operative  measures  by  those  who  see 
much  pleurisy,  and  who  are  able  to  keep  track  of  these  sufferers  for 
months  or  years  after  their  original  attack. 

It  is  only  in  this  collective  method  that  we  shall  be  able  to  speak 
pro  and  con  for  early  operative  methods. 

As  the  best  thinking  and  scientific  minds  of  the  Old  and  some  of 
the  New  School  are  busying  themselves  most  with  preventive  medi- 
cine, and  then  with  curative  medicine,  it  seems  to  us  that  a more 
fitting  field  for  such  investigations  does  not  exist  than  in  the  one 
under  discussion. 

In  orthopaedic  surgery  much  has  been  learned  and  discovered  within 
the  past  ten  years — recognizing  disease  early  (by  experts),  by  suit- 
able appliances  rectifying  deformities,  and  if  they  already  exist, 
minimizing  them  to  a marked  degree. 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


747 


In  pleurisy  a similar  picture  should  be  presented. 

Unrecognized  pleurisy,  or  pleuritis  with  effusion,  maltreated  leads 
to  a maiming  of  the  lung,  its  disability  to  perform  more  than  one- 
third  of  its  proper  work,  phthisis  and  lateral  curvature  of  the 
spine,  etc. 

Curative  medicine,  then,  in  such  cases  must  be  looked  for  in  two 
directions:  first,  as  a power  to  promote  recovery  from  injury  of  ex- 
ternal origin ; secondly,  as  a power  to  mitigate  or  remove  diseases 
arising  within  the  body. 

And  again,  we  are  led  in  such  cases  by  our  old  habits  of  thought 
to  regard  life  as  a thing  of  the  body  alone,  and  to  forget  that  life 
lies  between  the  body  and  the  medium,  and  is,  as  it  were,  a play  of 
activities  between  two  surfaces,  so  that  the  medium  needs  as  much 
curative  vigilance  as  the  body  does,  and  is  far  more  within  our  power 
and  comprehension. 

Therefore  the  prominent , and  often  even  exclusive , place  given  to 
the  administration  of  medicines  and  the  swallowing  of  drugs  is  not 
only  questionable,  but  positively  mischievous,  in  so  far  as  it  leads 
the  public,  not  to  mention  ourselves,  to  attach  primary  importance 
to  measures  at  best  auxiliary,  and  in  so  far  as  it  blinds  us  to  the  far 
greater  importance  of  studying  the  earlier  and  lesser  deviation  of 
function,  and  of  readjusting  the  conditions  under  which  the  indi- 
vidual lives  exist. 

Those  of  us  who  may  have  made  many  post-mortems  or  witnessed 
them  attentively,  must  have  been  impressed  with  the  great  frequency 
with  which  adhesive  pleuritis  was  met. 

And  it  seems  to  me  that  it  matters  little  where  these  adhesions  are 
found,  but  that  they  must  represent  just  so  much  mechanical  inter- 
ference with  the  act  of  respiration  and  interchange  of  oxygenation 
during  the  act  of  respiration. 

To  properly  understand  the  gravity  of  all  pleuritic  effusions  we 
should  appreciate  somewhat  the  pathology  of  such  cases. 

The  changes  which  take  place  in  an  inflamed  pleura  are  essen- 
tially the  same  as  those  met  in  other  serous  membranes.  The  earli- 
est stages  are  indicated  by  capillary  congestion,  and  sometimes 
ecchymotic  spots  in  the  subserous  tissue,  with  extravasations  of 
blood  into  the  pleura  itself;  the  membrane  then  loses  its  smooth, 
glossy  surface,  becoming  rough,  dull  and  opaque,  and  is  soon  cov- 
ered by  a delicate  gray  deposit,  consisting  of  fibrin,  epithelium  and 


748 


world’s  homceopathic  congress. 


young  cells,  and  as  this  deposit  increases  apparently  layer  by  layer, 
it  becomes  yellowish  in  color. 

These  changes  are  observed  both  on  the  parietal  and  pulmonary 
pleura. 

In  the  rare  cases  in  which  a more  or  less  diffused  pleuritis  stops 
here,  and  is  not  followed  bv  liquid  effusion,  the  inflammatory  prod- 
ucts are  either  entirely  absorbed,  or — which  occurs  most  frequently 
— the  opposing  surfaces  become  adherent  in  whole  or  in  part  by 
organized  connective  tissue,  and  the  sac  is  obliterated  over  the  ad- 
herent areas. 

Complete  obliteration  over  the  bases  is  seen  chiefly  in  severe  and 
long  standing  cases,  where  absorption  has  been  left  to  its  own  judg- 
ment, or  after  empyema. 

Meliu  and  Laboulbene  have  justly  maintained  that  the  ultimate 
recovery  of  the  patient  will  proceed  more  slowly  or  more  rapidly, 
according  as  the  exudations  are  more  or  less  fibrinous. 

The  next  step  to  congestion  and  fibrinous  exudation  is  the  effusion 
of  fluid. 

All  pleuritic  effusions  lead  naturally  to  a number  of  local  and 
general  pathological  conditions,  partly  owing  to  the  quantity  and 
quality  of  the  exudations  themselves,  and  partly  in  consequence  of 
the  changes  which  these  exudations  gradually  undergo.  The  amount 
of  the  exudation  will  limit  the  amount  of  the  compression  of  the 
subjacent  lung,  as  well  as  the  extent  of  the  displacement  of  the  ad- 
jacent organs,  as  the  mediastinum,  the  opposite  lung,  the  great 
venous,  arterial,  and  nervous  trunks,  the  diaphragm,  the  chest  wall, 
liver,  stomach,  etc. 

In  fibrino-serous  effusions — which  are  most  frequently  met  with 
at  the  onset  of  all  pleurisies — recovery  commences  in  most  cases  by 
the  gradual  concentration  of  the  exudation.  In  consequence  of  this 
the  absorption  proceeds  much  more  rapidly  at  the  beginning  than  it 
does  later  on.  Finally,  the  fluid  portion  of  the  exudation  may 
entirely  disappear,  and  the  pleural  surfaces,  roughened  by  deposits, 
come  again  in  contact  and  often  become  fused  together. 

If  the  process  of  absorption  sets  in  sufficiently  early,  the  com- 
pressed lung  again  becomes  permeable  to  air  and  re-expands. 

We  must  still  form  an  accurate  idea  of  the  anatomical  changes 
which  arise  in  those  chronic  cases  in  which  the  exudative  deposits 
become  organized  into  conuective-tissue  masses. 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


749 


In  the  course  of  the  pleuritis  we  note  repeated  exudations  taking 
place  which  undergo  organization,  harden,  and  finally  are  found  in 
layers  sometimes  an  inch  in  thickness. 

The  serous  and  sub-serous  tissues  are  often  merged  into  this  new 
formation,  and  are  hard  to  distinguish  from  it. 

If  the  pleura  pulmonalis  is  affected,  it  always  appears  thicker  on 
section  and  shrunk  on  the  surface. 

This  leads  to  a shrinking  and  retraction  of  the  subjacent  lung 
tissue,  the  hilus  of  the  lung  forming  the  centre  of  the  retraction, 
while  the  margins  of  the  lung  become  rounded  by  this  pleuritis  de- 
formans. 

This  retraction  leaves  a free  space  in  the  pleural  cavity  which  be- 
comes filled  with  fluid,  which  has  little  chance  of  being  absorbed  the 
thicker  the  two  pleural  surfaces  become.  The  pleura,  in  such  a 
state,  rapidly  loses  its  absorbent  power. 

Thus  the  capability  of  expansion  in  such  a lung  is  forever  lost. 

Again,  if  the  pleura  becomes  covered  with  thick  false  membranes 
while  there  is  still  considerable  effusion  in  the  pleural  cavity,  and 
before  its  absorption  has  been  possible,  this  circumstance  hinders  its 
further  absorption,  and  the  remainder  of  the  exudation  may  thus 
remain  for  months  or  years  encapsulated. 

The  thicker  and  more  fibrous  the  false  membranes,  the  less  vas- 
cular are  they. 

This  organized  false  membrane  sometimes  assumes  a pyogenic 
character,  from  which  pus  is  continuously  secreted.  When  the  fluid 
effused  in  the  earlier  stages  of  the  disease  becomes  absorbed  and  no 
new  liquid  (serous  or  purulent)  effusions  are  poured  out  between  the 
layers  of  exudation,  the  lung  must,  in  such  cases  of  pleuritis  de- 
formans, diminish  more  and  more  in  size. 

The  adjacent  movable  organs,  as  well  as  the  thoracic  walls,  must 
•contribute  to  the  filling  up  of  this  vacuum. 

The  different  character  of  the  effusions,  whether  serous,  sero-fibri- 
nous,  purulent  or  haemorrhagic,  all  have  their  important  significance. 

Anstie  and  Wagner,  from  clinical  and  microscopical  work,  have 
found  that  these  false  membranes  develop  more  freely  at  first  when 
the  opposing  surfaces  are  kept  apart  by  the  effused  liquids.  The 
running  of  the  two  pleurae  together  seem  to  impede  the  process  of  organ - 
ization. 

Wagner  betones  the  fact  that  these  newly-organized  and  vascular 


750 


world’s  homceopathic  congress. 


tissues  often  become  the  starting-points  of  fresh  inflammatory  pro- 
cesses and  of  new  products.  N 

The  question,  then,  now  which  presents  itself  to  us,  after  digest- 
ing the  foregoing  opinions  of  the  most  reliable  authors  upon  #the 
constant  tendency  for  pleuritis  with  effusion  to  leave  the  lung  dam- 
aged, is,  whether  we  should  be  satisfied  with  remedial  measures  until 
the  patient  is  nearly  in  extremis,  or  shall  we,  by  a timely  and  simple 
operative  procedure,  speedily  restore  our  patient  to  perfect  health  by 
removing  an  exudation  which  is  seldom  able  to  leave  the  organ  as  it 
found  it. 

Professor  Nothnagel  tells  us  that  “a  cure  consists  in  so  modifying 
pathological  processes — be  they  chemical  or  physical,  functional  or 
dynamic — as  not  only  to  arrest  them,  but  to  restore  to  a state  of 
physiological  and  anatomical  integrity  the  organs  and  tissues  that 
have  been  deranged.  The  cure  (sometimes)  can  only  take  place 
through  vital  organic  processes,  and  to  medicine  belongs  the  task  of 
determining  what  outside  support  can  be  rendered  to  the  vis  medica- 
trix  naturae .” 

The  large  majority  of  physicians  and  surgeons  are  opposed  to 
operations  in  pleuritis  with  effusion  during  its  acme  and  feverish 
state.  If  the  orthopncea  becomes  intense,  the  effusion  increases  rap- 
idly, etc.,  they  may  become  convinced  of  the  necessity  of  an  imme- 
diate relief  through  aspiration  or  incision. 

In  time  I feel  assured  that  all  pleurisies  will  be  treated  by  opera- 
tion where  an  effusion  exists. 

The  eminent  authority  on  this  subject,  Dr.  Bowditch,  of  Boston, 
lays  down  the  rule  that  if  the  dyspnoea  is  excessive,  so  as  to  amount 
to  permanent  orthopncea,  or  if  I learn  that  within  a few  hours  pre- 
vious to  my  visit  there  has  been  even  one  attack  of  momentary 
orthopnoea,  during  which  the  patient  felt  the  breath  would  be  wholly 
lost,  I tap  immediately,  provided  I am  sure  that  there  is  even  a 
small  quantity  of  fluid  in  the  pleural  cavity,  and  that  it  is,  appa- 
rently, the  chief,  or  perhaps  only,  cause  of  the  orthopnoea.  “ I fear,” 
he  adds,  “ death  may  occur  before  my  next  visit.”  He  states,  fur- 
ther on,  that  “when  a patient  comes  under  notice  in  whom  a large 
quantity  of  fluid  has  been  long  effused,  I advise  thoracentesis  as  the 
first  remedy.” 

During  the  past  year  I have  seen  three  cases  of  pleurisy  die  sud- 
denly for  the  want  of  immediate  evacuation  of  the  pleural  sac. 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


751 


In  such  cases,  even  during  the  febrile  stages,  thoracentesis  seems 
to  me  the  only  remedy.  Barnes  says,  “ It  is  my  practice  to  operate 
at  once  when  the  chest  is  two  parts  filled  with  fluid,  without  waiting 
for  urgent  dyspnoea.” 

The  propriety  of  operating  in  large  effusions  is  being  rapidly 
accepted  by  the  profession  generally,  but  there  is  considerable  dif- 
ference of  opinion,  even  among  enthusiasts  for  the  operation,  of  the 
demand  or  advisability  of  interfering  : 1st,  during  the  febrile  stage, 
and  2d,  where  moderate  effusion  remains  unabsorbed.  During  the 
febrile  stage  it  is  maintained  by  many  that  the  fluid  would  at  once 
reform,  and,  furthermore,  that  the  surgical  treatment  might  excite 
additional  inflammatory  action.  We  have  very  strong  evidence  to 
prove  that  this  is  not  correct. 

For  example,  Castiaux  (1873,  These  de  Paris)  claims  that  the 
operation  by  aspiration  will  hasten  the  cure  of  acute  pleurisy  and 
prevent  the  formation  of  the  fibrinous  deposits  and  bands  which  in 
nearly  all  cases,  even  in  moderate  effusions,  impair  the  expansion  of 
the  lungs.  He  operated  37  cases,  and  cured  them.  The  pulse  and 
temperature  fell  within  twenty-four  hours  of  the  operation,  and  the 
patients  improved  rapidly. 

As  soon  as  fluid  was  detected  he  operated  by  aspiration  points,  feel- 
ing that  he  had  at  his  disposition  sure  means  of  relief  which  are  harm- 
less or  nearly  so,  and  that  it  is  useless  to  leave  this  task  to  nature, 
which  she  so  often  cannot  accomplish  even  in  a half-way  satisfactory 
manner.  Medication  is  often  untrustworthy  in  such  conditions. 

He  operated  at  the  height  of  the  first  or  inflammatory  stage, 

In  operating  thus  promptly  he  relieved  the  lung  of  compression, 
which  must  impair  its  expansion  ; he  removed  an  effusion  rich  in 
fi brine  and  capable  of  increasing,  in  time,  the  thickness  of  the 
neo-membranes  ; he  restored  the  power  to  the  lung  to  dilate  by 
removing  this  tendency  to  false  membrane  formation,  which  squeezes 
the  lung  tissue. 

These  membranes  cannot  become  organized,  as  I have  stated  be- 
fore, as  long  as  they  are  separated  by  fluid. 

He  drew  off  all  the  fluid  he  could.  The  relief  to  the  patient  was 
often  most  marked.  The  lung  expanded  promptly  and  satisfac- 
torily, as  shown  by  auscultation.  In  a few  cases  the  effusion  re- 
turned, with  an  increased  pulse  and  rise  of  temperature  ; another 
aspiration  effectually  arrested  the  process. 


752 


world’s  homceopathic  congress. 


The  cases  treated  in  this  fashion  lasted  a much  shorter  time,  and 

• * 

apparently  no  false  membrane  supervened. 

No  accident  occurred  in  any  of  his  cases,  and  he  never  saw  as  a 
result  of  the  operation  the  transformation  of  the  serosity  into  pus. 

We  have  nearly  as  strong  testimony  in  some  cases  reported  by 
Moutard-Martin.  He  operated  in  twelve  cases,  of  about  ten  days’ 
standing,  with  sero-fibrinous  effusions,  accompanied  by  fever.  In 
eight  there  was  no  reproduction,  in  four  it  was  very  slight,  and  in 
none  did  it  become  purulent.  On  the  other  hand,  in  cases  in  exist- 
ence from  twenty  to  sixty  days  the  fluid  was  always  moderately  re- 
produced. 

He  insists  upon  the  prompt  withdrawal  of  the  fluid  as  the  most 
successful  method,  more  especially  if  we  suspect  the  formation  of 
false  membranes. 

Wedal’s  results  are  even  more  remarkable  than  those  of  Castiaux 
or  Moutard-Martin. 

He  considers  puncture  harmless  during  the  acute  stage,  and  claims 
it  shows  a hastening  of  the  cure. 

He  operated  seventeen  times  on  seventeen  patients  from  the  second 
to  the  fifth  day,  and  three  times  from  the  eighth  to  the  tenth. 

In  acute  cases,  where  the  patients  had  no  pulmonary  or  bronchial 
disease,  the  cure  was  not  protracted  beyond  the  twelfth  day.  Some 
were  cured  by  the  sixth.  His  clients  were  mostly  young,  vigor- 
ous men. 

Hr.  J.  L.  Mason  tells  us  that  in  one  hundred  and  thirty-t wo  cases, 
where  no  operation  was  performed,  the  duration  of  the  disease  ex- 
tended over  weeks  and,  in  some  cases,  months. 

What  a comparison  to  draw  between  Castiaux,  Wedal,  Moutard- 
Martin,  and  those  cases  of  Mason. 

Wedal  thinks  the  earlier  the  operation  is  done,  the  more  success- 
ful it  is  likely  to  be. 

Hieulafoy  thinks  we  should  wait  until  the  fever  ceases. 

According  to  Wilson  Fox,  the  density  of  the  adhesions  and  false 
membranes  is  determined  within  the  first  fortnight  of  the  effusion. 

As  to  the  aetiology  of  pleurisy,  we  will  content  ourselves  with 
making  the  inquiry : Is  it  due  to  exposure,  rheumatism,  or  tuber- 
cle? Hr.  Lindsay  found,  in  thirty-five  cases,  sixteen  of  them  due 
to  a wetting  or  exposure  to  cold  while  the  patient  was  overheated. 
Rheumatism  was  present  in  three  instances.  In  two  cases  there  was 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


753 


a family  history  of  tubercle,  and  in  three  haemoptysis  of  pulmonary 
origin.  In  ten  cases,  or  nearly  one-third,  no  cause  could  be  found. 
Organic  heart  disease  does  not  seem  to  induce  pleurisy. 

The  relation  of  tuberculosis  to  acute  pleurisy  is  the  most  impor- 
tant and  difficult  one. 

Dr.  Barrs,  in  a noteworthy  article,  shows  that  a very  large 
number  of  cases  of  simple  pleural  effusion  are  really  of  tubercular 
origin. 

He  hunted  up  the  after-history  of  seventy- four  cases  of  simple 
pleural  effusion,  and  found  that  within  five  years  thirty  two  of  these 
were  dead,  twenty-five  were  living,  and  seventeen  could  not  be 
found.  Of  the  thirty-two  reported  dead,  fourteen  died  of  phthisis, 
four  died  of  other  tubercular  affections,  and  several  of  the  others 
succumbed  to  some  pulmonary  affection. 

Leaving  out  those  who  could  not  be  traced  in  Dr.  Barrs’s  report, 
we  have  the  astounding  fact  that  more  than  one-half,  apparently  re- 
covering from  a simple  pleural  effusion,  died  within  five- years,  and 
these  mainly  of  some  tuberculous  affection. 

It  seems  but  a fair  inference  that  if  these  statements  are  correct 
and  are  fairly  typical  and  should  be  corroborated  by  others  and  by 
wider  knowledge  and  experience,  that  the  ultimate  prognosis  in  sim- 
ple pleural  effusion,  so  far  from  being,  as  it  is  now  commonly  re- 
garded, as  distinctly  favorable,  would  become  most  grave. 

In  Dr.  Lindsay’s  35  cases  only  two  instances  of  a family  history 
of  tubercle  existed  and  only  three  instances  of  pulmonary  haemor- 
rhage. In  others  the  presence  of  tubercle  was  suspected,  but  was 
not  absolutely  proven. 

The  association  of  pleurisy  and  tubercle  is,  therefore,  more  com- 
mon than  we  are  in  the  habit  of  believing. 

The  question  raised  by  Dr.  Barrs  is  one  of  the  most  important  in 
medicine,  and  each  one  of  us  should  sift  it  to  the  bottom. 

If,  then,  a patient  who  has  had  an  attack  of  acute  pleurisy  subse- 
quently develops  tuberculosis,  the  question  arises  whether  the  pleu- 
risy was  originally  of  tubercular  origin  or  whether  the  damage 
suffered  by  the  pleura  and  lung  have  not  invited  a tuberculosis  which 
did  not  exist  prior  to  the  pleuritis. 

I incline  myself  more  strongly  to  the  latter  opinion. 

The  method  of  the  treatment  of  the  pleuritic  effusion  is  here  often 
the  cause  of  the  dire  results  we  see  following  such  processes. 

48 


754 


world’s  homceopathic  congress. 


All  my  practical  knowledge  of  pulmonary  phthisis  inclines  me  to 
the  belief  that  if  a lung  be  left  collapsed  and  inexpansile  and  bound 
down,  as  the  result  of  pleural  effusion,  it  is  very  likely  to  become 
the  seat  of  tuberculosis,  and  that  the  development  of  tuberculosis 
under  such  circumstances  is  no  'proof  that  the  underlying  process  was 
tubercular  from  the  first. 

I must  further  make  the  statement  that  in  dealing  with  the  great 
number  of  cases  of  pulmonary  phthisis  which  come  under  my  ob- 
servation, I have  been  more  and  more  impressed  by  the  frequency 
with  which  pleurisy  is  found  as  an  antecedent  condition. 

This  is  a fact  which  we  cannot  and  should  not  ignore. 

It  is  to  be  much  regretted  that  we  have  no  satisfactory  records  to 
show  us  what  is  the  normal  course  of  pleuritic  effusions — moderate 
and  large — without  treatment.  The  tendency  is  probably  to  a spon- 
taneous subsidence — quoad  the  effusion  per  se — and  the  great  practi- 
cal question  is  whether,  by  the  administration  of  drugs  or  operative 
interference,  we  can  materially  hasten  the  cure.  It  is  now  generally 
admitted  that  many  of  the  methods  of  elimination  formerly  in  vogue 
by  the  Old  School  are  either  useless  or  injurious. 

The  testimony  of  those  employing  early  puncture  or  advocating 
early  operation  gives  a far  different  note  of  hope  to  the  aggressive 
element  in  the  profession. 

The  great  question,  then,  for -us  in  this  connection  to  settle  is,  not 
whether  aspiration  should  be  performed,  but  how  soon  must  it  be 
done  ? 

In  certain  cases  where  the  effusion  is  large  and  the  dulness  ascends 
as  high  as  the  second  rib  in  front,  or  if  the  measurement  of  the 
affected  side  be  markedly  increased,  much  dyspnoea,  etc.,  the  advan- 
tage of  aspiration  cannot  for  a moment  be  disputed. 

I maintain  that  we  should  not  allow  our  patient  to  come  to  such  a 
pass. 

Those  cases  which  present  the  most  difficulty  of  decision  are  where 
we  have  a moderate  effusion  with  or  without  fever  and  with  or  with- 
out dyspnoea  or  other  disturbing  symptoms.  In  such  cases  the  in- 
quiries arise : 1.  Does  aspiration  lessen  the  chance  of  a speedy  or 
remote  fatal  issue?  and  2.  Does  aspiration  shorten  the  duration  of 
the  disease,  with  the  immediate  prospects  of  restoring  the  affected 
parts  to  a condition  of  perfect  physiological  action-? 

The  first  question  may  be  somewhat  summarily  dismissed  as  to  a 


PLEA  FOR  EARLY  OPERATION-  IN  PLEURISY. 


755 


sudden  fatal  issue  where  the  effusion  is  moderate,  but  as  to  a remote 
fatal  issue,  where  the  accumulation  has  been  in  existence  some  time, 
our  judgment  must  be  reserved. 

The  second  inquiry  is  a very  interesting  one,  but  the  difficulty  of 
absolutely  determining  it  is  very  great. 

It  seems  to  me  that  the  duration  of  the  malady,  in  answering  the 
second  query,  must  first  be  taken  into  consideration. 

In  cases  of  several  weeks’  standing  I believe  the  lung — and  ergo 
its  pleural  surface — never  returns  to  a healthy  condition. 

We  must  take  cognizance,  though,  in  this  discussion,  of  the  litera- 
ture dealing  with  it.  It  must  shape  the  judgment  of  the  unexpe- 
rienced and  give  a strong  support  to  the  man  of  large  experience 
either  pro  or  con. 

One  practitioner  inclines  to  tap  early  in  all  cases,  and  to  repeat  it, 
if  necessary,  and  his  statistics  will  show  the  greatest  number  of  recov- 
eries and  the  shortest  duration  of  illness.  His  remote  results  will  be  the 
most  satisfactory  from  a medical,  surgical  and  prognostic  point  of  view. 

Another  practitioner  reserves  operation  for  serious  cases  with  large 
effusions,  or  for  chronic  or  semi-chronic  cases.  His  remote  results 
will  be  the  most  unsatisfactory  from  a medical,  surgical  and  prog- 
nostic point  of  view. 

In  empyema  most  writers  agree  that  aspiration  is  not  the  method 
to  employ,  but  that  free  incision,  with  drainage,  is  the  recognized 
operation  in  America  and  the  results  quoad  vitam  are  most  gratifying. 

In  children  we  should  note  the  marked  tendency  for  pleuritic 
effusions  to  become  purulent. 

As  a summary  we  would  state : 

I.  That  aspiration  carried  out  antiseptically  in  any  stage  of  pleu- 
ritic effusion  is  not  a dangerous  procedure. 

II.  More  people  die, from  a postponed  aspiration  than  from  any 
operative  interference. 

III.  Anstie  and  Weber  have  shown  that  organization  of  the  fibri- 
nous portion  of  the  effusion  can  proceed  very  slowly  and  imper- 
fectly when  the  two  pleural  surfaces  are  allowed  to  play  on  each 
other.  Effusion  separating  the  two  surfaces  hastens  the  formation 
of  neo-membranes. 

IV.  Aspiration  shortens  the  illness  to  fourteen  or  eighteen  days. 

V.  Pleuritis  without  operation  and  with  moderate  effusion  lasts 
seldom  shorter  than  three  weeks,  and  from  that  up  to  two  months. 


756 


world’s  homceopathic  congress. 


VI.  With  aspiration,  the  lung  pleurae  in  very  recent  cases  return 
to  a physiological  state. 

VII.  In  semi-chronic,  chronic  and  purulent  effusions  portions  of 
the  pleura  and  lung  are  permanently  damaged  and  lead  to  one  form, 
perhaps  the  most  frequent,  of  phthisis. 

VIII.  Early  aspiration  is  growing  in  favor,  and  I have  witnessed 
several  brilliant  cures  in  my  own  practice  and  that  of  others. 

IX.  In  three  cases  of  large  effusion  seen  in  consultation,  the  ope- 
ration being  postponed  until  the  following  day,,  the  patient  has  ex- 
pired suddenly  in  the  night. 


Discussion., 

Oscar  Leseure,  MJD. : I am  heartily  in  sympathy  with  the  prin- 
ciples advanced  in  Dr.  Schley’s  paper,  and  will  refer  to  them  spe- 
cially from  the  surgical  standpoint. 

I have  failed  to  find  an  authority  who  does  not  admit  the  fact 
that  the  sooner  a lung  oppressed  by  pleuritic  effusion  is  relieved 
from  compression,  the  more  completely  will  that  lung  be  restored  to 
its  normal  anatomical  and  physiological  condition. 

The  opposition  to  early,,  or  any , operation  for  the  relief  of  pleu- 
ritic effusions  (and  in  this  sense  I refer  to  serous  or  sero-fibrinous 
effusion  and  the  operation  of  aspiration)  is  based  mainly  upon  the 
accidents  which  have  accompanied  or  immediately  followed  the  ope- 
ration, and  which  have  very  unjustly,  in  many  instances,  been  attrib- 
uted to  it,  or  on  the  accidents  which  might  theoretically  complicate 
the  process. 

It  is  true  that  the  mortality  accompanying  the  early  history  of 
thoracentesis  was  discouraging.  Boyer  and  Gendrin  lost  100  per 
cent. ; Dupuytren,  96  per  cent. ; Davis,  33  per  cent.  (Donaldson). 
But  from  the  time  when  Trousseau  urged  and  practiced  thoracentesis 
with  the  trocar  of  Reybard,  and  Bowditch  first  used  the  method  of 
aspiration,  down  to  the  present  day,  the  statistics  of  the  operation 
have  so  improved  that  Matas,  in  1892,  records  over  one  thousand 
cases  without  a death. 

Of  the  more  important  accidents  attributed  to  the  operation,  we 
may  enumerate  the  following:  Injury  to  the  intercostal  vessels  and 
nerves;  injury  of  the  liver,  peritonaeum,  heart,  or  lungs;  syncope; 
cerebral  accidents,  as  paralysis  and  convulsions;  cough  and  albu- 
minous expectoration  ; purulent  transformation. 

We  may  dismiss  the  question  of  injury  to  the  intercostal  vessels 
and  nerves  by  saying  that,  given  a knowledge  of  their  location,  the 
average  intercostal  space,  a proper  instrument  and  reasonable  skill, 
the  objection  should  have  no  weight. 

Injury  to  the  liver,  peritonaeum,  heart,  or  lungs  we  cannot  dismiss 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


757 


so  lightly,  for,  with  the  distinguished  names  of  Aran  and  Claude 
Bernardo  associated  with  these  accidents,  we  must  admit  their  im- 
portance. Still,  with  the  advanced  knowledge  and  improved  methods 
of  to-day  ; with  the  results  of  experience  in  selecting  the  point  of 
puncture;  also  the  proof  from  the  statistics  just  quoted,  we  may  con- 
sider the  importance  of  this  objection  to  be  in  its  warning  to  the 
operator. 

Of  four  cases  of  syncope  occurring  at  the  time  of  or  immediately 
following  the  operation,  analyzed  by  Vergely,  Guyot,  Chaillou,  and 
Besnier,  one  was  due  to  heart  clot,  one  to  pulmonary  embolus,  one 
to  phlebitis  and  thrombosis,  and  one  to  pulmonary  gangrene.  Bow- 
ditch  and  Donaldson  have  also  attributed  the  accident  to  the  com- 
pilations existing  at  the  time  of  the  operation. 

This  accident  might  be  due,  also,  to  a too  rapid  evacuation  of  the 
fluid,  thus  suddenly  depleting  the  cerebral  vessels.  A skillful 
operation  will,  therefore,  remove  the  only  just  part  of  this  objec- 
tion. 

Cerebral  accidents  are:  paralysis,  due  to  an  embolus  not  directly 
traceable  to  the  operation,  or  convulsions  possibly  due  to  a disturbed 
intracranial  pressure,  in  turn  attributable  to  a too  rapid  or  complete 
evacuation  of  the  effused  fluid. 

Cough,  with  albuminous  expectoration,  due  to  acute  oedema  of  the 
lung,  is  justly  charged  to  the  operation,  but  is  a dangerous  condition 
only  when  the  operator  rashly  disregards  the  warning  which  is  given 
him,  and  which  was  so  clearly  described  in  the  interesting  paper 
presented  to  you  by  Prof.  Biggar  on  Wednesday  evening.  I refer 
to  the  irritating  cough,  sometimes  accompanied  by  dyspnoea,  which 
may  occur  during  the  evacuation  of  the  fluid.  That  it  is  an  acute 
oedema  of  the  pulmonary  tissue  has  been  demonstrated  by  Herard, 
Dieulafoy,  Lavaran,  Tissier,  Moutard-Martin,  Dujardin-Beaumetz, 
and  others,  and  by  them  ascribed  to  a too  rapid  removal  of  the  intra- 
pleural fluid,  which,  in  turn,  produces  an  extensive  congestion  of  the 
lung  suddenly  freed  from  pressure. 

Purulent  transformation  of  the  fluid  remaining  after  aspiration  is 
the  objection  most  strenuously  advanced  by  surgeons  who  oppose  the 
operation.  Late  microscopical  and  bacteriological  researches  promise 
to  prove  the  predictions  of  Fraenkel  and  Netter  to  be  well  founded, 
viz.,  that  an  early  examination  of  the  fluid  effused  will  determine 
whether  it  is  to  remain  a serous  fluid  or  whether  it  is  to  become  a 
purulent  fluid. 

The  observations  of  Dieulafoy  allow  him  to  state  that  when  the 
fluid  contains  five  thousand  (5000)  or  more  red  blood  globules  to 
the  cubic  millimetre,  empyema  will  be  the  result.  More  important, 
and  later,  are  the  researches  of  Baviere,  who  has  demonstrated  the 
presence  of  the  streptococcus  in  a certain  number  of  cases,  the  pneumo- 
coccus in  others,  and  the  bacillus  tuberculosis  of  Koch  in  others.  In 


758 


world’s  homoeopathic  congress. 


the  majority  of  cases  he  found  no  bacilli.  His  conclusions,  based  on 
a large  number  of  cases,  are  as  follows: 

1.  Early  aspiration. 

2.  If  the  pneumococcus  or  bacillus  of  Koch  is  found,  the  punc- 
ture is  to  be  repeated  if  the  fluid  persists  or  increases. 

3.  If  the  streptococcus  is  found , resort  at  once  to  pleurotomy. 

Briefly,  as  to  the  technique  of  the  operation  already  described  in 

our  presence  by  Prof.  Biggar: 

The  weight  of  opinion  is  in  favor  of  the  sixth  intercostal  space 
in  the  middle  axillary  line  as  the  point  for  puncture. 

The  instrument,  an  aspirator,  with  the  special  trocar  of  Potain  or 
Frautzel  to  avoid  wounding  the  lung. 

Use  absolute  asepsis.  Withdraw  the  fluid  very  slowly.  Do  not 
withdraw  more  than  a quart  at  one  operation.  Stop  the  moment 
the  patient  complains  of  pain,  or  cough  or  dyspnoea  appear. 

John  W.  Dowling, M.D. : After  reading  Dr.  Schley’s  able  argu- 
ment in  favor  of  early  operation  in  cases  of  pleurisy  with  effusion,  it  is 
difficult  to  open  the  discussion  when  one  is  in  almost  complete  accord 
with  the  views  expressed.  I have  seen  too  much  of  the  ill  effects 
following  delay  in  these  cases,  the  delay  in  some  cases  being  due  to 
timidity  and  in  other  cases  to  failure  to  recognize  the  actual  condi- 
tions present.  The  disadvantages  of  delay  are  many,  and  by  far  the 
most  important  of  these,  to  my  mind,  is  the  fact  that  every  day’s 
persistence  of  the  fluid  in  the  pleural  cavity  adds  to  the  chance  of 
that  fluid  becoming  purulent,  thus  creating  an  empyema  out  of  a 
simple  serous  effusion,  or  sero-fibrinous  perhaps  more  frequently  than 
simple  serous.  Every  one  admits  that  an  empyema  is  a more  grave 
condition,  and  it  seems  negligent  to  fail  to  resort  to  operative  meas- 
ures early,  the  result  being  the  not  unlikely  development  of  the  more 
serious  condition,  with  its  consequent  dangers  to  the  life  of  the 
patient. 

As  your  speaker  has  said,  many  are  not  in  favor  of  operation  when 
moderate  effusion  remains  unabsorbed.  It  seems  clear,  that  if  the 
consequences  of  the  prolonged  presence  of  this  fluid  were  properly 
considered,  the  number  of  those  who  hold  this  opinion  would  be 
materially  diminished.  The  presence  in  the  pleural  cavity  of  even 
a moderate  amount  of  serous  fluid  necessitates  the  compression  of 
part  of  the  lung  on  the  affected  side,  with  a retraction  of  the  lung  as 
well.  By  this  compression,  air  cells  are  obliterated  entirely  and 
portions  of  the  lungs  rendered  almost  impervious  to  the  entrance  of 
air  further  than  the  bronchi  and  larger  bronchioles.  The  circula- 
tion is  interfered  with  and  slowed.  From  what  we  know  of  the 
conditions  favorable  to  the  development  of  tubercular  processes  in 
the  lung,  we  see  that  the  conditions  required  are  thus  produced,  and 
though  the  effusion  may  eventually  be  absorbed,  the  chances  are, 
that  more  serious  trouble  of  the  nature  referred  to  will  have  had  an 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


759 


opportunity  to  develop.  Even  failing  this,  the  lung  thus  for  a long 
time  unable  to  expand  will  refuse  to  do  so  when  the  opportunity 
does  come,  and  there  will  be  a permanent  coupling  of  the  lung,  and 
not  uncommonly  a visible  deformity  of  the  chest  as  well.  The 
shorter  the  time  the  lung  has  been  compressed  the  more  readily  then 
will  it  expand  if  the  compression  be  removed,  and  the  earlier  the 
operation  is  performed,  even  though  necessarily  repeated,  the  greater 
chance  will  there  be  of  restoration  to  perfect  function. 

I would  differ  with  Dr.  Schley  in  his  statement  that  the  operative 
procedure  will  speedily  restore  our  patient  to  perfect  health.  It  is 
too  sweeping  a generalization.  Many  times  early  removal  of  the 
fluid  will  do  this,  but  in  my  experience  cases  not  infrequently  arise 
where  the  removal  must  be  repeated,  not  once  only  but  several  times, 
the  disease  lasting  over  a considerable  period.  I agree  with  the 
practice  of  early  operation,  but  am  not  so  sanguine  as  to  its  inevitable, 
favorable  and  speedy  cure.  Occasional  sad  experience  has  taught 
me  this. 

The  presence  or  absence  of  orthopnoea  I do  not  consider  a reliable 
indicator  by  itself  for  operation  or  delay.  In  many  cases^  the  accu- 
mulation has  been  so  gradual  that  a considerable  degree  of  toleration 
is  attained,  the  patient  being  able  to  lie  down  without  distress,  and 
even  to  endure  moderately  gentle  exercise  without  extreme  dyspnoea. 
If  orthopnoea  be  present,  operate  at  once,  but  if  it  be  absent,  try  to 
see  if  you  cannot  find  other  indications  for  operating,  and  if  you 
cannot,  operate  anyway,  and  I believe  your  results  will  give  you 
reasons  for  early  operation  in  succeeding  cases. 

As  to  whether  the  operation  sh  mid  be  that  of  aspiration  or  free  in- 
cision should  be  determined  by  the  character  of  the  fluid.  If  serous 
or  even  sero- fibrinous,  aspiration  would  be  indicated.  But  if  puru- 
lent, particularly  in  children,  the  recovery  of  a number  of  cases  after 
fiee  incision  has  been  performed,  the  immediate  improvement  conse- 
quent upon  the  complete  removal  of  the  pus,  an  impossibility  where 
aspiration  is  resorted  to,  and  the  ease  with  which  further  accumulation 
is  prevented  by  the  establishment  of  free  drainage,  all  speak  loudly 
in  favor  of  this  method,  and  in  these  cases  it  would  seem  to  be  almost 
certainly  indicated. 

A.  A.  Whipple,  M.D. : I want  to  agree  in  the  main  with  all  that 
has  been  said  in  the  first  paper  and  in  the  discussion.  I would  like 
to  state  a case  that  happened  to  me  three  or  four  years  ago  which  I 
left  in  other  care  during  a brief  absence.  When  I returned  I found 
the  boy  just  ready  to  die.  He  was  fourteen  years  of  age.  The  father 
and  three  or  four  brothers  or  sisters  died  of  consumption  and  some 
two  or  three  of  his  uncles  and  aunts.  He  had  hectic  fever,  high 
temperature,  and  all  the  symptoms  pointing  to  empyema.  Without 
any  hesitation  I made  a free  incision  between  the  fifth  and  sixth 
ribs,  removed  three  quarts  of  offensive  matter,  put  in  a drain- 


760 


world’s  homceop ath rc  congress. 


age-tube  and  syringed  as  thoroughly  as  possible,  and  followed  that 
up  for  a few  days,  morning  and  evening.  The  temperature  came 
down  considerably,  but  the  case  not  being  satisfactory  I put  him 
under  chloroform  and  made  another  incision  between  the  eighth  and 
ninth  rib,  put  in  another  drainage-tube,  and  followed  that  with  free 
syringing,  using  peroxide  of  hydrogen.  I used  it  frequently,  throw- 
ing it  in  at  the  upper  tube  and  letting  it  run  out  of  the  lower.  He 
made  a good  recovery,  and  in  a not  very  long  time.  But  the  fact 
was  it  ought  to  have  been  operated  earlier.  It  was  on  account  of 
my  absence  from  home  that  this  was  not  done.  In  several  in- 
stances I have  operated  early  and  have  always  found  it  best. 

W.  H.  Bijrt,  M.D. : It  seems  applicable,  while  on  this  subject, 
that  I should  show  you  a new  instrument  that  I have  just  devised 
for  examinations  of  the  lungs.  Heretofore  our  instruments  have 
been  made  principally  of  rubber,  and  rubber  is  a very  poor  con- 
ductor of  sound.  I have  devised  an  instrument  made  wholly  of 
metal,  and  with  the  use  of  the  ball  and  socket  joint  we  get  every 
motion  we  want,  and  I am  pleased  to  state  that  it  carries  the  sound 
ten-fold  better  than  any  other  device  up  to  date.  I simply  want  to 
exhibit  it  to  the  members  of  the  Society  at  this  time.  The  paper 
that  has  been  read  here  I can  heartily  endorse. 

E.  R.  Eggleston,  M.D. : It  seems,  ladies  and  gentlemen,  that  I 
am  to  take  up  the  unpopular  side  of  this  question.  Is  pleurisy  to 
be  treated  by  surgical  means  exclusively  ? 

That  is  the  question  I would  like  to  have  answered.  So  far 
neither  in  the  papers  nor  in  the  discussions  has  a single  word  been 
said  about  the  Homoeopathic  remedy.  I claim  this:  that  under  the 
proper  use  of  the  proper  remedy  administered  at  the  proper  time 
and  place  and  under  the  proper  conditions  the  trocar  becomes  ob- 
solete. So  much  for  that. 

Now,  I take  exceptions  to  the  philosophy  of  the  paper.  Let  us 
see.  An  inflammation  has  been  set  up  in  the  cavity.  Nature,  for 
the  express  purpose  of  keeping  the  surfaces  of  that  cavity  apart, 
has  filled  it  more  or  less  completely  with  fluid.  These  gentlemen 
propose  to  withdraw  that  fluid  and  hinder  the  operations  of  nature, 
let  those  surfaces  come  together  and  become  adherent.  That  is 
why  we  get  so  many  cases  of  fibroid  phthisis  in  the  hospitals  and 
so  few'  of  them  in  private  practice. 

Do  they  do  it  in  fractures?  Isn’t  the  process  precisely  the  same 
under  different  conditions?  Here  is  a broken  bone,  and  what  does 
nature  do  ? Throws  out  a provisional  callus  to  protect  the  fractured 
ends  of  the  bone.  In  pleurisy,  nature  throws  out  a provisional 
fluid  to  keep  the  surfaces  apart.  The  cases  are  precisely  analogous. 
Do  they  open  the  loeation  of  the  fractured  bone  and  take  out  this 
bony  deposit?  Why,  no;  they  encourage  it.  What  does  nature 
do  with  the  excess?  Absorbs  it,  just  exactly  as  it  does  in  pleurisy. 
Nature  takes  care  of  its  own  deposits. 


PLEA  FOR  EARLY  OPERATION  IN  PLEURISY. 


761 


The  only  experience  given  us,  so  far  as  I heard,  was  that  of 
the  Old  School.  Is  there  any  other?  I have  my  own  experi- 
ence, and  I have  heard  the  experience  of  many  others.  Now  what 
is  it?  That  at  the  onset  of  this  inflammatory  action,  just  as  in  the 
onset  of  every  other  inflammatory  action,  there  is  irritation,  hyper- 
aemia,  exudation  always.  Well,  now  what  are  the  remedies  that 
control  all  these  processes?  First,  Aconite.  Aconite  controls  the 
irritative  stage  on  a philosophical  and  physiological  basis.  As  soon 
as  the  irritative  stage  has  passed,  Bryonia  controls  the  exudation 
stage  on  philosophical  and  physiological  grounds,  and  it  will  do  it, 
other  things  being  equal,  every  time. 

J.  Montfort  Schley,  M.D. : I think  Dr.  Eggleston’s  remarks 
are  such  as  no  one  will  take  exception  to.  He  has  stated  his  case 
very  well,  but  we  had  nothing  to  do  with  the  medical  side  of  the 
case  at  all.  I have  seen,  within  the  last  sixteen  months,  nearly  fifty 
cases  of  pleurisy  with  effusion.  Perhaps  I have  been  peculiarly 
fortunate.  In  most  of  them  I was  in  consultation,  and  for  the  doc- 
tor’s special  benefit  I wish  to  emphasize  his  points.  I am  just  as 
good  a Homoeopath  as  he  is.  For  his  especial  benefit  I will  say 
that  every  one  of  these  cases  I operated  upon  had  been  attended  by 
the  best  Homoeopathic  physicians  in  New  York  and  vicinity.  They 
had  received  Aconite,  they  had  received  Bryonia  and  everything 
else — opiates  and  Iodine — and  that  is  all  the  good  that  it  did  them. 

Now,  there  are  two  sides  to  these  things  and  to  these  cases.  If 
they  had  come  from  the  Old  School,  I would  put  them  in  their 
proper  place;  but  not  one  of  them  had  been  treated  by  an  Allo- 
pathist,  because  I don’t  consult  with  them  if  I can  help  it.  Some 
of  them  were  treated  by  men  whom  you  have  applauded  on  this 
platform — men  who  have  come  from  New  York,  and  who  cannot  be 
beaten  as  far  as  a Homoeopathic  prescription  is  concerned. 

I repeat,  I believe  in  a large  majority  of  cases  that  the  Homoeo- 
pathic remedies  have  a wonderful  and  decided  influence  upon  pleu- 
ritic effusions,  but  sometimes  they  seem  to  utterly  fail.  Whether  it 
is  a predisposition  of  the  patient,  whether  it  is  a peculiar  condition 
of  the  atmosphere,  or  whether  it  is  the  peculiar  stage  of  the  virulent 
inflammation  that  takes  place,  I am  unable  to  say. 

When  the  doctor  comes  to  talk  about  fibroid  phthisis,  I want  to 
remind  him  that  ours  were  cases  that  never  had  been  operated  on 
for  fibroid  phthisis.  If  the  doctor  had  seen  the  post-mortems  that 
I have  had  in  the  Vienna  hospital,  he  would  know  that  the  major- 
ity had  never  seen  a physician.  With  the  pleura  as  thick  as  that 
(indicating),  and  the  trouble  entirely  on  one  side  of  the  lung,  it 
seems  to  me  that  it  is  plain  that  the  trouble  has  arisen  from  pleuri- 
tis,  and  not  from  a tuberculosed  condition.  I wrote  this  paper 
mainly  not  because  I am  afraid  to  go  to  the  Old  School — for  we  have 
got  plenty  of  good  Homoeopathic  physicians  in  New  York  who  have 


762 


world’s  homoeopathic  congress. 


a great  deal  of  experience — but  it  is  the  dread  and  disgust  that  a 
Homoeopathic  physician,  and  particularly  a good  Homoeopathic 
physician,  has  against  surgery.  He  prescribes  nothing  else  but 
Homoeopathic  remedies,  and  he  hates  to  have  his  patient  put  under 
the  knife,  and  will  fight  it  off  until  the  last  minute.  That  thing  is 
done,  in  my  opinion  and  experience,  repeatedly.  He  thinks  that  his 
remedies  will  relieve  these  conditions  ; but  how  can  they  do  it  when 
you  have  the  lungs  squeezed  down  to  the  size  of  your  fist  and  an 
enormous  pleural  mass  there,  and  the  pleura  so  thick  it  cannot  ab- 
sorb anything  at  all  ? 

Another  thing  is,  follow  up  these  cases,  and  see  whether  they 
develop  fibroid  phthisis  after  an  early  operation.  I have  had  a good 
many  under  my  care  when  I had  the  privilege  of  being  their  family 
physician,  and  have  followed  them  for  years,  and  you  can  scarcely 
detect  a trace  of  adhesion  of  the  pleura,  and  the  scar  has  nearly  all 
disappeared.  In  my  experience,  it  is  these  very  cases  (whether  it  be 
a thickened  pleura  or  a serous  effusion)  where  we  are  more  likely  to 
get  fibroid  phthisis  and  curvature  of  the  spine — the  cases  where 
nature  cannot  help  herself  nor  do  herself  justice  as  she  usually  does. 


PROPHYLAXIS  OF  CHOLERA. 


763 


PROPHYLAXIS  OF  CHOLERA. 

By  B.  N.  Banerjee,  Calcutta,  India. 


The  preventive  treatment  of  diseases  is  of  supreme  importance 
not  only  to  the  physicians  but  to  the  whole  world.  We  all  know 
the  great  boon  which  Jenner’s  discovery  of  vaccination  has  conferred 
on  the  world  at  large.  Vaccination,  properly  speaking,  is  a true 
Homoeo-prophylaxis.  The  ill  effects  of  vaccination  are  solely  due  to 
its  abuse.  Prophylactic  treatment  of  small- pox  was  long  in  vogue 
in  India,  and  the  system  is  known  as  inoculation.  That  inoculation 
is  a surer  prophylaxis  than  vaccination  is  beyond  all  doubt  and  cavil. 
There  is,  however,  one  recommendation  for  vaccination,  and  that  is 
its  safety.  This  is  neither  the  time  nor  the  place  to  weigh  the  rela- 
tive advantages  and  disadvantages  of  inoculation  and  vaccination, 
though  it  is  a fact  established  beyond  doubt  that  inoculation, 
although  certain  in  its  action,  is  dangerous  in  application,  and 
had  therefore  to  give  way  to  the  less  dangerous  method  of  vac- 
cination. 

Seven  years  ago  Dr.  Ferran,  of  Spain,  extensively  tried  his  new 
method  of  inoculation  of  “ cholera  virus.”  It  is  not  yet  known  to 
the  profession  what  “ cholera  virus”  is,  and  what  was  his  method  of 
inoculation.  When,  in  1885,  cholera  was  devastating  Southern 
Europe — more  specially  France,  Spain,  and  Italy — Dr.  Ferran 
astounded  the  world  by  his  extravagant  and  bold  assertion  that  of 
sixteen  hundred  inoculations  there  occurred  not  a single  case  of 
cholera.  Physicians  from  neighboring  countries  at  once  repaired  to 
Spain  to  see  for  themselves  the  astounding  result  of  “Ferraniza- 
tion,”  as  well  as  to  learn  the  method  of  Ferran’s  inoculations. 

The  Madrid  Academy  of  Medicine,  on  investigation,  found  “ Fer- 
ranization  ” useless,  and  publicly  declared  it  to  be  so.  German  and 
French  physicians  returned  to  their  respective  countries  well  satis- 
fied that  “ Ferranization  ” was  nothing  but  a snare  and  delusion. 

Nowt  comes  the  question,  whether  it  is  even  possible  to  prevent 
cholera  by  inoculation?  This  question  cannot,  indeed,  be  answered 
satisfactorily  in  the  present  state  of  our  knowledge.  The  specific 


764 


world’s  homoeopathic  congress. 


<c  cholera  virus  ” has  not  yet  been  discovered  and  demonstrated.  I 
assert  this  in  spite  of  Dr.  Koch’s  so-called  discovery  of  comma- 
shaped  “ cholera  bacillus”  as  the  true  “ cholera  virus.”  Dr.  Koch’s 
comma-shaped  bacillus  has  been  found  and  demonstrated  long  ago 
in  aphthous  sore  mouth  and  in  persons  suffering  from  dysentery  by 
Drs.  Lewis  and  Cunnigham.  Drs.  Klein  and  Heneage  Gibbs  also 
proved  the  inocuousness  of  Koch’s  comma-shaped  bacillus  by  drink- 
ing a whole  lot  of  these  bacilli,  cultivated  according  to  Koch’s 
method,  with  impunity.  Nor  could  Klein  and  Heneage  Gibbs  pro- 
duce cholera  in  pigs  and  other  animals  by  injecting  the  cultivated 
bacilli.  Though  Klein  escaped  from  an  attack  of  cholera  by  swal- 
lowing these  bacilli,  I must  admit  that  this  cannot  be  an  argument 
against  the  non-specificity  of  these  bacilli,  for  we  all  know  that 
every  one  exposed  to  small-pox  contagion  does  not  catch  the  infec- 
tion even  when  not  protected  by  vaccination.  To  get  an  attack  of 
cholera  or  small-pox  or  any  other  infectious  disease,  it  requires  a 
peculiar  state  of  the  system  ; or,  in  other  words,  specific  virus  of 
infectious  diseases  is  capable  of  infecting  a person  when  it  gets,  as 
it  were,  a suitable  nidus  for  propagation. 

Very  lately  Pettenkofer  largely  experimented  with  the  specific 
cholera  bacilli.  In  all  cases  he  failed  to  produce  cholera  in  those 
with  whom  he  experimented.  He  at  last,  on  several  different  occa- 
sions, experimented  on  himself.  Once  or  twice  diarrhceic  stools 
were  produced  only.  But  on  all  occasions  the  stools  were  found 
swarming  with  the  so  called  specific  bacilli  of  cholera.  Petten- 
kofer thus  satisfactorily  proved  that  these  bacilli  were  not  either 
the  remote  or  proximate  cause  of  cholera. 

Prevention  of  cholera  by  inoculation,  therefore,  must  be  ineffec- 
tual so  long  as  we  are  unable  to  discover  and  isolate  beyond  doubt 
the  specific  virus  of  cholera.  Besides,  if  cholera  could  be  avoided 
by  inoculation  of  cholera  virus,  I would  call  this  method  Iso-pro- 
phylaxis, and  not  Homoeo-prophylaxis. 

Vaccination  is  a true  Homoeo-prophylaxis.  It  is  efficacious  in  pre- 
venting spread  of  small-pox  amongst  those  who  are  protected  by  its 
inoculation.  Dr.  Burnett  admits  this,  but  he  at  the  same  time  raises 
questions  which  are,  to  my  mind,  very  pertinent. 

He  says  that  vaccination  has  been  able  to  protect  some,  but  it  has 
not  been  able  either  to  decrease  the  mortality  and  morbidity  of  those 
who  are  attacked  with  the  pox.  It  has,  on  the  other  hand,  increased 


PROPHYLAXIS  OF  CHOLERA. 


765 


the  morbidity,  i.e.,  proneness  to  get  diseases.  Dr.  Burnett’s  state- 
ments require  further  verification. 

If  Homoeo-prophylaxis  by  inoculation  increases  the  morbidity  of 
the  system,  it  would  then  be  useless  to  adopt  it.  It  has,  however, 
been  abundantly  proved  that  Iso-prophylaxis,  such  as  inoculation  of 
small-pox  and  hydrophobic  virus,  has  proved  dangerous  to  human  life. 
The  celebrated  French  savant,  M.  Pasteur,  has  been  trying,  with  the 
countenance  of  the  medical  profession  of  the  world,  inoculation  of 
hydrophobic  virus  in  cases  of  hydrophobia,  with  doubtful  results 
well  known  to  you  all. 

It  is  my  belief,  based  on  the  successful  preventive  treatment  of 
small-pox  by  vaccination,  that  Homoeo-prophylaxis  is  a safe  as  well  as 
successful  method  of  treatment. 

The  question  which  now  crops  up  is  whether  Homoeo-prophylaxis 
is  possible  and  practicable  by  administering  Homoeopathic  medicines? 
Our  great  master,  Hahnemann,  himself  suggested  two  such  medicines 
prepared  according  to  his  own  method.  These  two  medicines  were 
Cuprum  metallicum  and  Veratrum  album.  Drs.  Quin,  Dudgeon, 
Josttein,  Humphreys  and  others  believe  in  the  efficacy  of  these  two 
medicinal  substances  as  prophylactics  of  cholera;  whereas  Drs.  Hem- 
pel  and  Rutherford  Russel  deny  their  efficacy. 

Hahnemann’s  directions  for  the  use  of  Cuprum  was  to  take  a 
small  globule  of  the  30th  potency  of  Cuprum  or  Veratrum  once  a 
week  during  an  epidemic.  The  medicinal  action  should  not  be  dis- 
turbed by  dietetic  irregularities  and  smell  of  Camphor.  He  also 
urged  moderate  diet  and  cleanliness. 

Dr.  Quin’s  experience  showed  that  these  two-  substances  preserved 
a good  many  persons  from  attacks  of  cholera.  Dr.  Humphreys 
says,  “ It  is  the  general  experience  of  Homoeopathic  physicians  that 
among  those  who  took  the  medicines  (Cuprum  and  Veratrum),  and 
were  attacked  with  the  disease,  it  showed  itself  in  its  mildest  form, 
while  those  who  had  omitted  this  preventive  treatment  were  attacked 
with  great  violence. 

Dr.  Constantine  Ilering  says  that  “ the  surest  preventive  against 
cholera  is  Sulphur.  Put  half  a teaspoonful  of  flowers  of  Sulphur 
into  each  of  your  stockings,  and  go  about  your  business.  Never  go 
out  with  an  empty  stomach;  eat  no  fresh  bread  nor  sour  food.  This 
is  not  only  a preventive  in  cholera,  but  also  in  many  other  diseases. 
Not  one  of  the  many  thousands  who  have  followed  this,  my  advice, 
has  been  attacked  by  cholera.” 


766 


world’s  homoeopathic  congress. 


Dr.  Dudgeon  says : “ It  would  be  wrong  to  neglect  the  means 
which  the  genius  of  Hahnemann  and  the  labors  of  his  disciples  have 
put  within  our  reach,  when  the  means  are  so  simple  and  efficacious, 
whilst  the  cure  is  so  difficult  and  hazardous.” 

Some  physicians  of  the  Orthodox  School  recommend  an  ounce  of 
brandy  two  or  three  times  a day  after  meals,  as  a preventive  against 
cholera.  Others  of  the  same  school  urge  the  use  of  dilute  sulphuric 
acid,  ten  to  fifteen  drops  every  day  in  empty  stomach,  as  the  surest 
preventive  of  cholera. 

I have  thus  quoted  many  highest  authorities  in  our  school  about 
the  prophylaxis  of  cholera.  All  those  whom  I have  quoted  are  only 
partially  right.  I have  put  Cuprum,  Veratrura,  Sulphur,  Camphor, 
etc.,  to  the  crucible  of  practical  test,  with  results  neither  positive  nor 
negative. 

As  India  is  the  home  of  cholera,  so  I have  had  immense  oppor- 
tunities to  try  these  prophylactics  repeatedly.  I had  sometimes  suc- 
cess, other  times  failures.  At  last  I found  that  of  all  physicians 
Dr.  Dudgeon  struck  the  right  key-note  regarding  the  use  of  these 
prophylactics.  He  truly  says  “ that  prophylactics  that  were  useful 
in  the  previous  epidemics  might  not  prove  equally  useful  in  the 
next.  Consequently  we  can  determine  upon  a prophylactic  only 
when  we  know  the  actual  character  of  the  epidemic,  the  same  rule 
guiding  us  in  the  selection  of  a preventive  as  in  the  choice  of  a rem- 
edy, viz.,  a comparison  of  the  symptoms  of  the  disease, % with  the 
physiological  effects  of  the  remedies.” 

This  is  the  right  explanation  of  failures  and  successes  of  prophy- 
lactics. We  must  study  the  genus  epidemieus  before  we  can  hit  upon 
a prophylactic.  All  cholera  epidemics  are  not  of  the  same  character, 
neither  do  all  cholera  cases  present  similar  symptoms.  As  there  can- 
not be  any  specific  medicine  for  any.  disease,  so  there  can  never  be 
any  one  single  prophylactic  medicine  for  any  disease.  Many  physi- 
cians, therefore,  are  mistaken  in  their  notions  about  specific  medi- 
cines, both  curative  and  preventive,  for  diseases.  Every  one  of  us 
should  bear  in  mind  the  sage  advice  of  Dudgeon  in  the  selection  of 
prophylactics  of  cholera.  I have  had  very  satisfactory  results  since 
following  Dudgeon’s  advice.  Those  who  have  had  experience  of 
several  cholera  epidemics  must  have  noticed  that  the  type  and  char- 
acter of  all  the  epidemics  are  not  the  same  throughout  their  course. 
My  object  in  noticing  this  fact  is,  that  with  the  change  of  type  and 


PROPHYLAXIS  OF  CHOLERA. 


767 


character  of  the  prevailing  epidemic  we  must  as  well  change  our 
prophylactic  medicines. 

The  subject  of  prophylaxis  is  one  of  considerable  moment  both  to 
physicians  and  the  public,  though  it  has  not  been  hitherto  worked 
out  properly. 

Dudgeon  remarks  “ if  we  can  by  means  of  the  Homoeopathic  prin- 
ciple discover  preventives  for  such  diseases  as  scarlatina  and  cholera 
morbus,  the  discovery  of  medicinal  preventives  for  other  diseases  of 
an  equally  fixed  character  seems  to  be  feasible.  As  yet  I cannot 
say  that  such  preventives  have  been  discovered,  for  it  is  by  no  means 
supported  by  evidence.”  ....  “ That  we  shall  ultimately  succeed  in 
discovering  more  prophylactics  for  fixed  diseases  I do  not  doubt. 
In  the  meantime  it  can  be  said  that  we  have  advanced  in  this  direc- 
tion beyond  the  point  Hahnemann  brought  us  to.”  Now,  it  cannot 
be  gainsaid  what  Dudgeon  asserts. 

Is  it  not,  therefore,  our  imperative  duty  to  study  the  epidemics  of 
cholera  more  carefully,  more  scientifically  and  more  patiently  with 
the  view  of  combating  it  more  successfully?  “ Prevention  is  better 
than  cure”  is  better  applicable  in  this  dire  disease.  As  physicians 
trained  in  the  school  of  Hahnemann,  unfettered  by  any  dogmas,  and 
not  bound  down  by  any  orthodox  line  of  treatment,  I think  it  should 
be  our  primary  duty  to  study  the  Ilomoeo-prophylaxis  of  diseases, 
and  more  specially  of  cholera,  which  every  now  and  again  causes  so 
much  havoc,  alarm  and  mischief. 

To  sum  up : 

1.  Homoeo-prophylaxis  is  possible,  as  it  has  been  proved  abun- 
dantly in  many  cases. 

2.  Before  selecting  any  prophylactic  medicines,  we  should  study 
the  genus  epidemicus. 

3.  As  the  type  and  character'of  the  same  epidemic  vary  with  its 
progress,  so  we  shall  not  rest  content  with  the  same  prophylactic 
medicine  throughout  its  course,  but  change  it  with  the  change  of  the 
character  and  type  of  the  epidemic. 

4.  The  action  of  prophylactic  medicines  should  not  be  disturbed  by 
irregularity  of  diet,  smell  of  Camphor  and  insanitary  surroundings. 

5.  For  the  success  of  the  prophylactic  treatment,  observance  of 
general  hygienic  rules  are  absolutely  necessary. 

6.  The  prophylactic  medicines  should  be  administered  in  as  small 
a dose  as  possible,  and  should  be  repeated  at  longer  intervals. 


768 


world’s  homceopathic  congress. 


CHOLERA. — ITS  CURATIVE  TREATMENT. 

By  P.  C.  Majumdar,  M.D.,  Calcutta,  India. 

For  convenience  of  describing  the  medicine  in  the  treatment  of 
cholera  it  is  usual  with  authors  to. divide  the  disease  into  various 
stages.  It  is  not  exactly  true  that  these  stages  appear  one  after  the 
other  in  regular  succession  as  described  in  the  books.  On  the  con- 
trary, we  often  find  one  stage  merging  into  the  preceding  or  suc- 
ceeding stage.  We  cannot  always  expect  to  see  the  disease  phe- 
nomena occur  in  regular  successive  order. 

However,  all  writers  on  cholera  agree  in  recognizing  four  stages 
of  the  disease:  first,  the  premonitory  stage,  or,  as  it  is  sometimes 
called,  an  incubation ; second,  the  stage  of  evacuation,  or  full  de- 
velopment ; third,  collapse  ; and  fourth,  the  stage  of  reaction.  We 
shall  describe  the  treatment  in  this  successive  order,  reserving  com- 
plications and  sequelae  of  the  disease  till  the  end. 

The  number  of  remedies  in  actual  cholera  is  not  very  large. 
Hahnemann  was  the  first  to  suggest  Camphor,  Veratrum  and  Cup- 
rum, and  this  suggestion  is  so  simple  that  there  is  no  difficulty  in 
treating  the  disease  effectually. 

In  the  premonitory  stage  we  are  not  in  a position  to  say  that  these 
symptoms  would  lead  to  such  a serious  disease  as  cholera,  and  so  no 
particular  medicine  is  prescribed  or  a physician’s  help  deemed  nec- 
essary. If  there  is  some  diarrhoea,  it  can  be  easily  checked  by  the 
timely  administration  of  a few  doses  of  Camphor  or  Phosphoric 
acid  or  Podophyllum.  If  the  patient  is  complaining  of  malaise, 
pains  in  body  and  chilliness,  we  can  give  Aconite,  and  if  there  be 
no  appetite  and  the  bowels  are  irregular,  regulation  of  diet  and  rest 
are  all  that  is  necessary.  When  purging  and  vomiting  of  “ rice- 
water”  takes  place,  orr  in  other  words,  when  the  second  stage  is 
fully  established,  no  time  should  be  lost  in  selecting  and  adminis- 
tering one  of  the  following  remedies,  according  to  the  state  and 
symptomatic  indications  of  the  case. 


CHOLERA — ITS  CURATIVE  TREATMENT. 


769 


f Camphor. 

Cuprum  met.  or  acet. 

Rieinus. 

Yeratrum  alb.  { Jatr°pha* 

Euphorbia. 

Croton  tig. 

Antim.  tart. 

I^Elaterium. 

Yeratrum  album  may  be  considered  as  the  type  of  a class  of 
remedies  which  are  more  or  less  p’otent  in  checking  undue  evacua- 
tions and  bringing  them  to  a natural  color  and  consistency.  In 
fact,  by  their  timely  administration,  any  further  mischief  may  be 
averted.  In  such  cases  one  of  these  medicines  should  be  selected  in 
accordance  with  the  symptomatic  manifestations  of  the  case. 

Yeratrum  album. — We  are  familiar  with  the  fact  that  white 
Hellebore  is  a drastic  purgative ; so,  according  to  the  laws  of  Hom- 
oeopathy, it  is  a medicine  par  excellence  for  choleraic  evacuations,  both 
purging  and  vomiting.  From  our  repeated  personal  experience  we 
can  give  Yeratrum  the  highest  place  in  the  developed  stage  of  cholera. 
Our  late  lamented  Professor  Farrington  says,  “ Yeratrum  seems  to 
act  prominently  on  the  abdominal  organs,  acting  probably  through 
the  splanchnic  nerves.  When  these  nerves  are  paralyzed,  the  blood- 
vessels become  overcharged  with  blood  and  pour  forth  their  serum. 
The  prostration,  the  coldness  and  the  terrible  sinking  sensation  that 
belong  to  Yeratrum,  all  start  from  these  nerves.” 

Indications  for  Administering  Veratrum. — Yomiting  and  purg- 
ing of  a large  quantity  of  serous  fluid — rice-water  evacuations,  as 
they  are  called ; colicky  pains  through  the  abdomen,  with  cramps 
in  the  extremities,  especially  the  calves  of  the  legs;  great  prostra- 
tion ; cold  sweats,  especially  on  the  forehead ; coldness  and  blue- 
ness of  face  and  hands  ; great  thirst  for  large  quantities  of  cold 
water  and  for  acid  drinks. 

In  times  of  cholera  outbreaks  it  is  wise  to  give  Yeratrum  at  the 
first  appearance  of  diarrhoea,  so  that  no  further  and  serious  develop- 
ment would  take  place.  In  such  cases  Yeratrum  has  a marvellous 
effect.  It  is  true  that  in  Yeratrum  poisoning  the  stools  are  not  al- 
ways choleric;  they  are  sometimes  tinged  with  bile,  and  there  is  no 
total  suppression  of  urine.  Whatever  may  be  the  toxicological  ef- 

49 


770 


world’s  homceopathtc  congress. 


feet  of  Veratrum  about  the  evacuation,  our  clinical  experience  with 
this  drug  is  very  extensive.  We  can  confidently  give  this  medicine 
in  all  sorts  of  evacuation. 

In  cholera,  general  depression  of  strength  is  very  great,  and  here 
Veratrum  is  also  our  sheet  anchor.  Hahnemann  gives  us  the  fol- 
lowing picture  of  Veratrum  poisoning  in  his  Lesser  Writings: 
“ Two  children  took  white  Hellebore  by  mistake.  A few  minutes 
after  taking  the  drug  they  became  quite  cold,  fell  down,  their  eyes 
projecting  like  those  of  a person  in  a state  of  suffocation,  the  saliva 
ran  continually  from  their  mouths,  and  they  seemed  devoid  of  con- 
sciousness. I saw  them  half  an  hour  after  the  accident,  and  when  I 
arrived  both  seemed  at  the  point  of  death,  distorted,  projecting 
eyes,  disfigured,  cold  countenance,  relaxed  muscles,  closed  jaws  and 
imperceptible  respiration.” 

As  regards  dose,  I generally  commence  with  the  12x,  and  subse- 
quently to  the  30x.  Our  next  great  anti-choleric  remedy  is: 

Camphor . — It  is  generally  used  in  the  first  state  of  diarrhoea,  and 
also  sometimes  in  the  stage  of  collapse.  Body  is  cold,  voice 
husky,  prostration  very  great.  In  times  of  outbreak  as  soon  as  a 
patient  is  passing  diarrhoeic  stools,  no  time  should  be  lost  in  admin- 
istering Camphor.  At  this  time  one  to  five  drops  of  the  Camphor 
solution  after  each  stool  is  all  that  is  required,  and  we  are  almost 
sure  of  checking  the  further  progress  of  the  disease.  Hahnemann 
says:  “ In  the  first  stage  Camphor  gives  rapid  relief,  but  the  pa- 
tient’s friends  must  themselves  employ  it,  as  this  stage  soon  ends  in 
either  death  or  in  the  second  stage,  which  is  more  difficult  to  be 
cured,  and  not  with  Camphor.  In  the  first  stage  accordingly  the 
patient  must  get  as  often  as  possible  (at  least  every  five  minutes)  a 
drop  of  the  spirit  of  Camphor  (made  with  one  ounce  of  Camphor 
to  twelve  of  alcohol)  on  a lump  of  sugar  or  in  a spoonful  of  water.” 

“ The  quicker  all  this  is  done  at  the  first  onset  of  the  first  stage 
of  the  disease,  the  more  rapidly  and  certainly  will  the  patient  re- 
cover; often  in  a couple  of  hours,  warmth,  strength,  consciousness, 
rest  and  sleep  return,  and  he  is  saved.” 

What  Hahnemann  said  above  I had  several  opportunities  of  wit- 
nessing in  my  own  practice.  In  my  younger  days,  when  I was 
consulted  in  the  beginning  of  an  attack,  I was  almost  invariably 
successful  with  Camphor  alone,  but  later  on  I had  scarcely  a case 
when  I had  the  opportunity  of  administering  Camphor  with  sue- 


CHOLERA — ITS  CURATIVE  TREATMENT. 


771 


cess.  Dr.  Rubini,  of  Naples,  was  immensely  successful  with  his 
preparation  of  Camphor  (equal  parts  of  Camphor  and  Alcohol) » 
and  I believe  he  treated  his  cases  from  the  beginning  with  Camphor. 

Cuprum. — This  medicine  maybe  used  in  all  stages  of  cholera; 
especially  it  is  very  efficacious  in  the  developed  state  of  the  disease. 
It  has  the  power  of  checking  purging  and  vomiting,  and  is  pre- 
eminently useful  in  cutting  short  the  distressing  and  painful  cramps 
in  various  parts  of  the  body.  Hahnemann  placed  great  reliance  in 
this  medicine.  He  sometimes  advised  11s  to  give  it  in  alternation 
with  Veratrum.  Our  late  lamented  Dr.  B.  L.  Bhaduri,  who  had 
treated  more  cases  of  cholera  than  anybody  in  India,  used  to  say 
that  he  could  treat  nearly  all  his  cases  with  Cuprum  alone.  He  was 
very  fond  of  Cuprum  ars.  in  the  stage  of  collapse  with  purging,  vom- 
iting and  cramps.  Drs.  Drysdale  and  Russel  spoke  highly  of  it  and 
so  did  Mr.  Proctor.  This  latter  gentleman  treated  ninety-eight 
cases  of  fully-developed  cholera  with  this  drug,  and  was  satisfied 
with  it.  He  writes:  “For  the  cramps  it  is  unquestionably  the  best 
remedy,  and  I must  say  for  the  vomiting  also.  In  the  stage  of  col- 
lapse I gradually  found  myself  trusting  to  Cuprum,  and  the  impres- 
sion is  very  strong  in  my  mind  that  in  collapse  it  is  the  most  valu- 
able of  our  remedies.” 

Indications  for  Cuprum. — Purging  and  vomiting  up  rice-water 
fluid;  colic  of  a paroxysmal  nature;  constant  restlessness ; cramps 
in  the  extremities,  beginning  in  fingers  and  toes;  great  exhaustion  . 
icy  coldness  of  hands  and  feet;  quick,  rattling  and  short  breathing; 
almost  imperceptible,  weak  and  thready  pulse;  pale  and  sunken 
features;  great  thirst,  water  runs  down  with  a gurgling  noise;  relief 
of  vomiting  after  drinking;  scanty  or  entirely  suppressed  urine. 

I prefer  the  higher  dilutions,  from  12th  and  upwards.  I have 
seen  aggravation  from  the  use  of  lower  dilutions  in  several  cases. 

Cuprum  Arsen. — This  combination  of  copper  and  arsenic  is  very 
efficacious  in  cholera.  Dr.  Hale  first  draws  our  attention  to  its  use 
in  cholera  cases.  He  says,  in  his  New  Remedies , “ I first  used  it  in 
some  severe  cases  of  cholera  in  the  years  1867  and  1876.  These 
cases  were  marked  by  the  usual  intestinal  disorder,  to  which  were 
added  severe  and  painful  cramps  in  the  abdomen  and  extremities. 
The  alternation  of  Arsenic  and  Cuprum  did  not  prove  as  satisfac- 
tory as  I expected,  but  the  use  of  Cuprum  ars.  in  sixth  trituration 
in  water  for  children,  and  dry  on  the  tongue  in  adults,  generally 


772 


world’s  homoeopathic  congress. 


acted  promptly.  I can  recommend  it  in  cholera  infantum,  spas- 
modic and  neuralgic  pains  in  the  bowels,  accompanied  by  screams, 
and  cramps  in  the  fingers  and  toes,’ attended  with  great  debility  and 
threatened  collapse.” 

I can  bear  testimony  to  its  efficacy  in  many  serious  cases  of 
cholera. 

Allied  to  Yeratrum  and  Camphor  are  quite  a large  number  of 
medicines  more  or  less  applicable  to  cholera  evacuations,  and  these 
are  Ricinus,  Jatropha,  Croton  tig.,  Euphorbia  and  Elaterium. 
Among  these  we  had  a very  satisfactory  result  from  Ricinus  in 
the  epidemic  of  1883.  It  is  useful  in  cases  of  diarrhoeic  cholera. 
We  have  numbers  of  cures  reported  in  the  India  Homoeopathic  Re- 
view of  that  year.  I used  it  in  diarrhoeic  cases  where  the  disease 
took  its  origin  from  indigestion  or  simple  diarrhoea.  In  a big  family 
in  Calcutta  there  was  an  outbreak  of  cholera,  and  three  persons  died 
of  it,  though  Homoeopathic  treatment  was  had  recourse  to  from  the 
beginning.  I was  called  when  a fourth  case  appeared,  and  I at  once 
hit  upon  Ricinus,  which  had  a marvellous  effect  in  restoring  the  pa- 
tient to  health.  In  this  very  house  I had  to  treat  four  more  cases, 
and  all  of  them  were  saved  by  the  timely  administration  of  Ricinus. 
In  this  house  there  was  a medical  student,  who  asked  me  the  name 
of  the  medicine,  and  learned  that  it  was  Ricinus.  He  remarked 
that  in  all  previous  cases  which  died  Yeratrum,  Camphor  and  other 
medicines  were  given.  Ricinus  surely  is  a new  medicine.  He  gave 
the  credit  to  Hr.  George  Johnson,  who  promulgated  the  Castor  oil 
treatment  of  cholera. 

Indications  for  Ricinus. — Purging  and  vomiting  of  rice-water 
fluid;  cramps  in  the  extremities;  there  was  scarcely  any  pain  in 
abdomen;  extreme  prostration ; complete  suppression  of  urine;  pulse 
almost  imperceptible;  slight  coldness  of  the  hands  and  feet. 

In  Ricinus  cases  there  is  a gradual  sinking  of  the  vital  power; 
in  Yeratrum  and  Camphor  it  takes  place  rather  rapidly.  The  stools 
may  be  sometimes  tinged  with  bile.  If  the  disease  takes  its  origin 
from  transgression  in  food,  Ricinus  is  so  much  more  indicated.  I 
am  in  the  habit  of  using  the  6x  dilution,  repeated  after  each 
stool. 

Jatropha  is  sometimes  efficacious.  It  produces  depression  of  the 
heart;  vomiting  is  more  prominent  than  purging. 

Jatropha. — Whitish  vomiting,  copious  and  like  white  of  egg; 


CHOLERA — ITS  CURATIVE  TREATMENT. 


773 


stools  in  gushes,  gurgling  and  rumbling  in  the  bowels;  cramps  in 
the  extremities ; pains  and  burning  in  stomach;  coldness  of  body; 
slight  perspiration  and  thready  pulse;  “ watery  diarrhoea,  as  if 
spurted  from  him.”  The  very  alarming  symptoms  are  not  marked 
in  Jatropha,  and  the  patient  is  devoid  of  any  anxiety  for  his  future, 
but  is  rather  lively  and  cares  nothing  for  his  suffering  and  disease. 

Euphorbia  is  another  medicine  closely  allied  to  Jatropha.  In 
fact,  it  is  a remedy  for  simple  choleric  diarrhoea  and  not  for  cholera 
proper.  Both  Jatropha  and  Euphorbia  I use  in  the  6x  dilution  after 
each  stool. 

Croton  tig.  is  also  a medicine  for  diarrhoea,  but  it  often  cuts  short 
the  disease,  which  may  be  developed  into  actual  cholera.  Stools  are 
yellow,  watery,  passed  forcibly  like  shot,  worse  after  food  and  drink; 
there  is  deadly  nausea;  vomiting  after  drinking;  great  prostration 
of  strength.  For  suppressed  eczema,  Croton  is  a good  remedy  ; 
dilutions  from  6x  to  30  used. 

Very  closely  related  to  Veratrum  is  Antimonium  tart.  Its  indi- 
cations are  very  much  like  those  of  Veratrum  alb.  Practically,  when 
I find  Veratrum  fails  I resort  to  Ant.  tart.  Purging  of  rice-water 
stools ; vomiting  with  great  effort ; cold  and  clammy  perspiration  ; 
drowsiness,  with  complete  exhaustion;  pulse  almost  imperceptible 
or  nearly  so;  heart’s  action  failing;  respiration  labored  and  difficult. 
When  there  is  an  epidemic  of  small-pox  prevailing,  it  is  better  to 
give  Ant.  tart,  in  the  beginning  of  an  attack  of  cholera,  as  it  is 
alike  efficacious  in  both  diseases.  We  have  seen  it  act  beauti- 
fully. 

These  are  the  principal  remedies  in  developed  stages  of  cholera. 
They  are  more  or  less  efficacious  in  checking  the  cholera  evacua- 
tions, and  thus  bringing  the  case  to  safe  and  sound  grounds. 

In  what  is  called  English  cholera,  or  cholera  morbus,  I found  Iris 
versicolor  a useful  remedy.  When  vomiting  is  predominant  and  dis- 
tressing, with  acid  rising,  burning  throughout  the  alimentary  canal 
from  mouth  to  anus,  I frequently  had  to  resort  to  it.  In  the  case  of 
a young  gentleman  in  a suburban  town  of  Calcutta,  I got  a charming 
effect  from  Iris.  The  attending  physician  there  tried  all  cholera 
medicines  to  check  purging  and  vomiting  of  bilious  and  acid  mat- 
ters, with  burning  in  stomach,  without  any  effect  for  two  days.  I 
gave  him  Iris  vers.  6x,  and  in  a couple  of  hours  he  was  almost 
cured. 


774 


world’s  homoeopathic  congress. 


Now,  if  the  evacuations  are  not  stopped,  or  cease  after  a consider- 
able damage  to  the  constitution  of  our  patient,  the  case  goes  on  to 
the  next  stage.  I mean  the  collapse  stage.  In  this  stage  the  patient 
is  on  the  very  verge  of  death.  But,  as  Homoeopaths,  we  must  not 
lose  heart  even  in  this  stage.  The  following  medicines  are  to  be 
thought  of  now : 


Arsenicum  alb.  « 


r Aconite. 

Camphor. 

Carbo.  veg. 

Cuprum  acet.  and  Ars. 
Hydrocyanic  acid  and  Cyanides. 
Colera  (Naja). 

Secale  cor. 

Veratrum  alb. 
b Antim.  tart. 


Practically,  a great  deal  of  difficulty  would  arise  in  treating  this 
stage  of  the  disease.  We  have  a great  many  medicines  so  closely 
analogous  in  their  symptomatic  indications  that  it  is  very  hard  to 
say  which  is  most  appropriate.  However,  if  we  can  examine  our 
patients  more  minutely,  we  can  come  to  a definite  selection. 

Arsenicum  album  is  the  most  important  medicine  in  the  collapse 
stage  of  cholera.  Its  pathogenetic  symptoms  are  so  much  like 
cholera  symptoms  that  an  arsenical  poisoning  case  may  be  mistaken 
for  a genuine  cholera  case.  It  has  a vast  range  of  action,  and  we 
have  repeatedly  verified  its  curative  virtues  in  most  serious  cases  of 
cholera.  It  is  for  this  reason  that  I select  it  as  a prototype  of  col- 
lapse remedies.  Its  symptoms  are  very  marked  and  unmistakable. 
Great  irritability,  associated  with  profound  exhaustion,  is  the  promi- 
nent characteristic  of  Arsenic.  You  will  see  patients  whose  pulse 
is  no  longer  perceptible ; great  weakness ; even  unable  to  utter  a 
single  word;  yet  so  restless,  irritable,  and  anxious  that  you  will  be 
surprised. 

Indications  for  Arsenic : great  anxiety  and  restlessness ; fear  of 
death;  utter  prostration  of  strength;  sunken  eyes;  distorted  face; 
pointed  nose;  cold  and  clammy  perspiration  over  the  whole  body  ; 
burning  of  the  whole  body  ; unquenchable  thirst  and  vomiting  after 
drinking  ; drinks  often  but  little  at  a time  ; violent  burning  of  the 
stomach  and  abdomen  ; urine  completely  suppressed. 


CHOLERA — ITS  CURATIVE  TREATMENT. 


775 


When  cholera  attacks  come  on  after  eating  much  unripe  fruits, 
drinking  much  ice  water,  living  in  a damp  place  and  exposed  to  a 
putrefactive  and  offensive  smell  of  decaying  animal  and  vegetable 
substances,  Arsenic  should  be  selected  at  once. 

Lower  dilutions  of  the  medicine  are  not  so  efficacious  as  the  higher. 
I generally  give  30th  decimal  in  frequently  repeated  doses  until  fa- 
vorable symptoms  are  observed.  I have  many  a time  saved  des- 
perate cases  of  cholera  by  giving  the  200th  dilution  when  lower  and 
30th  had  failed. 

Arsenic  has  been  administered  indiscriminately  without  reference 
to  its  indications.  This  is  a bad  practice  and  harmful.  It  is  for  this 
reason  Dr.  Bell  says  “ that  Arsenic  does  more  harm  than  good  in 
the  hands  of  ignorant  persons.” 

Camphor  has  been  used  in  cases  of  collapse,  but  I have  not  used 
it  very  frequently.  It  may  be  given  in  following  indications : 
Diarrhoea  and  vomiting  ; sudden  prostration ; coldness  of  the  sur- 
face; cold  sweat:  bluish  countenance;  husky  voice  and  violent 
cramps.  It  should  be  cautiously  given  and  as  soon  as  improvement 
is  perceptible  and  warmth  returns  it  must  be  stopped. 

Aconite  is  pre-eminently  one  of  the  best  remedies  in  the  collapse 
stage  of  Cholera.  Dr.  Richard  Hughes  remarked  that  in  our  day 
Aconite  will  be  a valuable  medicine  for  cholera.  This  was  written 
long  ago  and  I think  that  day  is  come  and  Aconite  is  used  exten- 
sively and  with  good  results. 

Indications. — Great  anxiety  and  fear  of  death  : icy  coldness  of  the 
whole  body;  cold  perspiration;  great  thirst;  labored  respiration 
with  pains  and  oppression  of  chest;  pulse  quick,  thready  and 
scarcely  perceptible  ; heart’s  action  weak  and  slow.  In  cases  of  vio- 
lent cramps  and  pains  in  abdomen  it  is  one  of  my  great  helps.  An 
elderly  lady  had  an  attack  of  cholera  a few  years  ago  with  collapse 
and  unbearable  pains  in  the  epigastric  region.  Many  Homoeopathic 
remedies  had  been  tried  without  effect.  I found  her  in  great  agony 
and  gave  her  Aconite  lx  every  half  hour  and  after  two  days  she 
was  relieved  of  her  pains  and  reaction  took  place.  For  cholera  in 
warm  days  and  cool  nights  and  after  exposure  to  cold  I find 
Aconite  valuable. 

Carho  Veg.  is  another  of  our  important  collapse  remedies.  I used 
it  in  many  cases  of  impending  death  and  with  good  results.  When 
reactive  power  is  gone  it  is  indicated.  Indications  : patient  lies  as  if 


776 


world’s  homoeopathic  congress. 


dead  ; there  is  not  the  slightest  sign  of  irritability  about  him  ; pulse- 
lessness ; eold  and  clammy  sweat;  leaden  hue  of  the  body;  husky 
voice;  difficult  and  labored  respiration;  no  thirst;  no  purging  and 
vomiting;  abdomen  often  distended;  urine  quite  suppressed.  Lower 
dilutions  have  no  effect.  I generally  use  it  in  the  30th  and  upwards. 

Hydrocyanic  acid  is  a marvellous  medicine  when  indicated/acting 
promptly  and  often  snatching  away  patients  from  the  very  verge  of 
death.  On  one  occasion,  I had  to  attend  a little  girl  gasping  for  the 
last  breath  and  no  power  of  swallowing  medicines  or  anything.  I 
poured  a few  drops  of  Hydrocyanic  acid  3x  on  a clean  handkerchief 
and  held  it  to  her  nostrils  and  to  my  utter  surprise  I found  her 
breathing  quietly  in  a few  minutes,  and  she  made  an  ultimate  recov- 
ery. It  is  for  this  reason  that  our  esteemed  colleague  Dr.  Mohendra 
Lai  Sircar  speaks  of  it  in  these  terms : “ If  any  remedy  is  entitled 
to  be  spoken  of  as  a charm  it  is  Hydrocyanic  acid.  It  would 
seem  at  times  to  restore  animation  to  a corpse.”  Indications:  icy 
coldness  of  body  with  pulselessness ; cadaverous  expression ; breath- 
ing slow,  deep  and  somewhat  spasmodic  in  character  ; beating  of  the 
heart  slow;  urine  and  stool  generally  suppressed.  I generally  give 
it  in  the  3x  or  6x  dilution  every  half  hour  or  more  frequently. 

Colera  or  Naja-Tripudians. — This  is  a medicine  from  a venomous 
snake  of  India.  The  effect  of  this  poison  is  very  swift,  like  the 
rapidly  destructive  nature  of  cholera.  Our  learned  Dr.  Salzer  speaks 
of  it  and  Lachesis  in  the  following  words:  “We  administer  them 
when  respiration  quickens,  becoming  at  the  same  time  more  and  more 
superficial,  while  the  heart’s  action  is  normal  and  still  comparatively 
vigorous.  This  sort  of  respiration  is  a sure  sign  of  impending 
paralysis  of  the  respiratory  centre  and  coincides  so  far,  exactly  with 
what  occurs  under  the  venomous  influence  of  snake  poison.”  I use 
it  in  the  6th  centesimal  dilution  every  hour  or  so. 

Secale  cor. — Another  important  remedy  in  collapse  and  some  other 
stages  of  cholera  is  Secale. 

Indications . — Watery,  slimy  and  offensive  stools,  vomiting  of 
water  and  mucus;  eyes  sunken  ; violent  cramps  of  the  calves,  hands 
and  chest;  great  restlessness  and  thirst;  difficulty  of  breathing, 
pulselessness  or  small,  slow  and  almost  imperceptible  pulse ; cold- 
ness of  the  body,  but  patient  feels  very  hot  and  cannot  keep  clothes 
on.  I have  very  little  confidence  in  Secale  in  the  stage  of  collapse, 
but  in  other  respects  it  is  a very  useful  remedy.  I am  often  able  to 


CHOLERA — ITS  CURATIVE  TREATMENT. 


777 


relieve  distressing  cramps  when  Cuprum  fails.  I find  it  especially 
beneficial  in  that  dreadful  symptom — the  cramps  and  pains  in  the 
side  of  the  chest  and  more  in  spasm  of  the  heart.  Appearance  of 
menstrual  flow  during  an  invasion  of  cholera  is  a very  serious  mat- 
ter, and  in  this  I find  Secale  an  admirable  remedy.  Typhoid  con- 
ditions during  and  after  cholera  attacks  are  also  very  serious,  and 
here  Secale  is  powerful.  Feverish  heat  after  coldness;  sleepiness 
with  now  and  then  restlessness  or  profound  comatose  sleep ; pinched 
appearance;  frequent  and  small  pulse.  It  may  be  used  in  gangrene, 
bed  sores,  ulceration  of  cornea,  and  some  other  symptoms  derived 
from  low  vitality  of  the  system  after  an  attack  of  cholera. 

Verat.  alb.  is  alto  useful  in  collapse  state.  Dr.  Salzer  writes  as 
follows:  “ I can  hardly  believe  that  Veratrum  should  not  be  as  use- 
ful in  collapse,  owing  to  a paralytic  condition  of  heart.  Perhaps  we 
give  the  remedy  at  too  long  intervals.  Dr.  C.  Dunham  recommends 
it  to  be  given,  like  Camphor,  every  five  minutes.  Much  of  the  bad 
reputation  of  the  drug  in  collapse  may  also  be  owing  to  its  not  hav- 
ing always  been  administered  at  the  right  place  and  according  to 
right  indications.” 

Ant.  tart  being  a depressant  remedy  on  the  heart  is  recommended 
in  cholera  collapse,  and  I often  find  it  useful. 

Another  remedy  is  Nicotine , the  active  principle  of  tobacco.  My 
experience  is  very  limited  about  this  medicine.  It  may  be  admin- 
istered in  collapse  with  cold  sweat,  deadly  nausea  and  sleepiness.  I 
give  it  in  delirium  with  comatose  condition. 

Sequels  and  Complications. 

With  the  reaction  stage  our  trouble  does  not  end.  Various  other 
ailments  await  our  poor  patient,  and  we  must  be  on  our  guard  to 
combat  them  in  time.  These  are  as  serious  as  an  advanced  stage  of 
cholera  proper.  Many  a time  we  lose  our  patients  in  this  stage. 

Uraemia. — If  urine  is  not  voided  after  reaction  fully  sets  in,  we 
must  do  something  for  it.  Some  physicians  are  in  a hurry  about 
urinary  secretion,  and  they  get  so  very  impatient,  as  to  wish  it 
even  in  collapse  stage.  That  is  bad.  When  reaction  is  full  we 
must  stop  all  medicine  and  wait,  and  if  healthy  signs  are  not  present, 
urine  not  voided,  and  fear  of  typhoid  state  supervening,  then  we 
must  stir  up.  Many  a time  the  previously  administered  drugs  are 
sufficient  to  restore  urinary  secretion ; so  without  abandoning  them 


778 


world's  homoeopathic  congress. 


or  searching  after  new  medicines  we  must  continue  them  according 
to  symptoms.  Arsenic,  Hydrocyanic  acid,  Tabacum  and  Nicotine 
are  to  be  used  with  proper  indications.  But  if  they  fail,  and  if  there 
is  impending  congestion  of  the  urinary  organs,  and  subsequently  of 
brain,  we  may  resort  to  Belladonna . The  use  of  it  in  the  30th  dilu- 
tion often  gives  prompt  relief.  Opium  may  be  considered  as  one  of 
the  best  remedies  in  this  condition  if  there  is  a comatose  state  with 
uraemia.  We  have  seen  Agaricus  muse,  or  Muscarin  useful  in  such 
condition  associated  with  pulselessness  or  small  and  thready  pulse, 
coldness  of  the  surface,  comatose  state  and  delirium. 

If  urine  is  collected  in  the  bladder  and  there  is  sufficient  expul- 
sive effort  but  no  urine  voided,  Cantharis  6x  or  $0  may  be  used  with 
benefit.  Failing  this,  and  if  there  be  some  burning  in  the  urethra, 
Terebinihina  may  be  given. 

I sometimes  use  Acidum  carbolic  fix  or  12x  in  cases  of  uraemic 
intoxication  and  delirium  in  cholera,  with  the  following  indications : 
Constantly  agitated,  uttering  a piercing  cry,  delirious  starting  from 
sleep ; tongue  dry,  coated  with  thick,  yellow  fur,  great  thirst ; high 
fever ; urine  is  dark,  black  or  blackish  olive-green  color.  Our 
much-vaunted  Kali  bich.  is  not  a good  medicine  in  suppression  of 
urine  in  my  hands. 

Fever. — In  the  reaction  stage  we  often  meet  with  feverishness,  and 
when  slight  we  must  not  give  any  medicine;  but  when  it  assumes 
graver  form,  and  there  is  restlessness,  thirst,  dry,  parched  tongue, 
and  full  pulse,  I generally  give  Aconite , failing  which,  Veratrum 
alb.  may  be  used.  If  there  is  headache,  flushed  face  and  other 
symptoms,  Belladonna  high  has  its  place.  Bhus  tox.,  Bryonia  and 
Phosph.  acid  may  be  administered  with  proper  symptomatic  indica- 
tions. These  latter  three  medicines  may  be  thought  of  when  this 
reactionary  fever  assumes  a typhoid  form. 

Hiccough  is  ofteu  a very  distressing  and  obstinate  complication. 
Our  ordinary  hiccough  remedies  cannot  find  their  place  here.  Cu- 
prum met.  and  Arsen,  are  very  frequent  helps.  Veratrum  alb., 
Nicotine  and  Hydrocyanic  acid  are  recommended. 

In  the  reaction  stage  there  may  be  some  faulty  condition  of  the 
digestive  tract  generally,  and  we  may  think  of  Nux  vomica,  Cicuta, 
Phosphor.,  Ignatia,  Belladonna  and  the  like.  We  have  seen  pa- 
tients cured,  to  all  intents  and  purposes,  when  they  were  suddenly 
attacked  with  dyspnoea  and  died.  Dr.  Macnamara  is  of  opinion 


CHOLERA — ITS  CURATIVE  TREATMENT. 


779 


that  in  these  cases  there  is  formation  of  clots  in  the  right  side  of  the 
heart,  usually  extending  into  the  pulmonary  arteries.  Dr.  Salzer, 
on  the  authority  of  Dr.  Buchner,  advised  us  to  give  Calc.  ars.  6x  or 
12x,  but  death  is  so  sudden  that  nothing  can  be  done. 

After  the  choleraic  symptoms  are  over  we  sometimes  get  cases  of 
obstinate  diarrhoea.  In  these  cases,  when  the  stools  are  yellow  and 
watery,  quite  copious  and  sudden,  a few  doses  of  Croton  tig.  are  suffi- 
cient. When  stools  are  saffron-yellow,  watery,  with  severe  colic, 
Colchicum  is  to  be  thought  of. 

When  the  stools  are  white  or  yellowish-white,  painless  and  much 
prostration,  Phosph.  acid  or  Podophyllum  is  given.  If  there  is 
tympanitic  distension  of  the  abdomen,  passage  of  flatus,  rumbling, 
and  thin  yellow  stools,  Natrum  sulph.  or  China  may  be  given.  One 
or  two  doses  of  Sulphur,  higher  dilution,  is  sufficient  to  bring  the 
stool  into  its  natural  color  and  consistency.  When  there  is  a ten- 
dency towards  dysentery,  stools  are  greenish,  with  tenesmus  and 
colic,  Merc.  viv.  is  the  remedy;  but  when  they  are  bloody  and  slimy, 
Merc.  cor.  is  the  preparation  used. 

Vomiting  is  often  persistent  and  troublesome,  and  defies  all  our 
well-selected  remedies.  In  such  cases  some  bland  and  mucilaginous 
food  is  all  that  can  check  it.  I generally  give  some  arrowroot  or 
rice-water  salted  and  acidulated.  Our  chief  remedies  in  vomiting 
are  Arsenic,  Ipecac,  Iris  vers.,  Phosphorus,  Kreasote,  etc.  Other 
complications  may  be  treated  as  general  diseases. 

Diet. — There  is  a great  diversity  of  opinion  among  medical  men 
on  this  subject.  From  broth,  brandy  and  other  nourishments  to  no 
food  is  the  prevailing  idea  on  this  subject.  From  practical  obser- 
vations in  many  cases,  we  are  of  opinion  that  during  the  progressive 
and  collapse  stages  of  cholera  no  food  should  be  given  except  plenty 
of  water  and  ice  to  appease  thirst  and  cool  down  the  stomach.  After 
the  tempest  is  over,  bile  appears  with  the  evacuation  ; and,  urinary 
secretion  established,  barley-  or  arrowroot-water,  with  thin  fish  or 
meat  broth,  may  be  allowed.  When  there  is  craving  for  food,  grad- 
ual addition  of  nutritious  but  easily  digestible  food  should  be  given. 
The  stomach  becomes  very  sensitive  after  an  attack  of  cholera, 
so  that  particular  care  is  necessary  in  giving  food  and  nourish- 
ment. 


780 


WORLD’S  HOMOEOPATHIC  CONGRESS. 


Discussion. 

W.  J.  Hawkes,  M.D. : I have  been  very  much  pleased  to  listen  to 
this  very  excellent  paper  on  this  very  important  subject.  I believe 
firmly  in  the  old  adage  that  an  ounce  of  prevention  is  worth  a pound 
of  cure,  so  that  the  hygienic  and  medicinal  prophylaxis  of  cholera 
is  of  extreme  importance  ; that  the  hygienic  prophylaxis  is  of  much 
greater  importance  than  the  therapeutic  prophylaxis,  for  the  reason 
that  the  individual  can  take  care  of  himself  with  the  prophylaxis  of 
hygiene,  while  he  cannot  take  care  of  himself  with  the  prophylaxis 
of  therapeutics.  The  disease  is  rapid,  and  requires  prompt  atten- 
tion when  therapeutics  are  required.  Consequently,  I would  put 
great  stress  upon  the  hygienic  prophylaxis  of  cholera.  I think  the 
prophylaxis  of  cholera  may  be  summed  up  in  three  cardinal  points: 
cleanliness,  temperance,  and  a thorough  cooking  of  everything  that 
is  taken  into  the  stomach.  The  more  recently  it  is  cooked  before 
being  taken  into  the  stomach  the  better.  The  prophylactic  remedy 
acts  decidedly  in  preventing  disease,  just  as  the  therapeutic  remedy 
acts  in  curing  the  sick,  in  this,  that  its  action  is  to  bring  the  indi- 
vidual health  up  to  par  as  soon  as  possible. 

In  regard  to  the  remedies  prescribed  or  described  here  by  our 
foreign  friend,  the  indications  are  remarkably  well  given.  As  far 
as  experience  goes,  I have  had  none  with  cholera,  but  the  indications 
given  are  remarkably  applicable. 

J.  H.  Henry,  M.D. : I am  very  much  pleased  with  the  paper  of 
our  friend  from  India,  who  represents  the  treatment  of  cholera  by 
Homoeopathy.  In  1849,  when  the  cholera  visited  the  United  States, 
I was  a student  of  medicine  in  New  York  city,  and  had  charge  of  a 
Catholic  lying-in  hospital  in  that  city.  People  died  not  only  by 
scores  but  by  hundreds.  I was  affected  by  the  disease,  but  was 
cured  by  Arsenicum  and  Veratrum.  A most  remarkable  thing 
occurred  at  that  time.  We  were  one  night  seated  on  a balcony  dis- 
coursing about  the  question  of  cholera  and  its  remedies.  The  ladies 
of  the  hospital  were  present.  We  had  everything  neat  and  clean ; 
we  had  no  signs  of  anything  that  would  develop  into  cholera  in  the 
institution.  Of  those  who  were  sitting  on  that  balcony  that  night, 
every  one  was  buried  the  next  morning  except  myself. 

What  effect  has  Hydrocyanic  acid  upon  cholera?  In  a practice  of 
over  forty  years  I have  seen  no  effect  produced  by  Veratrum,  Cu- 
prum, or  Carb.  vegetabilis  upon  cholera  in  its  collapsed  state.  And 
now  what  are  the  remedies  when  we  have  this  extreme  collapse  of 
the  whole  nervous  system?  Our  only  remedy  is  Aconite,  and  for 
that  remedy  we  are  indebted  to  Dr.  Hempel.  Whenever  you  have 
those  violent  types,  you  must  rely  upon  Aconite  in  appreciable 
doses.  The  paper  is  instructive.  I am  very  glad  that  it  has  been 
read. 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  781 


SOME  OBSERVATIONS  ON  NEURASTHENIA  AND 
ITS  TREATMENT. 

By  Conrad  Wesselhoeft,  M.D.,  Boston,  Mass. 


When,  thirty-five  years  ago,  the  writer  first  made  the  acquaint- 
ance of  what  is  now  called  neurasthenia,  it  was  known  as  spinal 
irritation,  and  the  best  of  modern  researches  have  been  unable  to 
give  a better  definition  beyond  a functional  disturbance  of  the  spinal 
and  cerebral  nerves,  dependent  on  a morbid  process,  for  which  “ irri- 
tation ” is  as  proper  a term  as  any.  As  deaths  do  not  occur,  autop- 
sies throw  no  light  on  the  subject.  Briefly  stated,  neurasthenia, 
when  observed  from  the  beginning  through  its  chronic  course,  has  a 
period  of  prodromal  symptoms  followed  by  a protracted  acute,  and 
succeeded  by  a still  more  protracted  chronic,  state,  between  the  end 
of  which  and  the  beginning  of  convalescence  there  is  a very  vague, 
often  indiscernible,  boundary  line. 

The  prodromal  symptoms  are  quite  indefinite  and  very  variable, 
pointing  to  nothing  in  particular.  Loss  of  appetite,  irregular  sleep, 
excitability  alternating  with  lassitude,  etc.,  are  often  overlooked, 
especially  when  the  second  stage — display  of  unusual  mental  and 
physical  energy  without  subsequent  fatigue — becomes  apparent. 
This  is  often  mistaken  for  a sign  of  unusually  good  health.  When 
a young  girl  or  mature  woman,  married  or  unmarried,  feels  that  she 
can  study  ten  hours  a day  and  devote  half  of  her  night  to  pleasure 
or  business ; when  besides  much  mental  occupation  she  begins  to 
rejoice  in  long  wTalks  without  fatigue,  that  is  the  time  when  the  mis- 
chief is  going  on  without  exciting  timely  suspicion.  Relief  is  at 
last  sought  when  the  functional  disorder  of  the  nerves  has  gone  to 
the  opposite  extreme,  and  becomes  manifest  in  what  is  properly  and 
popularly  termed  “nervous  prostration,”  when  instead  of  having  no 
sense  of  fatigue,  the  least  bodily  or  mental  effort  seems  intolerable, 
in  grave  cases  rendering  the  patient  a helpless  being,  completely  de- 
pendent on  the  unremitting  assistance  of  others  whom  she  (it  is 
usually  a woman)  rules  with  the  inexorable  power  of  the  vis  inertia. 


782 


world’s  homceopathic  congress. 


During  this  usually  very  protracted  period  of  the  disease  conval- 
escence usually  sets  in,  but  so  imperceptibly  that  the  physician  alone 
can  sometimes  estimate  its  progress,  which  is  unnoticeable  to  others 
towards  whom  the  patient  acts  as  she  has  for  months  or  years.  This 
is  the  time  for  action,  too  often  delayed  from  motives  of  misplaced 
sympathy  on  the  part  of  relatives  and  friends. 

The  affection  is  in  many  instances  limited  to  the  spine,  the  mind 
becoming  only  secondarily  tired.  In  other  cases  it  is  spinal  and 
cerebral ; in  others  again  chiefly  cerebral.  The  line  between  this 
and  insanity  is  always  clearly  definable.  Though  a neurasthenic 
patient  may  become  insane,  and  probably  the  reverse,  yet  both  are 
distinct  conditions. 

Books  speak  of  this  disease  as  common  to  men  and  women.  Yet 
in  this  region  in  small  towns  as  wHl  as  in  large  cities  the  cases  of 
neurasthenia  in  women  are  preponderatingly  great. 

Hypochrondia  and  hysteria  stand  in  peculiar  relation  to  neuras- 
thenia. They  may  be  regarded  as  different  species  of  the  same 
genus;  that  is,  more  or  less  deeply  seated  disturbances  of  the  cere- 
bro-spinal  system  in  which  the  sympathetic  system  is  probably  in- 
directly involved,  as  many  functional  disturbances  presided  over  by 
the  great  sympathetic  system  often  testify.  Hypochondriasis,  pure 
and  simple  as  occurring  in  men,  is  easily  distinguishable  by  its 
striking  characteristic  of  introspection  and  despondency,  occasioned 
by  abnormal  sensations,  without  marked  physical  weakness  and 
tiredness.  Pure  hypochondriacs  are  often  energetic,  conscientious 
workers.  In  hysteria  there  is  neither  great  tiredness  nor  tendency 
to  introspection,  but  a paroxysmal  or  prolonged  absence  of  the 
power  of  self  control,  in  grave  cases  associated  with  tonic  or  clonic 
muscular  spasms  and  loss  of  consciousness.  While  neurasthenia  in 
its  uncomplicated  forms  is  free  from  these  symptoms,  but,  as  ample 
experience  teaches,  often  complicated  with  both  of  the  preceding 
forms  to  such  an  extent  that  it  is  often  very  difficult  to  tell  which  is 
primary  and  which  secondary.  The  symptoms  known  as  intro- 
spection, hysterical  aberrations  of  the  emotions,  and  neurasthenic 
sense  of  exhaustion  are  in  their  distinctive  manifestations  most  im- 
portant and  constitute  indications  in  the  selection  of  remedial  and 
dietetic  measures. 

The  following  are  some  observations  of  peculiarities  observed  in  a 
large  number  of  cases  and  peculiar  to  all  : 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  783 


Introspection. — The  neurasthenic,  patient  invariably  expresses  her 
desire  for  relief,  not  so  much  in  a direct  appeal  as  in  a supplicating, 
subdued  tone  of  voice  and  manner.  She  rarely  asks,  “ What  can 
you  do  to  relieve  me?”  but  almost  invariably,  “ What  is  the  cause 
of”  this  or  that  sensation?  If  she  is  introspective,  that  is,  hy- 
pochondriacal, she  becomes  a nosomaniac,  watching  acutely  every  one 
of  her  numerous  distressing  sensations,  on  the  unremitting  analysis 
of  which  her  mind  dwells.  In  marked  cases  she  is  quite  unable  to 
think  of  anything  outside  of  herself,  and  in  many  cases  dislikes  to 
do  so,  preferring  to  rivet  her  attention  on  herself.  Attempts  to 
divert  her  annoy  or  anger  her.  Friends  and  relatives  implore  the 
physician  to  divert  the  patient,  but  all  their  attempts  are  in  vain 
because  quite  misdirected. 

Positive  and  Negative  Will. — It  seems  sometimes  as  if  the  patient 
delights  in  her  self-inspection,  and  that  she  prefers  her  condition  to 
speedy  recovery.  This  is  not  the  case,  for  the  patient  will  always 
assure  the  physician  of  her  wish  to  get  well.  During  the  acute 
stage — a long  yet  definable  period — this  wish  and  longing  cannot 
well  be  utilized,  but  the  long  and  ill-defined  period  of  convalescence 
must  first  be  awaited.  Here  we  shall  always  discover  that  the  wish 
and  the  will  of  the  patient  are  two  very  different  mental  conditions. 
The  desire  or  wish  for  recovery  is  entirely  unattended  by  any  will 
effort  to  accomplish  the  desired  end.  The  injunctions  and  directions 
of  the  physician  are  resisted  by  the  same  unconquerable  power  of 
negative  power,  or  vis  inertix.  The  patient  having  been  unable  to 
exert  her  will,  now  thinks  herself  unable  to  use  it. 

Numerous  Symptoms  of  Patients. — To  physicians  in  search  of  in- 
dications for  medicines  each  statement  of  the  patient  concerning  a 
sensation  is  apt  to  be  considered  as  a symptom.  Many  years  ago, 
when  resolved  to  get  at  the  keynote  of  a patient’s  case,  the  writer 
determined  to  allow  the  patient  to  detail  all  her  symptoms  as  long 
as  she  chose  and  to  take  accurate  notes  of  each  one  till  the  right  one 
should  be  disclosed;  and  this  was  to  be  done  regardless  of  time  and 
exertion.  The  patient,  one  who  needed  no  urging  to  describe  her 
“ symptoms,”  began  in  an  almost  inaudible  voice,  detailing  one  sen- 
sation after  another  with  an  unrivalled  degree  of  clearness  and  vivid- 
ness of  expression  ; as  she  proceeded  the  voice  became  stronger,  her 
face  slightly  flushed,  and  the  most  perfect  descriptive  language 
flowed  in  an  endless  stream.  Each  word  was  written  down,  page 


784 


world’s  homceopathic  congress. 


after  page  was  filled  ; still  she  went  on  with  unmistakable  signs  of 
satisfaction  at  being  able  to  pour  her  pent-up  emotions  into  willing 
and  sympathetic  ears.  If,  for  a moment,  the  flow  of  language  was 
interrupted,  a simple  question  would  re-animate  her  to  proceed  with 
renewed  energy.  Feelings  seemed  to  beget  feelings;  their  com- 
plexity gave  the  patient  no  trouble;  her  intellect  was  equal  to  the  oc- 
sion  of  unravelling  the  most  complicated  sensations,  separating  them 
into  their  component  parts  and  spreading  them  out  before  the  mind 
of  the  listener.  A glance  at  the  watch  showed  that  nearly  two 
hours  had  passed,  during  which  the  feeblest  of  neurasthenic  pa- 
tients had  talked  incessantly.  The  note-book  was  full,  the  keynote 
was  found.  It  was  this : neurasthenic  patients  have  innumerable 
sensations  and  exhibit  no  signs  of  fatigue  after  talking  incessantly 
for  nearly  two  hours. 

Great  Endurance  of  Neurasthenics. — The  instance  just  related, 
which  is  one  of  many,  illustrates  two  things.  One  is,  that  it  is  not 
the  kind  of  sensation  described  but  the  fact  that  neurasthenics  have 
innumerable  sensations,  that  constitute  the  symptoms.  The  other 
thing  is  that  many  neurasthenics  are  capable  of  great  exertion  with- 
out suffering  disagreeable  after-effects  from  fatigue.  This  is  illus- 
trated by  other  cases  of  which  I have  notes.  A highly  neurasthenic 
young  lady  consented  to  camp  out  for  her  health  near  a lake.  She 
was  induced  to  join  a party  for  a short  walk  along  the  lake.  By 
trying  what  they  thought  a shorter  road  the  party  lost  their  way  and 
took  a very  long  walk  of  about  four  hours,  through  bogs  and  over 
fences.  The  neurasthenic  was  less  fatigued  than  some  of  the  others. 
The  interesting  observation  was  subsequently  made  that  the  patient 
had  become  interested  in  a. young  man  of  the  party.  She  recovered 
her  health  within  a year  from  that  time.  Other  cases  of  this  kind 
will  appear  under  the  head  of  therapeutic  suggestions. 

Neurasthenic  Patients  Crave  Sympathy. — This  is  one  of  the  most 
formidable  obstacles  to  the  curative  management  of  such  cases,  for 
the  kind  of  sympathy  such  patients  crave  is  expressions  of  con- 
dolence and  more  or  less  deep  affliction  at  so  much  suffering  as  the 
patient  expresses.  Such  sympathy  is  most  natural  and  does  honor  to 
the  feelings  of  parents,  sisters,  brothers  and  husbands,  but  it  is  unfor- 
tunate that  the  deeper  their  expressions  of  affliction  so  much  the 
more  profound  will  be  the  mental  dejection  and  weakness  of  the 
patient.  Almost  every  case  which  has  come  under  the  writer’s  ob- 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  785 


servation  has  been  much  hampered  if  not  made  hopeless  by  this  con- 
dition of  things,  against  which  no  remedy  suggests  itself  that  would 
not  be  construed  as  “ unkind.” 

The  origin  of  this  very  formidable  and  refractory  nervous  disease, 
like  that  of  most  diseases  usually  termed  chronic,  is  either  hereditary 
or  acquired , as  the  histories  of  every  observed  case  plainly  testify. 
Either  the  father  was  a hypochondriac  or  the  mother  neurasthenic, 
or  both  parents  were  of  unsound  nervous  constitution.  Dipsomania 
on  the  part  of  parents  produces  neurasthenia  in  the  children,  as 
readily  as  it  will  be  followed  by  any  other  form  of  nervous  disease, 
according  to  the  individual  predisposition  of  the  offspring.  The  ex- 
cessive use  of  tea  and  coffee  is  another  very  active  factor  in  the  his- 
tory of  neurasthenics.  Where  fathers  inclined  to  alcohol,  mothers 
are  addicted  to  tea  and  coffee,  which,  while  its  immediate  effects  do 
not  obtrude  themselves  upon  our  notice,  are  none  the  less  insidious 
in  their  more  remote  consequences. 

The  acquired  forms  of  neurasthenia  are  of  utmost  interest  to  the 
therapeutist,  and  the  sources  of  acquisition  are  readily  stated.  They 
are  much  brain-work  with  insufficient  food  and  sleep.  Such  con- 
ditions obtain  chiefly  in  women  (less  frequently  in  men)  of  fine 
intellectual  ability,  conscientiousness  and  ambition.  Physical  over- 
work with  unintellectual  women  has  no  such  effect.  Quite  analo- 
gous to  the  above  are  the  conditions  of  care  and  sorrow,  especially 
in  women  who  are  able  for  a long  time  to  conceal  and  control  their 
emotions.  The  usual  consequence  of  such  states  of  mind  is  disre- 
gard of  food  and  insufficient  sleep.  Instances  of  acquired  neuras- 
thenia are  presented  in  families  of  several  girls  and  boys,  where  one 
or  more  of  the  former  are  neurasthenic  while  the  latter  are  vigor- 
ous and  athletic.  Boys  delighting  in  vigorous  exercise  do  not,  as  is 
the  case  with  girls,  lose  appetite  and  sleep. 

The  effects  of  nervous  exhaustion  in  boys  are  usually  much  less 
grave  than  in  girls;  as  a rule  such  effects  are  manifested  in  mental, 
not  muscular,  tiredness,  and  they  are  relieved  by  air  and  exercise, 
while  in  girls  and  women  those  influences  are  shunned  because  they 
seem  to  increase  the  tiredness. 

Predisposition — The  temperament,  or  what  in  modern  phraseology 
is  called  the  personal  equation,  plays  a visible  but  uncontrollable 
part  in  the  progress  of  neurasthenia,  as  temperament  greatly  deter- 
mines the  other  imperfectly  known  condition  known  as  predispo- 

50 


786 


world’s  homoeopathic  congress. 


sition.  Where  the  disease  is  hereditary,  it  is  easy  to  say  that  the 
predisposition  is  due  to  that  source;  where  there  is  no  history  of 
heredity  and  where  neurasthenia  exists  in  the  last  members  of  a 
generation,  it  may  be  attributed  to  acquired  predisposition  which 
needed  only  the  exciting  cause  to  establish  the  disease  in  its  most 
typical  form. 

One  of  the  most  common  forms  of  neurasthenia,  often  quite  in- 
tractable, results  from  a serious  defect  in  our  public  school  system, 
one  which  affects  chiefly  girls  from  twelve  to  fourteen  years  of  age. 
The  following  is  a brief  example:  The  child  rises  late  with  no  appe- 
tite for  breakfast  and  no  time  to  eat  it  if  so  inclined.  The  lessons, 
however,  have  been  learned  the  evening  before,  and  the  school  work 
is  begun  with  an  ambitious  will  and  a crammed  mind,  and  continues 
with  one  intermission  of  often  not  more  than  ten  minutes  for  three 
or  four  hours.  The  pupil  arrives  at  home  ravenously  hungry,  eats 
too  fast,  and  too  much  of  injudiciously  prepared  food,  too  long  in 
digesting  to  leave  room  for  an  appetite  for  even  a light  evening 
meal,  or  even  for  a breakfast  the  next  morning. 

In  another  case  the  girl  or  boy  grows  desperately  hungry  while 
at  school,  but  being  unprovided  with  food  (lunch),  goes  on  with  the 
school  exercises,  at  the  end  o*f  which  the  sense  of  hunger  has  vanished 
and  has  been  replaced  by  an  aversion  to  normal  food,  with  a possible 
craving  for  something  pungent  and  indigestible.  This  observation 
can  easily  be  made  in  many  instances,  and  will,  in  as  many  cases,  be 
seen  to  lead  to  nervous  prostration,  which  is  then  treated  by  vile, 
patented  concoctions  consisting  largely  of  whiskey,  under  the  name 
of  “ tonics,”  while  the  patient  needs  only  the  best  that  a legitimate 
market  affords  prepared  in  a sensible  manner. 

Typical  Cases  Ending  in  Rapid  Recovery. — Curative  results  have 
already  been  indicated  in  what  has  been  said  above,  and  further  in- 
dications for  treatment  may  be  gathered  from  a few  cases  of  extremely 
rapid  recovery  of  apparently  incurable  cases,  to  which  brief  allusion 
will  here  be  made.  A woman  of  forty  had  been  a victim  of  grave 
neurasthenia  for  five  years.  In  the  absence  of  an  inclination  to 
exert  herself,  she  had,  during  that  period,  been  mostly  confined  to 
her  bed  or  lounge,  in  the  meantime  giving  birth  to  two  children, 
going  through  gestation  and  confinement  normally,  without  recover- 
ing from  neurasthenic  prostration  which,  in  the  course  of  some  years 
more,  rendered  her  entirely  helpless.  Her  condition  was  associated 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  787 


with  a feeling  of  dropping  to  pieces  unless  supported  and  braced 
by  a harness  of  wood,  iron  and  leather,  in  which  she  “ sat  up  ” for 
several  hours  each  day,  spending  the  rest  of  the  time  in  bed.  Hav- 
ing left  the  patient  in  this  condition,  it  was  reported  before  the 

writer’s  next  professional  visit  that  Mrs. had  been  cured,  and 

that  she  was  able  to  go  out  like  other  people.  A visit  to  the  house 
confirmed  the  report.  The  patient  came  to  the  door  herself,  and  in  a 
quiet  manner,  entirely  without  the  least  expression  of  joy  or  wonder  at 
her  release,  stated,  that  having  heard  of  a famous  li  magnetic  physi- 
cian,” she  summoned  him,  was  ordered  by  him  to  arise  and  stand  ; 
protesting  that  it  was  impossible,  she  was  raised  to  her  feet  and  again 
ordered  to  stand,  then  to  walk.  Fearing  that  she  would  fall,  she 
begged  the  magnetic  doctor  to  support  her,  which  he  peremptorily 
refused,  saying  she  might  fall  if  she  liked.  Instead  of  falling,  she 
had  to  walk  about  the  room,  was  then  placed  upon  a lounge  and  sub- 
jected to  a severe  treatment  of  rolling  and  pummelling,  and  then 
ordered  to  dress  and  sit  up  until  tired,  to  remain  up  and  about  like 
other  people,  and  to  call  on  the  doctor  in  future,  as  he  would  not 
come  so  far  to  the  patient  again.  This  happened  about  twenty-five 
years  ago,  and  the  patient  has  been  in  very  fair  health  since;  not, 
however,  without  occasional  relapses,  which  were  finally  arrested  by 
insisting  that  all  professional  visits  by  the  writer  or  any  other  physi- 
cian to  whose  sympathy  the  patient  could  appeal  must  cease.  This 
injunction  was  carried  out  conscientiously  with  the  best  results  by 
the  husband  of  the  patient.  Perhaps  we  may  learn  from  this  that 
sometimes,  at  least,  the  familiar  motto  is  reversed,  and  angels  rush 
in  where  fools  fear  to  tread. 

Profiting  by  this  experience,  another  neurasthenic  woman,  unmar- 
ried, but  of  most  intractable,  antagonistic  temperament,  confined  to 
her  bed,  in  and  out  of  hospitals,  for  years,  wearing  out  the  strength 
and  means  of  her  relatives  and  the  patience  of  many  physicians,  was 
at  length  abandoned  by  them.  It  was  a case  of  spinal  and  cerebral 
neurasthenia  complicated  with  hypochondriasis  in  its  most  trying 
form  of  introspective  maunderings  and  endless  description  of  symp- 
toms. She  tormented  her  advisers  by  her  endless  tirades,  the  indul- 
gence of  which  invariably  aggravated  her  condition,  and  were  there- 
fore avoided,  until  once  her  physician  yielded  to  the  patient’s 
importunities  for  a visit,  when  he  found  her  in  her  usual  abject  state 
of  prostration.  Guided  by  experience  derived  trom  cases  like  the 


788 


world’s  homoeopathic  congress. 


one  first  described,  he  assisted  the  patient  to  her  feet  and  marched 
her,  will  you  nil  you,  up  and  down  the  room  until  he,  at  least,  was 
thoroughly  tired,  and  then  departed  with  the  promise  never  to  do 
so  again.  The  patient,  on  her  part,  made  a number  of  her  unami- 
able  promises,  but  kept  on  her  feet  and  let  the  doctors  alone. 
Though  not  cured  of  deeply-rooted  morbid  mental  faults,  the  neu- 
rasthenic phase  of  her  condition  had  yielded  to  the  change  of  the 
antagonistic  element  of  her  character  from  passive  to  very  practical 
activity. 

A third  very  serious  case  of  this  kind  occurred  in  the  person  of  a 
girl  of  fifteen,  of  selfish  character,  who  gradually  became  bed-ridden 
with  spinal  and  cerebral  neurasthenia,  and  tormented  with  the  usual 
multifarious  painful  sensations,  none  of  which,  on  the  most  pains- 
taking physical  examination,  resulted  from  demonstrable  organic 
disease  of  genital  or  abdominal  organs.  The  patient  was  most  ten- 
derly cared  for  by  her  mother,  who,  in  the  course  of  years,  became 
so  imbued  with  the  idea  of  yielding  to  every  wish  and  whim  of  the 
patient,  that  at  length  remonstrance  became  useless.  The  mother, 
though  recognizing  the  importance  of  persuading  or  urging  her 
daughter  to  depend  more  on  herself,  admitted  that  she  had  yielded 
so  long  that  now  she  must  continue  to  feed,  dress  and  assist  her 
charge  in  the  most  trivial  things.  Her  food  had  to  be  placed  in  her 
mouth,  the  position  of  a hand  or  foot  changed  by  some  one  else, 
although  the  patient  did  so  spontaneously  when  she  chose.  This 
went  on  for  fifteen  years,  when  the  mother,  growing  old  and  feeble, 
died.  Her  maternal  support  being  gone,  the  patient  at  once  proved 
her  ability  to  walk,  to  dress,  to  feed  herself,  and  to  seek  light  em- 
ployment. Though  far  from  well,  she  is  equally  far  from  being  a 
helpless,  bed-ridden  invalid. 

A fourth  case,  still  very  vividly  impressed  on  the  writer’s  mind, 
was  one  of  a healthy,  romping  girl  of  14,  who,  as  happens  in  this 
rerfiarkably  capricious  disease,  in  the  midst  of  perfect  health,  one 
day  took  to  her  bed  and  remained  there  with  all  the  symptoms  of 
neurasthenia,  involving  first  the  spinal  and  finally  the  cerebral  nerves. 
This  patient  was  very  amiable,  conscientious,  and  sensible,  never 
loquacious,  and  not  troubled  with  hypochondriacal  thoughts  or  sen- 
sations. Tiredness  was  the  only  expression  she  used  in  describing 
her  feelings.  There  was  literally  no  variation  from  this  condition, 
which  confined  her  to  her  bed  for  years,  till  she  grew  from  a girl  to 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  789 


a woman.  Eating  and  sleeping  well,  and  improving  perceptibly  in 
personal  appearance  and  character,  yet  she  lay  on  her  couch  tired 
and  watched  over  with  unremitting  care  by  a most  anxious  mother, 
showing  her  solicitude  and  sympathy  in  every  feature.  Once,  in 
the  second  year  of  the  disease,  a favorable  interruption  occurred. 
The  mother,  still  a young  woman,  gave  birth  to  another  child. 
During  her  confinement  the  neurasthenic  patient  was  in  charge  of 
her  mother’s  nurse,  assisted  by  other  servants.  The  nurse,  while  de- 
voted to  the  daughter,  agreed  with  the  writer  that  excess  of  sympa- 
thy was  injurious,  and  used  her  best  and  judicious  endeavors  gradu- 
ally to  persuade  the  patient  to  make  some  physical  effort  at  walking 
and  standing.  In  this  she  was  so  successful  that  in  two  weeks  she 
accompanied  the  girl  on  half-mile  walks  up  and  down  hill,  finally 
without  assistance.  Thus,  recovery  seemed  assured,  and  everything 
was  favorably  progressing  towards  it  when  the  mother,  having  fully 
recovered,  again  took  charge  of  her  daughter,  with  the  result  that 
she  at  once  took  to  her  lounge  and  remained  there  two  years  longer. 
About  that  time  other  advice  was  urged  and  gladly  acceded  to,  with 
the  result  that  the  case  was  diagnosed  by  an  eminent  surgeon  as 
spinal  paralysis  in  consequence  of  concussion,  though  it  could  never 
be  shown  when  and  where  it  occurred.  Salves,  plasters,  anodynes, 
nervines,  and  electricity  did  no  good,  but  effectually  destroyed  appe- 
tite and  digestion,  which  hitherto  had  been  normal.  So  this  adviser 
resigned  in  favor  of  a third,  who,  being  a younger  and  less  preju- 
diced man,  agreed  perfectly  with  the  writer’s  original  opinion.  He 
advised  return  to  moderate  exercise,  avoidance  of  drugs,  and  less  dis- 
play of  sympathy.  This,  though  formerly  rejected  as  “ unkind,” 
was  now  acceded  to  as  coming  from  a nerve-specialist,  fresh  from 
Europe,  at  that  time  very  rare.  Still  attending  the  other  members 
of  the  family,  the  writer  had  ample  opportunity  of  observing  the 
course  of  the  case.  Improvement  was  very  slow  and  uncertain  till 
financial  misfortune  overtook  the  family.  Almost  with  a bound  our 
patient  left  her  couch,  and,  organizing  a kindergarten,  strove  ener- 
getically in  supporting  herself  and  assisting  her  mother.  The 
change  came  about  in  less  than  three  weeks,  and  resulted  in  perfect 
recovery. 

At  this  point  another  very  instructive  case  of  very  speedy  re- 
covery, after  six  or  seven  years  of  neurasthenic  prostration,  deserves 
to  be  mentioned.  A woman  of  35  had  been  in  bed  and  on  the 


790 


world’s  homoeopathic  congress. 


lounge  most  of  the  time  for  nearly  seven  years,  at  the  end  of  which 
time  she  became  my  patient,  her  regular  medical  attendant  having 
gone  to  Europe.  She  was  of  very  amiable  disposition  and  as  sen- 
sitive as  she  was  weak.  Her  symptoms,  as  in  the  other  cases,  were 
instantaneous  exhaustion  on  the  least  physical  exertion.  She  could 
give  herself  up  to  no  mental  occupation  beyond  directing  her  house- 
hold affairs,  the  education  of  her  son,  and  the  rehearsal  of  her  nu- 
merous sensations.  She  had  not  been  my  patient  long  when  her 
husband  failed  in  business,  so  that  the  family  was  reduced  from 
very  comfortable  circumstances  to  a condition  which  made  it  neces- 
sary for  the  patient  to  make  her  own  living  and  that  of  the  family. 
This  she  almost  at  once  proceeded  to  do,  setting  aside  all  other  con- 
siderations and  establishing  a boarding-house,  where  she  did  most  of 
the  work  herself.  This  she  has  done  now  for  ten  or  twelve  years 
without  a serious  relapse.  The  time  involved  in  the  period  of 
convalescence  was  scarcely  more  than  three  weeks,  although  her 
work  may  be  said  to  have  begun  at  the  moment  her  resolution  was 
taken. 

Prognostics. — From  these  and  other  cases  in  and  outside  of  the 
writer’s  practice,  it  is  safe  to  say  that  the  majority  of  cases  of  neu- 
rasthenia recover,  though  years  may  elapse  before  that  period.  We 
learn,  furthermore,  that  recoveries,  especially  of  very  inveterate 
cases,  depend  on  conditions  beyond  the  control  of  the  physician, 
as  was  the  case  in  the  above-recorded  instances,  where  circum- 
stances forced  the  patient  to  cease  to  wish  for  recovery  and  to 
make  an  effort  of  the  will.  This  having  been  once  accomplished, 
self-confidence,  for  a long  time  in  abeyance,  was  permanently  re- 
stored. 

Curability,  further,  depends  very  much  on  the  temperament  of 
the  patient,  whether  amiable,  tractable  and  confiding  in  the  honest 
endeavors  of  the  physician,  or  whether  refractory,  suspicious,  un- 
truthful, selfish  and  antagonistic,  of  a disposition  impossible  to  win 
over  on  account  of  unnatural  distrust  of  every  well-meaning  person. 
The  degree  of  intelligence  of  patients  also  has  a pronounced  influ- 
ence on  the  result.  The  most  readily  curable  cases  are  those  acquired 
without  hereditary  predisposition,  where  the  cause  is  found  in  the 
absence  of  food  and  sleep,  also  where  sorrow  and  anxiety  can  be 
averted  or  counteracted  by  judicious  conduct  of  near  relatives  and 
friends. 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  791 


Dietetic  Treatment. — This,  as  medicinal  treatment,  must  be  gov- 
erned by  the  stage  at  which  the  case  comes  into  the  physician’s 
hands — whether  yet  in  its  prodromal,  its  acute  or  its  chronic  phase. 
The  prodromal  stage  of  the  disease  has  no  very  decided  pathogno- 
monic signs.  The  most  that  can  be  recognized  in  this  stage  is  that 
the  patient’s  habits  or  duties  are  of  a kind  which  will  eventually* 
lead  to  obdurate  neurasthenia  if  not  arrested  in  time  by  removing 
the  exciting  causes.  Too  much  pleasure,  as  well  as  too  much  care, 
especially  in  girls  and  women,  tends  to  neglect  of  food  and  rest,  in 
the  absence  of  which,  excitement,  whether  of  pleasure  or  care,  begets 
a state  of  unrest  in  which  repose  is  disagreeable.  With  such  a con- 
dition comes  a list  of  incipient  casual  complaints  of  headache,  im- 
perfect sleep,  notional  ways  of  eating,  working  or  playing.  A few 
questions  will  determine  whether  the  patient  is  living  according 
to  normal  or  abnormal  habits  with  regard  to  appetite,  sleep  and  oc- 
cupation. Where  these  are  found,  their  alteration  to  normal  ways 
must  be  insisted  on.  It  is  unnecessary  to  say  that  this  is  easier  said 
than  done,  for  it  will  probably  meet  with  serious  objections  on  the 
part  of  the  patient,  if  not  on  that  of  her  relatives ; for  most  likely 
she  has  examinations  for  college  to  prepare  for,  involving  several 
months  of  close  and  careful  study  at  night,  and  the  patient  cannot 
waste  time  in  sleeping  and  eating  while  cramming  that  little  excited 
and  ambitious  brain.  A failure  in  the  examinations  would  be  as 
much  of  a disappointment  to  parents  as  to  patient,  who  proves,  as 
usual,  that  this  appellation  is  a misnomer.  She  accordingly  goes  on 
as  she  pleases,  impelled  by  an  increasing  morbidly  ambitious  im- 
pulse, and  the  result  is  likely  to  be  the  mournful  satisfaction  on  the 
part  of  the  physician  of  being  obliged  to  say,  “ I told  you  before 
what  would  happen.”  Of  course,  all  regret  the  now  evident  nerve- 
prostration,  while,  if  the  doctor  had  succeeded  in  enforcing  his  rules, 
he  would  in  many  cases  experience  the  still  more  painful  reproach 
of  having  been  too  severe.  Nevertheless,  absolute  firmness  and  a 
kindly  but  unflinching  exertion  of  his  will,  without  the  least  com- 
promise, reward  the  physician  with  the  best  results  in  such  cases. 

When  the  case,  after  the  stage  of  excitement  and  untiring  rest- 
lessness (at  which  it  would  still  be  speedily  curable  by  simple  die- 
tetic rules)  has,  after  weeks  or  months,  entered  upon  the  phase  of 
painful  prostration,  here  we  encounter  backache,  oppressive  head- 
ache, and  absolute  loss  of  mental  or  bodily  endurance,  measures  of 


792 


world’s  homoeopathic  congress. 


dietetic  management  are  much  less  effective  and  much  more  difficult 
to  find.  It  is  at  this  stage  that  slight  rise  of  temperature  will  occur, 
especially  towards  evening ; then  the  backache  and  headache  disap- 
pear, the  pallor  is  replaced  by  a flush  of  color,  the  eyes  lose  their 
listless  look,  and  the  patient  is  inclined  to  enter  upon  some  diversion 
or  excitement,  followed  by  a restless  night  and  a morning  of  exhaus- 
tion and  a renewal  of  all  painful  sensations.  Most  of  such  patients 
feel  much  better  in  the  evening  when  they  are  ready  for  some  enter- 
tainment, while  in  a normal  state  this  would  be  the  time  for  relaxa- 
tion and  repose. 

The  dietetic  treatment  of  this  stage  is  methodical  rest.  In  severe 
cases  the  patient  will  do  well  to  remain  in  bed  for  several  days  or 
even  for  weeks.  It  is  well  to  shorten  this  period  as  much  as  possi- 
ble and  to  insist  on  walking  about,  or,  at  least,  sitting  for  a specified 
time  every  day.  This  may  be  varied  by  equally  specified  periods  of 
rest  in  the  recumbent  position. 

Irregularities  of  eating  are  at  this  and  at  all  times  to  be  superseded 
by  the  most  rigid  regularity  of  meals.  The  traditional  and  conven- 
tional three-meal  system,  however  well  adapted  to  the  needs  of  a 
vigorous  man  or  woman,  does  not  agree  with  the  neurasthenic  pa- 
tient. It  is  much  better  that  these  should  eat  oftener  ; four  times 
a day  is  best  in  most  cases,  for  the  simple  reason  that  in  this  way  a 
patient,  while  eating  less  at  a time,  consumes  more  food  in  the 
aggregate. 

As  neurasthenic  patients  are  rarely  troubled  with  absolute  aver- 
sion to  wholesome  food,  they  are  generally  able  to  consume  a liberal 
quantity,  about  which  it  is  only  needful  to  remark  here  that  the  food 
should  be  selected  from  among  the  articles  and  dishes  which  the  pa- 
tient likes,  provided  they  belong  to  the  order  of  good,  normal  arti- 
cles of  food,  to  the  exclusion  of  those  which  simply  please  the  taste 
without  being  digestible.  A dish  entirely  of  meat  or  “ animal  food” 
is  as  far  from  being  a good  diet  for  neurasthenics  as  one  consisting 
entirely  of  “ vegetable”  food.  As  a rule,  the  diet  list  should  com- 
prise one-third  of  nitrogenous  material  and  two-thirds  of  carbo- 
hydrates. Together  with  these,  it  is  a great  mistake  to  neglect  the 
fats,  such  as  good  butter  and  the  fats  of  meats.  And,  lastly,  every 
patient  of  this  kind  should  be  made  to  drink  some  water  often,  a 
dietetic  feature  too  often  neglected. 

During  this  stage,  actually  fatiguing  exercise  of  body  and  mind 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  793 


should  be  avoided,  while,  on  the  other  hand,  the  patient’s  mind  should 
be  directed  away  from  herself,  in  which  she  is  much  assisted  by  with- 
holding a certain  kind  of  emotional  sympathy,  quite  as  natural  as  it 
is  difficult  to  repress  on  the  part  of  affectionate  persons.  Of  this,  a 
few  words  further  on. 

There  is  no  definite  time  for  the  duration  of  this  stage,  which, 
however,  depends  largely  on  the  time  during  which  the  exciting 
causes  have  acted,  either  aided  by  or  without  a predisposition.  It 
is  certain,  however,  that  the  sooner  it  is  recognized  and  the  exciting 
causes  eliminated,  so  much  the  sooner  recovery  will  begin.  But 
there  is  a stage  at  which  the  best  of  experience  and  judgment  often 
fail,  especially  in  very  inveterate  cases.  If  the  case  is  one  of  a pa- 
tient whom  the  physician  has  had  opportunity  of  watching  at  least 
since  the  earlier  stages,  the  difficulty  is  not  so  great  as  it  is  in  old 
cases  of  many  months  or  even  of  several  years’  duration  which  come 
to  treatment  late.  In  these,  the  line  between  the  intermediate  stage 
and  incipient  convalescence  cannot  be  drawn.  The  patient  is  as  neu- 
rasthenic and  hypochondriacal  as  ever ; cannot  bear  the  slightest 
mental  or  bodily  exertion,  not  even  a word  or  a look,  without  signs 
of  apparent  exhaustion,  while  nearly  the  whole  time  is  spent  in  bed 
under  anxious  care  of  sympathetic  attendants.  In  such  cases,  having 
become  assured,  by  careful  physical  examination,  of  the  absence  of 
organic  disease,  seeing  the  patient  generally  well  nourished  and  in 
fair  muscular  condition,  the  physician  is  warranted  in  assuming  that 
the  disease  has  run  its  course,  that  whatever  morbid  (pathological) 
process  there  may  have  been  progressing  in  the  nervous  system,  this 
process  has  now  come  to  an  end,  but  it  has  left  the  patient’s  mental 
condition  habituated  to  the  moods  of  the  past  months  or  years,  and 
fixed,  as  it  were,  indelibly  in  the  memory.  It  is  the  habit  that  now 
remains,  not  the  disease. 

If  reasonably  sure  of  this,  and  calling  to  mind  the  rapid  recov- 
eries and  the  circumstances  attending  them,  as  above  detailed,  the 
physician  is  now  safe  in  ordering  a more  energetic  treatment,  calcu- 
lated to  rouse  the  self-reliance  of  the  patient.  All  visible  signs  of 
sympathy  must  now  be  set  aside;  the  actions  and  demeanor  of  the 
attendants  should,  from  this  time,  if  not  before,  be  changed  so  as  to 
give  the  patient  the  impression  that  she  is  no  longer  an  invalid,  but 
expected  to  rely  on  her  own  exertions.  Instead  of  being  fed,  the 
food  should  be  placed  where  she  must  go  for  and  eat  it.  She  should 


794 


world’s  homceopathic  congress. 


now  be  expected  to  dress  and  attend,  without  assistance,  to  her  natu- 
ral wants.  This,  with  some  temperaments,  is  almost  impossible, 
with  all  extremely  difficult.  The  best  course  to  pursue  is  to  remove 
such  patients  from  sympathetic  relatives  or  friends,  and  to  place  them 
in  charge  of  kind,  reliable,  but  eminently  practical  nurses. 

The  first  effect  of  this  is  either  to  throw  the  patient  into  a state  of 
helpless  despondency,  which,  again  appealing  powerfully  to  the  sym- 
pathies of  those  nearest  to  her,  often  frustrates  the  physician’s  plans 
which,  if  firmly  but  kindly  adhered  to,  would,  ere  long,  prove  their 
superiority  by  signs  of  returning  self-reliance  and  absence  of  com- 
plaints on  the  part  of  the  patient.  A second  form  of  effect  is  that 
occurring  in  patients  of  obstreperous,  selfish  disposition,  whose  oppo- 
sition and  even  anger  is  aroused  by  being  thrown  on  their  own  re- 
sources after  the  removal  of  depressing  and  unpractical  sympathy. 
This  opposition  or  temper,  often  manifested  in  all  sorts  of  intrigues 
and  subterfuges  on  the  part  of  the  patient,  if  not  supinely  yielded 
to  by  sympathetic  persons,  will  finally  be  replaced  by  a more  rational 
disposition.  On  the  whole,  anger  or  active  opposition  are  signs  of 
returning  energy,  which,  once  coming  to  the  consciousness  of  the 
patient,  takes  the  form  of  self-reliance.  It  is  in  this  way  that  the 
cures  of  chronic  cases  above  related  can  be  explained,  and  physi- 
cians should  profit  by  such  experiences  for  the  benefit  of  their 
patients. 

The  general  dietetic  management  now  readily  follows  from  what 
has  been  said,  and  needs  only  a few  general  modifications.  The  first 
duty  of  the  physician  will  be  to  test  the  degree  of  reliance  to  be 
placed  on  the  patient  and  her  friends,  and  to  win  them  over  if  pos- 
sible to  his  plans,  and  his  success  will  be  in  proportion  to  the  degree 
of  confidence  he  is  able  to  inspire.  This  personal  confidence  should 
not  degenerate  into  a mere  personal  liking  or  attachment  of  a sym- 
pathy-craving neurasthenic  who  should  discover  henceforth  that  all 
sentimental  expressions  of  sympathy  are  about  to  take  a practical 
form,  aiming  at  a definite  result — the  patient’s  health  — which  she 
wishes  but  cannot  exert  her  will  to  attain.  The  best  and  often  the 
only  way  to  do  away  with  sentiment  and  to  reach  practical  kindness 
is  to  remove  the  patient  from  certain  home  influences,  and  to  place 
her  in  a hospital  or  elsewhere  under  the  management  of  competent 
nurses  who,  without  being  selfish,  know  how  to  exert  a certain 
amount  of  wholesome  push  as  fast  as  the  patient  can  bear  it.  With- 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  795 


out  the  removal  of  sentimental  sympathy,  all  efforts  at  counteracting 
the  purely  hypochondriacal  side  of  neurasthenia  are  useless. 

In  these  cases  of  neurasthenia  as  yet  uncomplicated  with  the  hypo- 
chondriacal element  of  introspective  nosomania,  there  is  only  one 
unconditional  rule  to  be  followed,  especially  in  acquired  cases  whose 
evident  cause  was  incessant,  conscientious  work  of  mind  and  body, 
together  with  insufficient  food  and  sleep.  Such  cases  come  on  very 
insidiously,  the  loss  of  strength — -that  is,  the  actual  waste  of  nerve- 
substance — being  just  a trifle  greater  than  the  quantity  restored,  the 
patient  unconsciously  using  up  a minute  part  of  her  capital  every 
day.  Here  the  rule  should  be  to  reverse  matters  by  insuring  a sup- 
ply of  nourishment  and  time  for  its  assimilation  greater  than  was 
the  case  heretofore.  The  cases  of  young  school-girls  belong  in  this 
class.  The  time  of  food  and  rest  should  be  carefully  controlled  at 
home,  the  duty  of  the  physician  being  to  educate  indifferent  and 
ignorant  parents  up  to  an  appreciation  of  the  nature  of  the  case.  It 
is  generally  not  difficult  to  open  their  eyes  through  the  medium  of 
their  anxiety  concerning  their  children’s  health.  Having  thus  in- 
sured sufficient  rest  and  food  at  home,  the  physician’s  next  object  of 
attention  should  be  the  regulations  of  the  school.  Here  is  the  point 
where  teachers  have  an  opportunity  of  exerting  their  most  practical 
influence.  It  should  be  made  obligatory  on  the  part  of  teachers  to 
institute  inquiry  as  to  whether  pupils  have  had  their  meals  before 
coming  to  school.  This  they  could  often  ascertain  without  a ques- 
tion, by  reading  the  pupil’s  condition  in  her  emaciated  form,  pale 
face  and  nervous  manner.  To  guard  against  neglect  at  home,  it 
would  be  an  easy  matter  to  insist  that  all  pupils  of  public  and  pri- 
vate schools  should  bring  with  them  some  proper  food.  The  few 
who  do  so  generally  bring  sweets — an  apple,  orange  or  a few  dry 
crackers — when  a piece  of  good  bread  and  slice  of  cold  meat  would 
be  what  they  actually  need.  All  pupils  should  pass  inspection,  and 
if  remiss  in  this  important  particular,  the  delinquent  should  be  dis- 
missed with  several  marks  against  her.  To  expect  this  of  teachers 
would  be  a great  advance  in  the  place  of  futile  innovations  of  endeav- 
oring to  send  forth  from  our  common  schools  graduates  in  arts  and 
sciences. 

Sudden  Effects. — A large  number  of  cases  of  neurasthenia,  espe- 
cially those  complicated  with  inveterate  hypochondriasis,  are  fre- 
quently traced  to  some  sudden  occurrence,  having  the  effect  of  a 


796 


world’s  homoeopathic  congress. 


mental  or  physical  shock.  In  one  patient,  a vigorous  girl,  used  to 
romping,  climbing  and  running  like  a boy,  the  cause  was  supposed 
to  be  a slight  thump  she  received  during  a game  of  blind man’s-buff. 
She  thought  nothing  of  it  at  the  time,  but  it  was  suggested  long 
after  the  patient’s  illness  began.  In  another  case  some  mental  shock 
of  joy  or  grief,  not  very  severe  and  such  as  is  often  experienced  in 
every  person’s  life,  is  the  beginning  of  months  of  nervous  pros- 
tration. 

There  is  quite  an  array  of  evidence  that  neurasthenia  which  has 
entered  upon  a hypochondriacal  stage  or  complication  with  or  with- 
out a strong  hysterical  admixture,  is  curable  by  sudden  impressions 
in  the  form  of  a shock,  or  more  gradually  by  frequent  repetitions  of 
an  impression.  Such  cases,  as  I have  shown  above,  occur  most 
commonly  in  the  stage  when  what  may  be  considered  the  essential 
pathological  disturbances  of  function  have  run  their  course  and  have 
left  the  patient  in  a state  of  mental  disturbance  which  indicates  that 
the  patient’s  recovery  depends  entirely  upon  her  volition.  But  there 
is  none,  and  so  far  nothing  has  succeeded  in  arousing  it.  Persuasion 
is  as  useless  and  irritating  as  argument  would  be  in  a case  of  insan- 
ity with  a fixed  illusion.  The  resemblance  between  this  and  the 
state  of  mind  of  a hypochondriacal  neurasthenic  is  very  close.  She 
cannot  move  nor  think.  Exhaustion  overcomes  her  and  keeps  her 
its  victim  for  years,  when  suddenly  the  scene  changes,  and  a few 
days  or  weeks  suffice  to  restore  the  patient  to  activity.  In  one  in- 
stance it  is  attributed  to  medical,  in  another  to  “ mind  cure,”  in  a 
third  to  “ Christian  science;  ” in  still  other  cases  massage  has  done 
it,  in  others  again  “ magnetic  influence,”  in  others  the  very  powerful 
factor  necessity.  It  is  certain  that  cases  of  this  kind,  produced  by 
sudden  effects  on  the  mind  of  a predisposed  person,  are  also  cured 
by  such  effects.  Whatever  the  visible  form  of  these  effects  may  be 
— whether  that  of  te  Christian  science,”  joy,  grief  or  absolute  inex- 
orable necessity,  there  is  always  to  be  noticed  a certain  force  and 
condition  involving  the  modern  idea  of  suggestion,  which  comes  to 
the  patient  in  an  irresistible  degree  and  now  sets  the  function  of  the 
will  in  motion  again. 

Experience  teaches  that  it  is  by  no  means  a matter  of  indifference 
which  of  these  forms  of  effect  are  brought  into  action.  In  one  case 
it  is  the  professional  Christian  scientist’s  method,  in  another  the 
almost  brutal  exertion  of  a person’s  will  combined  with  some  phys- 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  797 


ical  force.  In  either  case  the  patient  is  aroused  from  his  inertia, 
and  discovers  his  powers  of  mental  and  bodily  ability  to  act. 

A deplorable  result  is  that  recoveries  after  such  effects  are  attrib- 
uted in  the  popular  mind  to  supernatural  causes.  That  such  is  not 
the  case  may  be  gathered  from  instances  occurring  in  very  sensible 
and  intelligent  patients,  whose  reason  is  scarcely  ever  so  far  disturbed 
and  weakened  that  they  do  not  resent  the  proposition  of  trying,  e.g ., 
Christian  science  or  mind  cure. 

Nevertheless,  it  is  the  mind  cure  which  the  intelligent  patient 
needs  quite  as  much  as  the  ignorant  and  superstitious  person;  the 
difference  is  only  the  form  in  which  the  influencing  force  is  applied. 
While  in  one  case  it  is  obedience  to  the  candidly  expressed  instruc- 
tions of  the  physician,  in  the  other  case  the  result  is  due  to  mystifi- 
cation. In  either  case  it  is  the  powerful  stimulus  of  hope  and 
aroused  confidence  that  recovery  will  be  realized. 

The  definition  of  suggestion  does  not  fully  cover  the  meaning,  be- 
cause the  influence  employed  is  greater  than  mere  suggestion.  The 
physician’s  plan  of  action  should  be  straightforward  assurance  of 
recovery,,  a direct  appeal  to  hope,  and  an  unceasing  endeavor  to 
arouse  the  self-reliance  of  the  patient,  not  so  much  by  verbal  exhor- 
tations as  by  a manner  and  deportment  from  which  the  patient  learns 
more  readily  than  from  words  what  is  expected.  If  the  attitude  of 
the  physician  is  appreciated,  and  seconded  by  the  relatives  and  atten- 
dants, a favorable  result  is  much  more  certain  to  follow. 

Hypnotism  is  not  advisable.  There  are  now  existing  ancient 
neurasthenic  invalids  dating  from  the  times  of  spiritualism  when 
they  were  famous  “ mediums.”  Hypnotism  weakens  the  will  and 
nervous  endurance,  and  produces  a predisposition  to  emotional  ner- 
vousness with  an  intractable  erotic  admixture.  The  suggestions 
sought  to  be  instilled  into  a hypnotized  patient  amount  to  nothing. 
The  mental  influence  of  mystical  treatment  administered  while  the 
patient  is  awake  is  much  more  powerful  in  awaking  hope  and  confi- 
dence than  the  uncertain  effects  of  an  abnormal  state  like  that  of 
hypnotism.  Mystification,  again,  though  sometimes  unavoidable 
with  the  best  intention,  is  less  powerful  than  direct  and  intelligible 
encouragement.  While  resort  to  mystification  should  be  shunned 
by  reputable  physicians,  the  question  arises  as  to  what  shall  be  done 
with  the  many  who,  from  lack  of  intelligence  or  education,  are  en- 
tirely beyond  the  reach  of  honest  common  sense,  and  who  will  persist 


798 


world’s  homoeopathic  congress. 


in  mystifying  themselves,  who  remain  neurasthenic  invalids  in  spite 
of  the  best  regulations  of  the  physician,  and  who  do  not  recover  un- 
less their  encouragement  follows  some  mystical  formalities  which 
alone  arouse  their  “ faith”  and  finally  their  confidence  and  will- 
power. For  the  present  there  is  no  way  out  of  the  dilemma  but  to 
submit  such  patients  to  the  suggestive  methods  of  what  is  popularly 
known  as  mind  cure  and  Christian  science.  In  doing  so,  physicians 
should  use  their  influence  as  far  as  possible  in  selecting  the  most 
honest  persons  of  this  class. 


Discussion. 

James  C.  Wood,  M.D. : I have  nothing  but  words  of  praise  for 
Dr.  Wesselhoeft’s  excellent  paper.  It  is  very  evident  that  the 
author’s  inspiration  came  not  from  books  but  from  actual  contact 
with  neurasthenic  subjects,  for  the  impress  of  originality  is  most  con- 
spicuous. It  is  a production  which  could  only  come  from  one  of 
experience  and  from  a reasoner.  I consider  it  a most  valuable  con- 
tribution to  the  literature  of  that  now  most  interesting  subject,  “ neu- 
rasthenia.” 

The  doctor,  in  his  paper,  has  sometimes  used  the  term  u neurosthe- 
nia”  instead  of  “ neurasthenia.”  The  first  of  these  means,  according 
to  Thomas,  great  nervous  power  or  excitement ; the  second,  nervous 
debility.  I take  it  from  the  context  that  the  subject  dealt  with  is 
neurasthenia.  To  the  average  mind  there  exists  what  seems  to  me 
a needless  confusion  regarding  the  terms,  nervous  prostration,  hys- 
teria and  hystero-neurosis.  As  I understand  these  terms  they  define 
distinct  conditions,  though  there  is  a frequent  blending  the  one  with 
the  other.  The  term  nervous  prostration,  which  is  a synonym  of 
neurasthenia,  defines  itself;  the  term  hysteria  should  be  restricted  to 
those  general  neuroses  characterized  particularly  by  psychical  mani- 
festations, though  not  infrequently  by  motor,  sensory,  secretory,  vaso- 
motor and  reflex  derangements  as  well ; while  the  term  hystero- 
neurosis  implies  the  uterine  origin  of  symptoms  manifesting  them- 
selves in  organs  remote  from  the  uterus  without  structural  changes 
in  such  organs,  being  the  direct  result  of  reflex  nervous  influence 
starting  from  the  uterus.  The  last  term  does  not  occur  in  the  paper 
under  discussion.  From  the  standpoint  of  a gynaecologist  I think 
that  this  is  misleading. 

Let  us  see  why  and  how  it  is  that  these  three  conditions  (I  will 
not  call  them  diseases)  are  so  frequently  associated.  I think  that  all 
will  admit  the  frequent  occurrence  in  women  of  reflex  symptoms, 
the  result  of  pelvic  lesions.  An  irritation  starting  from  the  pelvis 
is  conveyed  to  the  genito-spinal  centre,  thence  to  any  or  all  organs 
with  which  this  centre  communicates.  The  organ  oftener  involved 


OBSERVATIONS  ON  NEURASTHENIA  AN1>  ITS  TREATMENT.  799 


than  any  other  is  the  stomach.  This  is  shown  by  the  frequent  oc- 
currence of  nausea  and  vomiting  following  conception.  The  ner- 
vous system  may  have  been  previously  involved,  but  oftener  it  be- 
comes so  only  after  the  nutrition  is  depraved,  which,  sooner  or  later, 
occurs  if  the  pelvic  lesion  is  not  removed.  The  depraved  blood 
fails  to  supply  the  nerve  centres  with  that  which  they  need  to  sus- 
tain them,  and  they  become  anaemic.  Prostration  is  but  a subjective 
manifestation  of  the  anaemia,  and  it  varies  in  degree  from  a slight 
indisposition  to  the  most  abject  helplessness. 

If,  then,  nervous  prostration  may  have  its  beginning  in  a pelvic 
lesion,  is  it  possible  for  a pelvic  lesion  to  be  inaugurated  by  systemic 
disturbances?  Personally,  I believe  that  it  is,  and  offer  this  expla- 
nation as  the  modus  operandi  by  which  such  a lesion  is  induced : 
Marked  circulatory  changes  nearly  always  attend  nervous  prostra- 
tion. The  circulation  is  presided  over  by  the  vaso-motor  system, 
and  wear  and  repair  depend  upon  the  proper  regulation  of  this  sys- 
tem. If  it  becomes  disturbed,  the  bloodvessels  dilate  or  contract 
unduly,  with  resulting  local  hyperaemia  or  local  anaemia,  as  the  case 
may  be.  The  climacteric  flushes  are  the  result  of  such  disturbance. 
The  alternate  coldness  and  heat  of  the  extremities,  so  often  associ- 
ated with  rectal  and  uterine  lesions,  is  another  familiar  illustration. 
If  the  brain  is  involved,  either  insomnia  or  drowsiness  occur,  de- 
pending upon  whether  the  brain  is  anaemic  or  hyperaemic.  Flatu- 
lence, gastralgia,  and  nervous  dyspepsia  result  when  the  stomach  is 
similarly  affected.  The  womb  and  the  ovaries,  because  of  the  peri- 
odical congestion  imposed  upon  them,  are  oftener  implicated  by 
these  unnatural  circulatory  disturbances  than  any  of  the  pelvic 
organs,  and  in  time  also  become  unduly  hyperaemic  or  anaemic,  as 
the  case  may  be. 

It  will  thus  be  seen  that  nervous  prostration  may  exist  indepen- 
dently of  pelvic  lesions,  or,  conversely,  pelvic  lesions  may  exist  in- 
dependently of  nervous  prostration.  Nevertheless,  the  two  are  fre- 
quently associated,  and  this  fact  ought,  I believe,  to  be  kept  in  mind 
in  dealing  with  the  affection  known  as  neurasthenia.  Hysterical 
manifestations  nearly  always  come  to  the  surface  in  nervous  pros- 
tration, and  they  also  frequently  attend  pelvic  lesions.  Indeed,  the 
term  “ hystero-psychosis has  been  coined  for  the  purpose  of  defin- 
ing certain  psychical  disturbances  of  presumably  pelvic  origin,  and 
in  the  broadest  sense  neurasthenia  is  not  uncommonly  an  hystero- 
neurosis.  It  is  the  frequent  association  of  these  three  conditions 
which,  it  seems  to  me,  makes  it  more  practicable  to  study  them  con- 
jointly. 

The  special  symptoms  of  nervous  prostration  are  most  variable. 
Introspection,  as  Dr.  Wesselhoeft  has  pointed  out,  makes  of  the  pa- 
tient a nosomaniac.  The  anaemic  nerve  centres  are  unduly  impres- 
sionable, and  a mental  shock  which  would  not  seriously  affect  a 


800 


world’s  homoeopathic  congress. 


stronger  and  more  rugged  woman  falls  with  crushing  force  upon  one 
whose  nutrition  is  already  depraved.  In  this  way  are  developed 
disorders  of  sensibility,  alterations  of  mobility,  circulatory  disturb- 
ances, anomalies  of  secretion  and  excretion,  disorders  of  the  gastro- 
intestinal canal,  dermatoses,  and  general  and  psychical  disturbances 
of  all  kinds.  Many  of  these  affections  start  from  pelvic  lesions,  and 
are  nearly  always  associated  with  depravity  of  nutrition  and  more 
or  less  nervous  prostration. 

Some  of  the  worst  symptoms  of  neurasthenia  with  which  I have 
had  to  contend  have  been  hyperaesthesia  of  the  articulations,  giving 
rise  to  the  so-called  “ hysterical  joint.”  Here  the  prostration  is 
usually  not  profound,  and  it  is  possible  to  apply  the  somewhat  en- 
ergetic treatment  recommended  by  Dr.  Wesselhoeft.  I remember 
one  case  very  distinctly,  the  detailed  history  of  which  I shall  give 
in  another  place,  which  brought  me  much  reputation  because  of  the 
“ remarkable  ” cure  I was  fortunate  enough  to  make. 

The  patient,  a beautiful  girl  of  eighteen,  had  been  bed-ridden  for 
three  years  with  supposed  hip-joint  disease.  She  was  in  college  be- 
fore assuming  the  rdle  of  an  invalid,  and  worried  much  over  her 
studies  and  work.  She  sustained  a fall  a short  time  previously  to 
taking  to  her  bed,  and  to  this  fall  the  injury  to  the  hip  was  attri- 
buted. She  had  been  from  physician  to  physician  and  from  sani- 
tarium to  sanitarium  without  receiving  benefit.  All  of  the  numer- 
ous medical  men  under  whose  care  she  had  been,  directed  their 
attention  to  the  hip  and  applied  the  classical  treatment  for  morbus 
coxarius  without  avail.  The  patient  had  finally  reached  a point 
where  introspection  was  her  chief  occupation  and  her  mind  dwelt 
almost  continually  upon  a “diseased  hip.”  She  was  finally  brought 
to  me,  coming  in  an  invalid’s  chair  and  looking  the  very  picture  of 
despondency.  There  was  a slight  degree  of  anaemia,  though  this 
was  not  marked.  Notwithstanding  the  expression  of  abjectness  the 
girl  did  not  look  seriously  ill.  The  hip  was  excessively  tender  upon 
pressure,  but  there  was  no  local  increase  of  temperature,  no  evidences 
of  fever  and  suppuration,  and  forcible  apposition  by  striking  the 
heel  wTas  not  very  painful.  More  or  less  spastic  contraction  of  the 
flexor  muscles  of  the  affected  side  existed,  which  gave  to  the  limb 
an  appearance  of  actual  shortening,  which  was  very  deceptive. 
Hysterical  symptoms  were  common.  On  examination  I found 
the  left  ovary  exquisitely  tender.  Compression  of  the  ovary  in- 
creased the  pain  in  the  hip  most  decidedly  and  gave  rise  to  much 
nervous  agitation.  I did  not,  therefore,  deem  it  wise  to  recommend 
local  treatment  other  than  the  daily  use  of  the  hot  douche.  She  had 
long  been  a victim  of  ovarian  dysmenorrhoea.  I placed  upon  the 
ankle  of  the  affected  limb  three  pounds  of  bar-lead,  prescribed  a 
pair  of  crutches  and  insisted  upon  her  walking.  The  lead  was  used 
to  overcome  the  spastic  contraction  as  well  as  for  its  moral  effect.  I 


OBSERVATIONS  ON  NEURASTHENIA  AND  ITS  TREATMENT.  801 


did  not  deem  the  joint  lesion  of  such  a character  as  to  need  exten- 
sion. In  two  months’  time  this  patient  discarded  her  crutches  for  a 
cane.  Six  weeks  later  she  put  up  the  cane  and  is  now  perfectly 
well. 

This  was  a case  in  which  somewhat  harsh  measures  were  emi- 
nently appropriate. 

In  marked  contrast  to  the  case  just  recorded  is  the  following: 

Mrs. , set.  47,  a widow  for  twenty  years.  She  is  a devoted  church- 

woman,  and  for  years  was  a leader  in  all  charitable  work  done  in 
the  community  in  which  she  resided.  Through  friends  she  was 
urged  to  consult  me,  and  I think  that  the  call  to  the  neighboring 
town  in  which  she  lived  was  countermanded  at  least  four  or  five 
times  before  she  finally  mustered  up  courage  and  strength  enough 
to  see  me.  Upon  reaching  the  bedside  I found  my  patient  in  a 
room  made  dark  by  closed  blinds,  over  which  were  hung  heavy 
blankets  to  shut  out  every  ray  of  light.  The  mirror  was  turned 
toward  the  wall  for  fear  a ray  of  light  might  strike  it  and  flash 
throughout  the  darkened  room.  Nor  did  the  patient  rest  under 
these  extreme  precautions,  for  the  eyes  were  protected  with  two  pairs 
of  colored  glasses  with  side  attachments.  Hypersesthesia  of  the  sense 
of  hearing  was  equally  marked  and  the  noise  was  excluded  from  the 
room  by  double  doors  whose  keyholes  were  stuffed  with  cotton.  She 
also  had  her  ears  filled  with  cotton,  over  which  she  wore  ear-muf- 
flers. She  was  emaciated  to  an  extreme  degree,  and  had  been  re- 
duced to  her  miserable  condition  by  a series  of  events  which  fre- 
quently precede  profound  neurasthenia.  Her  husband  was  killed  dur- 
ing the  war,  and  she  was  left  childless.  Twelve  months  previous  to 
taking  to  her  bed  she  nursed  her  mother  through  a long  and  fatal  ill- 
ness. This  greatly  prostrated  her,  yet  she  kept  up  until  a favorite 
brother-in-law  was  thrown  from  a carriage  and  killed.  This  was 
the  last  straw,  and  the  shock  compelled  her  to  take  to  her  bed.  In 
due  time  loss  of  appetite  with  irritability  of  the  stomach  developed, 
which,  of  course,  led  to  marked  depravity  of  nutrition.  With  the 
anaemia  came  hypersesthesia  of  the  special  senses,  spinal  irritation, 
headache,  hysterical  manifestations,  etc.  There  was  no  serious  pel- 
vic lesion,  although  she  had  been  much  treated  for  an  alleged  uterine 
displacement  with  congestion.  Unfortunately,  she  was  encouraged, 
instead  of  discouraged,  in  her  invalidism,  and  she  soon  became  a 
nosomaniac  of  the  worst  type.  She  had  written  down  her  symp- 
toms one  at  a time,  and  the  record  is  such  a typical  one  that  I 
should  like  to  give  it  in  full,  but  time  forbids. 

With  great  difficulty  the  patient  was  moved  on  a couch  to  a pri- 
vate hospital  and  placed  under  the  Weir  Mitchell  treatment.  I 
ignored  the  pelvic  trouble  entirely.  It  is  unnecessary  to  give  in 
detail  the  progress  of  the  case  from  day  to  day  after  this  treatment 
was  inaugurated.  Suffice  it  to  say  that  the  improvement  was  of  the 

51 


802 


world’s  homoeopathic  congress. 

most  marked  character,  and  in  six  weeks  from  the  time  she  entered 
the  hospital  she  walked  to  her  carriage  with  her  eyes  and  ears  un- 
protected. She  soon  resumed  her  church  and  charitable  work,  in 
which  she  again  takes  much  delight. 

This  woman  wanted  to  get  well.  She  was  a woman  of  pure  mo- 
tives and  high  ideals.  She  had,  in  the  language  of  Dr.  Wessel- 
hoeft,  the  wish,  but,  unaided,  not  the  will.  She  required  the  aid  of 
an  intelligent,  strong-minded  nurse  who  could  bring  to  her  exercise 
applied  in  such  a way  as  to  enable  her  to  assimilate  food  without  the 
expenditure  of  nerve  force.  She  co-operated  with  her  physician 
and  nurse  in  every  possible  way,  and  as  soon  as  the  anaemic  nerve-  ' 
cells  became  flushed  with  new  blood  she  began  to  improve.  To 
have  commanded  this  patient  “to  take  up  her  bed  and  walk”  before 
improving  her  nutrition  would  have  been  as  unscientific  as  to  have 
placed  the  first  patient  in  bed  with  extension  and  counter-extension 
applied  to  the  limb.  I know  of  no  class  of  cases  requiring  for  their 
successful  treatment  more  tact  and  discrimination  than  that  under 
consideration. 

I feel  confident  that  I have  many  times  cut  the  affection  short  in 
its  prodromal  stage  by  removing  the  girl  from  college  work  and 
insisting  upon  open-air  exercise.  Static  electricity  has,  in  my  hands, 
proved  exceedingly  useful  both  during  the  prodromal  stage  and  that 
of  convalescence 

I will  conclude  by  saying  that  I have  been  impressed  with  the 
frequency  with  which  an  hereditary  history  of  epilepsy  has  been 
met  with  in  the  cases  of  neurasthenia  passing  under  my  observation. 


bright’s  disease. 


803 


BRIGHTS  DISEASE* 


By  P.  Jousset,  M.D.,  Paris,  France. 


Bright  demonstrated  the  existence  of  a morbid  species  character- 
ized by  inflammation  of  the  kidney,  albuminuria  and  oedema.  He 
deemed  the  different  clinical  forms  which  this  disease  presents  differ- 
ent phases  of  the  same  morbid  condition.  Physicians,  after  him, 
struck  by  the  differences  which  these  forms  assume,  subdivided 
Bright’s  disease  into  two  distinct  diseases:  parenchymatous  nephritis 
and  interstitial  nephritis.  There  is,  then,  a dualist  school  opposed 
to  the  unicist  school  of  Bright.  It  is  represented  principally  by 
Lancereau.  Is  there  really  a single  malady,  of  different  character- 
istics, according  to  the  phases  which  it  goes  through,  or  do  there 
really  exist  several  affections  of  different  nature,  incorrectly  joined 
together  by  the  single  name  of  “ Bright’s  disease?  ” 

This  question  is  difficult  to  answer.  On  the  one  hand  is  a fact 
impossible  to  contest,  namely,  that  when  parenchymatous  nephritis 
ends  neither  by  recovery  nor  by  death,  either  in  the  first  weeks  or 
the  first  months  of  the  disease,  but  pursues  a slow  and  chronic  course, 
it  is  soon  accompanied  by  the  symptoms  and  the  lesions  of  intersti- 
tial nephritis,  so  that  as  a consequence  in  such  a case,  the  intersti- 
tial nephritis,  with  ultimate  renal  atrophy,  is,  indeed,  the  last  phase 
of  the  parenchymatous  nephritis;  and  that  in  such  a case  the  theory 
of  Bright  is  absolutely  true. 

On  the  other  hand,  it  cannot  be  denied  that  there  are  cases  in 
which  the  disease  begins  in  an  insidious  manner,  progresses  very 
slowly,  with  more  or  less  complete  periods  of  remission,  and  with 
periods  of  aggravation  characterized  by  a symptomatic  complexus 
which  has  no  resemblance  to  that  of  parenchymatous  nephritis,  and 
in  which  the  kidney,  throughout  all  periods  of  the  disease,  shows 
the  lesions  of  interstitial  nephritis,  and  ends  fatally  in  renal  atrophy. 


* Translated  by  Clifford  Mitchell,  M.D.,  Chicago. 


804 


world’s  homoeopathic  congress. 


In  such  cases  the  nephritis  is  interstitial  in  the  outset,  and  rightly 
distinguished  from  Bright’s  disease  proper.  To  this  must  be  added 
that  interstitial  nephritis  is  always  joined  to  arterio-sclerosis ; that 
it  is,  as  it  were,  the  last  symptom  of  gout,  of  syphilis  and  of  lead- 
poisoning; that  it  is  accompanied,  in  consequence,  by  the  hepatic, 
pulmonary,  encephalic,  and,  especially,  cardiac  lesions  common  to 
arterio-sclerosis. 

Physicians  who,  like  Lecorchfe  and  Talamon,  defend  the  unicist 
doctrine  of  Bright’s  disease,  strive  to  show  that  in  acute  cases,  des- 
ignated by  the  name  of  parenchymatous  nephrites,  there  is  always 
an  affection  of  the  heart  and  of  the  vessels  analogous  to  that  which 
is  always  observed  in  interstitial  nephritis.  They  affirm  that 
every  nephritis  is  always'  accompanied  by  considerable  increase  in 
arterial  pressure,  and  consequently  by  dilatation  and  then  by  hyper- 
trophy of  the  heart. 

Traube  has  explained  these  cardiac  and  vascular  phenomena  by 
the  obstacle  which  the  arterial  circulation  meets  in  the  kidney  in  con- 
sequence of  inflammation  there.  This  explanation  is  question- 
able, but,  what  is  more  important,  dilatation  of  the  heart  is  by 
no  means  always  found  in  all  cases  of  Bright’s  disease.  (Lecorch6, 
page  419.) 

Thus,  Bamberger’s  statistics  show  807  cases  of  primary  Bright’s 
disease  to  be  accompanied  -only  344  times  by  hypertrophy  of  the 
heart. 

The  statistics  of  Galabin  cover  101  cases  and  show  only  34  cases 
of  hypertrophy.  Upon  autopsies  made  at  the  Charity  Hospital  in 
Berlin,  Vais  remarked  that  in  20  cases  of  parenchymatous  neph- 
ritis, hypertrophy  existed  in  14  cases. 

Labadie-Lagrave,  in  the  Dictionary  of  Medicine  and  Surgery , 
says,  word  for  word,  “ that,  if  a certain  degree  of  dilatation  of  the 
ventricles,  together  with  fatty  degeneration  of  the  myocardium,  is 
the  rule  in  chronic  parenchymatous  nephritis,  hypertrophy  of  the 
left  ventricle  is  wholly  foreign  to  the  symptomatology  of  this  neph- 
ritis.” (Article  on  “ The  Kidney,”  page  783.) 

Experiments  made  upon  animals  are  not  sufficiently  unanimous  in 
results  to  show  that  hindrance  to  the  circulation  determines  cardiac 
hypertrophy  and  elevation  of  arterial  pressure. 

Ludwig  tied  the  renal  arteries  without  causing  either  elevation  of 
arterial  pressure  or  hypertrophy  of  the  heart.  Grawitz  and  Israel, 


bright’s  disease. 


805 


contracting  the  renal  artery  and  removing  one  of  the  kidneys,  pro- 
duced hypertrophy  of  the  left  ventricle,  but  did  not  increase  arterial 
pressure. 

Lewinski  alone  produced  hypertrophy  of  the  left  heart  and  an 
increase  in  the  arterial  tension  by  contracting  the  renal  arteries  in 
dogs.  (Lecorche,  page  407.) 

The  conclusion  from  the  total  of  these  experiments,  and  also  from 
clinical  facts,  is  that  hypertrophy  of  the  left  ventricle,  instead  of 
being  closely  united  to  the  existence  of  the  parenchymatous  nephritis, 
is  only  an  exceptional  occurrence  in  the  course  of  this  disease.  Le- 
corche and  Talamon,  and  those  who  uphold  the  doctrine  of  absolute 
unity,  plainly  exaggerate  when  they  speak  of  hypertrophy  of  the 
heart  as  a constant  lesion  in  this  disease.  Increase  of  arterial  ten- 
sion, which,  according  to  Huchard,  has  always  for  its  corollary 
chronic  inflammation  of  the  arteries  and  hypertrophy  of  the  heart, 
is  the  constant  lesion  of  interstitial  nephritis,  for  the  reason  that 
this  latter  form  of  disease  is  joined  to  the  existence  of  gout,  or 
of  lead-poisoning,  which  has  for  its  lesion  general  arterio-sclerosis. 

It  is  difficult  to  say  whether  interstitial  nephritis,  supervening  as 
a terminal  phase  of  parenchymatous  nephritis,  is  accompanied  by 
general  arterio-sclerosis  or  not.  It  is  difficult  to  say,  because  we 
have  not  yet  studied  this  question  of  pathological  anatomy,  nor  dis- 
tinguished sufficiently  simple  interstitial  nephritis  from  the  intersti- 
tial nephritis  which  follows  parenchymatous  nephritis,  and  which 
constitutes  Bright’s  disease  in  its  last  stage. 

Upon  the  whole,  then,  we  hold  that  there  is  such  a thing  as  an  in- 
terstitial nephritis  which,  from  beginning  to  end,  has  always  the 
characteristics  of  sclerosis;  that  this  nephritis  is  accompanied  always 
by  intense  thirst,  by  polyuria,  by  albumin  in  the  urine,  usually  in 
small  quantity  and  sometimes  but  intermittently  present,  by  pale 
urine  of  low  specific  gravity,  with  notable  diminution  of  urea. 
Let  us  add,  as  a characteristic  of  this  form  of  nephritis,  that  it 
is  not  usually  accompanied  by  oedema,  except  in  the  period  of 
cachexia. 

Interstitial  nephritis  is,  then,  in  symptoms  and  in  lesions,  abso- 
lutely distinct  from  parenchymatous  nephritis.  It  is  also  distin- 
guished by  an  extremely  chronic  course,  a very  long  duration,  and 
a constant  termination  by  uraemic  accidents. 

Interstitial  nephritis  is,  moreover,  plainly  distinguished  from 


806 


world’s  homoeopathic  congress. 


parenchymatous  disease  by  its  relations  with  gout,  plumbism,  and 
the  general  arterio-sclerosis  accompanying  these  two  latter  con- 
ditions. 

We  shall,  therefore,  take  two  chapters  for  the  consideration  of  our 
subject : one  for  Bright’s  disease,  a morbid  species ; the  other  for 
interstitial  nephritis,  a disorder  depending  on  arterio-sclerosis. 

Chapter  First. — Bright’s  Disease. 

Bright’s  disease  is  characterized  by  anasarca,  albuminuria,  and 
inflammation  of  the  kidney,  first  parenchymatous,  but  finally  inter- 
stitial, if  the  disease  lasts  long  enough. 

Bright’s  disease  has  two  forms — one  markedly  acute  in  its  begin- 
ning, the  other  of  insidious  origin  and  chronic  course. 

i.  Acute  Bright’s  Disease. — This  may  begin  when  the  patient 
is  in  full  health,  or,  on  the  contrary,  by  way  of  complication,  in  the 
course  or  at  the  end  of  acute  diseases  : scarlet  fever,  diphtheria, 
typhoid  fever,  pneumonia,  etc. 

An  intense  febrile  movement,  vomiting  and  headache  mark  the 
beginning  of  the  disease.  The  patient  usually  feels  a dull  pain  in 
the  region  of  the  kidneys,  while  at  the  same  time  the  urine  is  dimin- 
ished in  quantity,  although  micturition  is  frequent ; the  urine  often 
contains  blood,  is  always  high-colored,  of  specific  gravity  lower  than 
normal — falling  to  1010  or  even  1006,  together  with,  at  the  same 
time,  a great  diminution  of  urea,  which  falls  as  low  as  9 grammes 
to  the  litre ; but  the  characteristic  feature  is  the  presence  of  albumin 
in  quantity  habitually  considerable  (4,  6,  8,  12  grammes  or  more); 
sometimes  the  urine,  when  heated,  solidifies  in  the  tube. 

At  the  same  time  the  dropsy  shows  itself.  It  begins  almost 
always  in  the  face,  in  the  eyelids  or  in  the  subconjunctival  tissue. 
There  is  then  observed  what  is  called  the  Brightic  eye ; the  eye  is 
brilliant,  as  when  full  of  tears,  and  there  is  shown  the  raising  of  the 
ocular  conjunctiva  by  a layer  of  liquid.  (Edema  increases  over  the 
face,  the  natural  lines  disappear,  and  the  face — immobile,  pale  and 
shining — appears  like  marble.  Dropsy  spreads  over  the  rest  of  the 
body  and  anasarca  becomes  general.  The  disease,  thus  established, 
progresses  rapidly,  and  may  terminate  in  some  days  or  some  weeks 
by  death  or  recovery. 

Death  takes  place  customarily  either  from  internal  oedema  (oedema 
of  the  lung,  oedema  of  the  glottis,  pleuritic  effusion,  pericarditis, 


bright’s  disease. 


807 


encephalic  dropsy);  often  general  anasarca,  diarrhoea  and  progressive 
enfeeblement  characterize  the  last  days  of  the  disease;  at  other  times 
uraemic  accidents,  of  which  the  most  frequent  are  eclampsia  and 
coma,  come  to  put  an  end  to  the  sufferings  of  the  patient. 

When  the  disease  is  to  terminate  by  recovery,  the  first  symptom 
is  the  increase  of  the  urine,  which  rises  rapidly  to  1,  2,  3 and  4 
litres.  At  the  same  time  the  febrile  movement  disappears  and  ana- 
sarca diminishes  in  proportion  to  the  increase  of  the  urine. 

This  liquid  undergoes  considerable  change  in  composition — dimi- 
nution of  albumin,  increase  in  urea,  wTith,  at  the  same  time,  increase 
in  specific  gravity  to  1018  and  1022,  are  what  we  principally 
observe. 

When  this  acute  form  of  Bright’s  disease  terminates  neither  by 
death  nor  recovery,  it  passes  into  the  chronic  state.  The  febrile 
movement  disappears  and  anasarca  diminishes.  The  urine  increases 
in  quantity;  the  albumin  is  less  abundant,  but  persists.  At  this 
time  the  disease  presents  the  course  and  symptoms  which  we  shall 
find  again  soon  when  describing  Bright’s  disease,  chronic  from  the 
outset. 

2.  Bright’s  Disease,  Chronic  from  the  Outset. — This  form, 
like  the  preceding,  may  follow  an  eruptive  fever,  typhoid  fever, 
diphtheria  or  pneumonia,  but  in  this  case  the  beginning,  instead  of 
being  febrile  and  tumultuous,  is  wholly  unperceived  and  unrecog- 
nized ; only  by  asking  patients  aboqt  their  past  may  we  succeed  in 
connecting  this  chronic  form  of  Bright’s  disease  to  the  previous  ex- 
istence of  one  of  the  diseases  in  which  parenchymatous  inflammation 
of  the  kidney  is  observed.  In  other  cases  damp  cold,  long  con- 
tinued, is  the  only  cause  to  which  we  may  attribute  the  development 
of  the  disease.  Lastly,  there  are  cases  in  which  it  is  impossible  to 
find  or  to  establish  the  aetiology  of  this  form  of  Bright’s  disease, 
chronic  from  the  outset.  Loss  of  strength,  a particular  kind  of 
anaemia,  with  paleness  of  the  face,  puffiness  of  the  lids,  interpalpe- 
bral  oedema,  pale  urine  voided  frequently,  especially  at  night,  but  in 
volume  below  normal,  anorexia,  and  pain  in  the  head  mark  the 
beginning  of  this  form. 

If  one  examines  the  urine,  one  finds  specific  gravity  diminished 
from  1006  to  1010;  urea  falls  also  sometimes  to  9 grammes  per 
litre,  but  the  principal  characteristic  is  the  presence  of  albumen  in 
notable  quantity,  reaching  4,  6,  8,  10  grammes  and  more. 


808 


world’s  homoeopathic  congress. 


After  several  months  the  disease  shows  its  character  more  and 
more.  Oedema  increases  considerably,  changing  place,  seizing  often 
the  face  in  the  morning  and  the  ankles  in  the  evening.  There  is 
waxy  pallor;  loss  of  strength  is  marked,  while  difficulty  of  breath- 
ing is  caused  by  the  least  movement. 

The  disease  thus  established  may  be  prolonged  for  months,  or  even 
longer,  but  never  more  than  three  years. 

The  course  is  not  regularly  progressive  ; there  are  exacerbations 
followed  by  more  or  less  complete  remissions. 

The  exacerbations  are  caused  usually  by  a chill,  by  overwork,  by 
emotion,  but  especially  by  errors  of  diet.  They  are  characterized 
by  a decrease  in  the  urine,  which  sometimes  becomes  bloody  and 
contains  always  a greater  quantity  of  albumin.  Anasarca  makes 
progress.  There  is  sometimes  vomiting,  sometimes  headache,  and 
always  a loss  of  strength,  until  the  patient  is  obliged  to  keep  to  his 
bed.  Then  amelioration  takes  place;  it  is  marked  by  an  increase  in 
the  quantity  of  the  urine,  a dimunition  in  albumin  and  anasarca, 
return  of  strength  and  appetite.  This  remission  which  is  never  as 
complete  as  in  interstitial  nephritis,  nevertheless  allows  the  pa- 
tient to  resume  his  occupation,  in  part,  and  under  the  influence  of 
intelligent  treatment  may  be  prolonged  for  a greater  or  less  period 
of  time. 

From  exacerbation  to  remission,  and  from  remission  to  exacerba- 
tion, the  disease,  sometimes  siowly,  sometimes  more  rapidly,  comes 
to  the  period  of  cachexia.  This  period  is  characterized  by  consider- 
able dropsy.  Anasarca  distends  the  lower  limbs,  the  skin  of  which 
becomes  the  seat  of  erythema,  of  fissures  and  sometimes  of  gan- 
grenous plaques.  Effusions  form  in  the  peritonaeum  and  in  the 
pleura.  A certain  degree  of  pulmonary  oedema  is  usually  evident. 
The  urine  becomes  more  and  more  scanty,  albumin  is  always  pres- 
ent, but  may  diminish  in  quantity  nevertheless,  without  improve- 
ment in  the  condition  of  the  patient. 

Anorexia,  vomiting,  and  diarrhoea,  still  help  to  diminish  the 
strength  of  the  patient. 

Seated  usually  upon  a chair,  because  stay  in  bed  is  no  longer  pos- 
sible, a prey  to  dyspnoea,  resulting  from  dropsy  of  the  pleura  and 
lungs,  pale  and  swollen,  with  limbs  cracked  and  dripping  incessantly 
with  the  liquid  which  distends  them,  the  patient  would  die  of  ex- 
haustion if  uraemic  accidents  did  not  more  usually  terminate  the  dis- 


bright’s  disease. 


809 


ease.  Failure  of  sight  and  headache,  are  the  usual  symptoms  of  this 
ending,  which  takes  place  either  from  eclampsia  or  from  apoplexy, 
or  from  asphyxia,  caused  by  pulmonary  oedema. 

In  other  cases,  Bright’s  disease  assumes  a form  more  chronic  and 
slower.  The  renal  lesion,  from  parenchymatous  becomes  interstitial, 
and  the  disease  shows  in  every  way  the  symptoms,  course,  and  du- 
ration of  the  sclerotic  form  which  we  shall  shortly  describe. 

Pathological  Anatomy. — The  acute  nephritic  lesion  is  essen- 
tially a glomerulitis,  desquamative  and  with  variable  alteration  in  the 
tubular  epithelium,  infiltration  of  the  interstititial  tissue  by  round 
cells,  catarrhal  inflammation  of  the  straight  tubes,  and  inflammation 
of  the  arterioles. 

The  kidneys  are  considerably  increased  in  size;  they  are  soine- 
times  hard  and  tense,  sometimes  soft.  Hyperplasia  is  found  only  in 
the  cortical  substance.  Divested  of  their  envelope  the  kidneys  are 
found  sometimes  of  uniform  redness,  or  sometimes  presenting  a 
mottled  aspect  tinged  with  yellow.  The  pyramids  show  a more  or 
less  violet  red  tint. 

Microscopical  Examination. — More  or  less  advanced  inflam- 
mation of  the  glomeruli,  which  are  not  all  in  the  same  condition  ; 
some  are  congested,  others  anaemic,  some  normal.  Albuminous  and 
granular  exudations  from  certain  capsules  take  place.  At  other 
times  the  exudations  are  haemorrhagic.  The  tubuli  are  in  general 
dilated  somewhat.  The  epithelial  cells  are  infiltrated  with  fat; 
sometimes  pale  cylinders,  sometimes  red  globules,  the  result  of 
haemorrhages,  fill  the  loops  of  Henle  and  the  straight  canal.  The 
connective  stroma  is  not  intact ; it  is  oedematous,  and  shows  round 
cells,  more  or  less  confluent,  which  indicate  a certain  degree  of  in- 
terstitial nephritis.  Lastly,  the  small  arterioles  show  cylindrical 
or  fusiform  thickening,  which  is  the  beginning  of  an  obliteration 
of  these  arterioles. 

This  lesion  is  susceptible  of  complete  recovery,  at  least  if  we  may 
believe  clinical  experience.  In  other  cases  it  ends  with  death.  It 
may  also  end  by  passage  into  the  chronic  state.  And  in  this  case 
we  have  to  study  the  evolution  of  a lesion  which  ends  sooner  or 
later  in  interstitial  nephritis. 

This  conclusion  is  not  that  of  authorities  who  allow  the  absolute 
separation  of  parenchymatous  from  interstitial  nephritis,  but  is 
typical  of  acute  nephrites,  parenchymatous  in  character,  having 


810 


world’s  homoeopathic  congress. 


burst  forth,  either  on  occasion  of  typhoid  fever,  scarlet  fever  or 
some  other  infectious  disease,  or  even  in  consequence  of  the  effect  of 
cold,  and  being  terminated  after  several  years  by  the  symptoms  and 
lesions  of  interstital  nephritis. 

It  is  impossible  to  deny  the  morbid  transformation  of  one  of  these 
lesions  into  the  other. 

The  large  red  kidneys,  more  or  less  mottled  with  yellow  and  gray, 
soft  or  indurated,  are  transformed  when  the  disease  passes  to  the 
chronic  state  into  the  large  white  kidneys.  Then,  by  a continuation 
of  the  evolution  into  small  granular  kidneys,  retracted,  white 
or  red. 

In  the^cute  period  the  interstitial  tissue  is  but  little  attacked.  We 
find  at  most  a few  round  cells  interposed  here  and  there  in  form  of 
a trail  between  the  tubules  and  at  the  openings  of  the  arterioles. 
But  the  longer  the  disease  the  more  are  interstitial  lesions  noticed, 
leading  by  their  evolution  to  atrophy  and  retraction  of  the  kidney. 
Thus,  facts  show  us  that  parenchymatous  nephritis,  when  it  passes 
to  the  chronic  state,  assumes  all  the  characters  of  interstitial  ne- 
phritis. 

Chapter  II. — Interstitial  Nephritis. 

We  have  already  said  that  interstitial  nephritis  depends  upon 
arterio-sclerosis. 

The  beginning  of  interstitial  nephritis  often  passes  unperceived ; 
it  is  characterized  by  polyuria  and  polydipsia,  analogous  to  that  of 
diabetes.  There  is  perceived  at  the  same  time  an  increase  in  arterial 
tension.  It  is  to  this  increase  of  arterial  tension  that  we  should  at- 
tribute the  symptom  of  the  “dead  finger,”  deemed  by  Dieulafoy 
a sign  of  nephritis  without  albuminuria. 

In  this  first  period,  as  a matter  of  fact,  albuminuria  shows  itself 
often  only  in  a transitory  way,  at  long  intervals,  and  in  quantity  es- 
timated with  difficulty.  As  we  have  already  said,  the  urine  is  very 
abundant ; it  is  pale,  of  very  low  specific  gravity,  which  varies  from 
1002  to  1012,  containing  a quantity  of  urea  less  than  normal.  The 
urine  is  slightly  turbid,  and  may  reach  2,  3 and  9 litres. 

Patients  are  often  tormented  by  continual  headaches.  Anorexia, 
vomiting,  or  diarrhoea,  dimness  of  vision,  and  amaurosis  are  ob- 
served in  this  form  as  in  the  preceding,  but  “ in  interstitial  nephritis, 
amaurosis  is  related,  not  to  a primitive  alteration  in  the  elements  of 


bright’s  disease. 


811 


the  retina,  but  to  a sclerotic  alteration  of  the  optic  nerve  and  of  the 
retina.”  (Lancereau.) 

Olid  era  a may  be  completely  lacking  during  nearly  all  the  course 
of  the  disease.  It  is  only  when  the  nephritis  has  lasted  for  years, 
and  when  the  patient  becomes  cachectic,  that  a certain  degree  of 
dropsy  is  evident,  while  at  the  same  time  albumin  may  reach  1,  2, 
and  3 grammes  per  litre. 

We  must  call  attention  to  the  cardiac  symptoms  which  always 
accompany  interstitial  nephritis. 

We  have  already  referred  to  arterial  tension.  We  must  add  to  it 
hypertrophy  of  the  heart  and  the  “ bruit  de  galop,”  which  is  often 
so  diagnostic  of  this  disease. 

We  must  not  forget,  moreover,  that  interstitial  nephritis  is  only 
an  affection  of  arterio-sclerosis,  and  consequently  that  it  may  be  ac- 
companied by  the  cardiac,  pulmonary,  hepatic,  and  cerebral  symp- 
toms peculiar  to  this  lesion  of  the  arteries. 

Interstitial  nephritis  progresses  slowly,  and  is  prolonged  for  years. 
It  shows,  from  one  time  to  another,  periods  of  aggravation,  character- 
ized either  by  bloody  and  scanty  urine  or  by  the  appearance  of  oedema, 
or,  above  all,  by  manifestations  of  uraemic  symptoms,  of  which  we 
shall  speak  in  a moment.  These  aggravations  are  always  due  to  errors 
of  diet  or  to  failure  to  observe  the  rules  of  health ; subsequently,  an 
amelioration,  more  or  less  complete,  takes  place,  and  thus  the  disease 
is  prolonged  through  many  years. 

Almost  always  death  comes  from  uraemic  accidents,  which  may 
assume  two  principal  forrfis,  pulmonary  and  cerebral. 

In  the  pulmonary  form  the  patient  is  seized  by  paroxysmal  dysp- 
noea, which  comes  especially  at  night,  and  which  may  be  accompa- 
nied by  pulmonary  congestion,  with  expectoration  of  rust-colored 
sputum.  This  dyspnoea  may  lead  to  the  death  of  the  patient. 

The  cerebral  form  is  much  more  frequent.  A number  of  patients 
show  symptoms  of  cerebral  apoplexy,  together  with  hemiplegia,  and 
die  comatose. 

Others  have  veritable  attacks  of  eclampsia,  more  or  less  intense 
and  more  or  less  lasting,  taking,  in  severe  cases,  a subintrant 
course,  such  that  the  patients  are  in  a veritable  “ etat  de  mal,”  and 
die  comatose. 

Other  patients  resist  ursemic  eclampsia.  Some  gain  their  health 
completely,  at  least  in  appearance,  and  may  yet  live  for  a long  time 
after  having  experienced  its  attack. 


812  • 


world’s  homoeopathic  congress. 


Uraemic  accidents  are  always  ushered  in  by  a considerable  dimi- 
nution in  the  quantity  of  urine,  just  as  amelioration  is  accompanied 
by  abundant  diuresis.  Dimness  of  vision,  increase  in  headaches, 
slight  twitching  of  the  limbs  often  precede  and  usher  in  serious 
uraemic  accidents. 

/Etiology. — The  causes  of  interstitial  nephritis  are  first  and  fore- 
most the  causes  of  arterio-sclerosis.  Abuse  of  strong  liquors,  life  in 
a damp  locality,  and  chilling  of  the  body  are  circumstances  which 
favor  localization  of  arterio-sclerosis  in  the  kidney. 

Pathological  Anatomy. — In  interstitial  nephritis  the  two  kid- 
neys are  invaded  almost  equally.  In  the  first  stage  the  lesion  is 
characterized  by  congestion  and  increase  in  the  volume  of  the  kid- 
ney ; the  capsule  is  easily  detached  from  the  organ;  the  parenchyma, 
slightly  soft  and  pale,  varies  in  color  from  red  to  gray,  and  is  sown 
with  capillary  dilatation.  On  section,  the  cortical  substance  is 
brownish,  with  gray  or  white  stains,  the  medullary  substance  of  a 
violet  hue.  Histological  examination  shows  a more  or  less  abundant 
proliferation  of  embryonic  elements  spread  unequally  throughout  the 
cortical  substance,  and  seizing  upon  the  connective  and  vascular  tis- 
sue of  the  region  of  the  convoluted  canaliculi  and  of  the  corpuscles 
of  Malpighi.  Sometimes  the  Malpighian  glomeruli  are  the  seat  of  a 
haemorrhage  which  becomes  mixed  with  the  urine. 

The  kidney  diminishes  gradually  in  volume,  its  tissue  is  retracted, 
and  its  surface  becomes  roughened  in  all  its  extent.  The  kidney 
takes  on  a solid  and  coriaceous  consistency;  its  capsule  becomes  ad- 
herent and  is  removed  with  difficulty.  More  or  less  numerous  cysts 
are  formed.  Atrophy  of  the  kidney  takes  place  upon  the  cortical 
substance,  which  is  sometimes  reduced  to  a millimetre.  The  round 
cells,  of  which  we  have  already  spoken,  stretch  out  and  form  fusi- 
form bodies  soon  to  be  transformed  into  cicatricial  tissue. 

Next  retraction  supervenes,  with  atrophy  of  the  convoluted  tubes 
and  of  the  glomeruli. 

The  epithelia  of  the  tubes  undergo  a granulo-fatty  degeneration, 
and  end  by  disappearing. 

The  lesion,  having  arrived  at  its  last  stage,  shows  the  kidneys  re- 
duced to  the  size  of  a large  chestnut,  and  in  weight  190  grammes,* 
partly  transformed  into  fibrous  tissue,  and  then  constituting  that 
which  is  called  the  small  red  kidney. 


* About  six  ounces  Troy. 


bright’s  disease. 


813 


The  renal  artery  is,  like  most  of  the  arteries  of  the  body,  attacked 
by  arterio-sclerosis. 

It  is  useless  to  describe  here  the  lesions  common  to  arterio-sclero- 
sis and  to  gout,  of  which  interstitial  nephritis  constitutes  only  an 
affection. 

Differential  Diagnosis  Between  the  Two  Nephrites. — 
This  paragraph  is  perhaps  superfluous.  We  wish,  however,  to 
call  to  mind  that  true  Bright’s  disease  is  distinguished  from  inter- 
stitial nephritis  by  the  intensity  of  the  anasarca  and  by  urine  so 
well  marked  in  character,  namely,  scanty  and  loaded  with  albumin  ; 
while  in  interstitial  nephritis  the  urine  is  exceedingly  abundant, 
with  albumin  scanty,  or  but  a trace.  Cardiac  symptoms;  hyper- 
trophy of  the  heart,  the  “ bruit  de  galop  ; ” the  symptoms  of  aortitis  ; 
arterial  tension,  and  more  or  less  general  arterio-sclerosis  serve  to 
distinguish  interstitial  nephritis  and  permit  us  to  recognize  it. 

Prognosis  in  Bright’s  Disease. — The.  prognosis  of  Bright’s 
disease  is  always  grave.  This  disease  is  terminated  usually  by  death 
in  the  first  days  of  the  malady,  or  by  passage  into  the  chronic  state, 
the  termination  of  which  is  always  fatal.  However,  it  is  necessary 
to  remember  that  complete  recovery  from  Bright’s  disease  may  take 
place.  I have  records  of  recovery  in  cases  dating  back  more  than 
thirty  years. 

Signs  Pointing  to  Recovery  in  Bright’s  Disease.— Diminu- 
tion of  the  fever  and  of  the  anasarca,  but,  above  all,  increase  in  the 
quantity  of  urine,  are  signs  which  may  foretell  an  approaching  re- 
covery. 

As  soon  as  the  urine  becomes  more  abundant,  it  becomes  clearer. 
Blood,  if  any,  disappears.  Albumin  diminishes  and  urea  increases 
in  quantity.  At  the  same  time  strength  and  appetite  return,  but 
recovery  is  not  assured  until  albumin  has  completely  disappeared, 
and  until  the  urine  has  resumed  its  ordinary  color,  density  and 
chemical  composition. 

We  should  not  forget  that,  if  recovery  is  possible,  this  possibility 
exists  only  in  the  first  period  of  the  disease  and  before  the  lesions  of 
interstitial  nephritis  are  produced. 

Signs  of  death  are,  in  the  first  days,  an  increase  in  the  febrile 
movement,  diminution  in  the  quantity  of  urine  and,  most  commonly, 
the  appearance  of  ursemic  symptoms  ; convulsions  or  coma. 

Sometimes  erysipelas  supervenes  as  a complication,  or  some  other 
inflammation,  as  bronchitis,  pneumonia,  pleurisy  or  pericarditis. 


814 


world’s  homoeopathic  congress. 


The  signs  of  passage  into  the  chronic  condition,  and  change  from 
parenchymatous  to  interstitial  nephritis,  are  as  follows : profound 
anaemia  and  lack  of  color  in  the  integuments;  sometimes  the  urine 
remains  scanty  and  contains  much  albumin,  with  persistence  of  the 
anasarca;  gastric  symptoms  appear  (anorexia,  vomiting,  which  is 
often  obstinate,  frequent  and  continual  diarrhoea) ; often  oedema  of 
the  lung  and  hydrothorax  complicate  the  condition  of  the  patient. 
Death  comes  from  exhaustion,  asphyxia  or  inflammation  of  the 
lungs. 

In  other  cases  the  progress  is  slower.  The  patient  may  return  to 
a condition  of  health,  doubtless  incomplete,  but  which  permits  a 
fairly  long  survival.  The  urine  becomes  more  abundant  and  clearer, 
always  remaining  albuminous;  anasarca  diminishes,  and  the  disease 
takes  upon  itself,  more  or  less,  the  pace  and  termination  of  intersti- 
tial nephritis. 

Prognosis  in  Interstitial  Nephritis.— The  prognosis  is  that  of 
a disease  of  very  long  duration,  but  absolutely  incurable.  If  the 
patient  is  subjected  to  the  proper  diet,  he  may  live  for  many  years, 
with  every  appearance  of  health.  We  have  already  said  that  he 
usually  falls  a victim  to  uraemic  accidents,  and  the  prognostic  sign 
which  causes  us  to  fear  these  accidents  is  drawn  absolutely  from  the 
quantity  and  the  quality  of  the  urine.  As  long  as  the  urine  is  abun- 
dant and  not  too  poor  in  urea,  as  long  as  its  density  reaches  1012, 
the  physician  may  rest  easy;  but  as  soon  as  the  urine  diminishes  in 
quantity,  while  at  the  same  time  urea  falls  to  very  small  quantities, 
we  must  expect  to  see  uraemic  symptoms  burst  forth. 

Treatment  of  Acute  Bright’s  Disease. — In  the  beginning, 
when  the  urine  is  scanty,  bloody  and  albuminous,  when  there  is  pain 
in  the  region  of  the  kidneys  and  general  anasarca,  the  indicated 
remedies  are:  Belladonna,  Cantharides,  Apium  virus,  Koch’s  lymph, 
Iodium. 

1.  Belladonna.- — This  is  the  remedy  in  the  beginning.  We  should 
give  it  preference  over  the  other  three  when  fever  is  present,  with 
headache  and  vomiting;  scanty  urine  colored  red  by  haemato-glob- 
ulin  (haemoglobin)  confirms  us  in  its  choice. 

Dose  and  Method  of  Administration:  The  first  three  dilutions : 
Six  drops  in  200  grammes  of  water  (about  seven  fluidounces).  A 
teaspoonful  every  two  hours. 

2.  Cantharides. — The  symptoms  and  lesions  of  acute  Bright’s  dis- 
ease correspond  exactly  to  the  symptoms  and  lesions  produced  by 


bright’s  disease. 


815 


poisoning  with  Cantharkles.  The  experiments  of  Galippe  pat  this 
fact  beyond  doubt,  and  in  later  days  Lancereau  has  held,  before  the 
Academy  of  Medicine,  that  the  best  remedy  for  albuminuria  is  Can- 
tharides.  This  is  truly  scandalous,  and  reply  has  been  made  that 
Cantharides  may  be  very  dangerous  in  the  treatment  of  albuminu- 
ria, since  it  causes  nephritis.  It  goes  without  saying  that  this  objec- 
tion is  of  no  consequence  to  the  disciples  of  Hahnemann.  Can- 
tharides is  suitable  in  the  treatment  of  Bright’s  disease  at  all  times 
when  the  urine,  containing  albumin  and  blood  in  abundance,  is 
passed  in  small  quantity,  together  with  tenesmus.  We  should  ad- 
minister it  after  the  beginning,  when  there  is  no  fever,  or  when 
Belladonna  has  reduced  the  temperature.  Cantharides  acts  very 
promptly.  Its  first  effect  is  to  cause  blood  to  disappear  from  the 
urine  and  to  increase  the  quantity  of  urine  considerably.  It  is  not 
unusual  to  see  the  urine  reach  2,  3 and  4 litres  from  the  first  days 
of  the  administration  of  Cantharides. 

Dose  and  Method  of  Administration  : We  seldom  prescribe  the 
tincture,  and  then  never  more  than  three  drops  a day  of  it.  We 
have  been  most  rapidly  successful  by  the  use  of  the  first  dilutions, 
administered  as  in  the  case  of  Belladonna. 

3.  Apium  Virus . — The  poison  of  the  honey-bee,  in  its  action  upon 
acute  nephritis,  has  great  analogy  to  that  of  Cantharides,  but  it  is 
more  particularly  indicated  when  there  is  considerable  anasarca.  In 
my  clinical  lessons  of  1892  may  be  found  observations  on  a case  of 
acute  Bright’s  disease,  very  rapidly  helped  by  the  poison  of  the 
honey-bee,  with  a diuresis  which  exceeded  three  litres  a day.  Apium 
virus  lacks  at  present  sufficiently  extensive  clinical  confirmation, 
but  we  know  enough  about  this  remedy  not  to  hesitate  to  prescribe 
it  when  the  indications  are  present  which  I have  mentioned. 

Dose  and  Method  of  Administration : I use  habitually  the  three 
first  triturations : twenty  centigrammes  (about  three  grains)  dissolved 
in  distilled  water,  taken  three  times  a day.  Apis  mellifica  gives  the 
same  results,  and  is  employed  in  the  same  doses. 

4.  Koch’s  Lymph. — Clinical  observations  and  experiments  upon 
animals  have  shown  that  injections  of  Koch’s  lymph  produce  paren- 
chymatous nephritis  together  with  albuminous  urine.  I am  not 
aware  of  the  signs  which  allow  us  to  determine  the  indications  for 
the  use  of  this  remedy  in  the  acute  stage  of  Bright’s  disease ; there- 
fore I have  almost  always  reserved  its  use  for  the  chronic  period  of 


816 


world’s  homoeopathic  congress. 


this  disease,  and  also  for  the  treatment  of  interstitial  nephritis.  We 
know  that  in  these  two  cases  the  lesions  of  the  kidney  are  established, 
and  that,  in  consequence,  we  cannot  hope  for  a radical  cure.  When- 
ever we  have  prescribed  Koch’s  lymph  in  such  cases,  we  have  ob- 
tained an  amelioration  characterized  by  considerable  diminution  of 
albumin  and  by  amelioration  of  the  general  health. 

Dose  and  Method  of  Administration  : We  have  never  made  hypo- 
dermic injections  in  the  treatment  of  the  nephritis.  We  have  con- 
fined ourselves  to  prescribing  Koch’s  lymph  in  the  sixth  or  third 
dilution  ; three  doses  a day  for  six  days.  Cease  giving  the  remedy 
from  one  to  four  days  following  the  effect  obtained,  then  begin 
again. 

5.  Iodium. — This  is  a remedy  which  we  shall  find  suitable  to  the 
treatment  of  interstitial  nephritis,  but  it  has  also  given  us  very  good 
results  in  the  treatment  of  Bright’s  disease,  which  is  still  acute.  The 
dose  in  this  case  has  been  one  of  the  first  triturations  of  the  Iodide 
of  sodium.  The  other  remedies  indicated  in  the  treatment  of  chronic 
Bright’s  disease,  or  in  interstitial  nephritis,  are  Lead,  Arsenic,  Phos- 
phorus, Mercury,  Nitric  acid,  etc. 

If  we  should  wish  to  enumerate  all  the  drugs  which  may  produce 
interstitial  nephritis,  with  passage  of  albumin  into  the  urine,  the  list 
would  be  long ; but  I do  not  believe  that  the  physician  would  de- 
rive great  benefit  from  use  of  them. 

Phosphorus,  and  especially  Phosphoric  acid,  produce  the  majority 
of  the  symptoms  of  interstitial  nephritis.  But  have  they  ever  cured 
a single  case  of  this  affection  ? 

As  to  Plumbum,  no  drug  presents  a more  complete  image,  not 
only  of  interstitial  nephritis,  but  even  of  general  arterio-sclerosis, 
and  yet  I have  never  obtained  results  from  the  use  of  this  drug. 
Possibly  I have  not  administered  the  preparation  in  suitable  dose. 
Plumbum  should  always  be  studied  in  connection  with  the  treat- 
ment of  chronic  inflammations  of  the  kidney. 

Iodium,  and  especially  the  Iodide  of  sodium,  have,  in  my  hands 
and  those  of  many  other  physicians,  produced  a veritable  and  durable 
amelioration,  not  only  of  the  symptoms  'of  arterio-sclerosis,  but  also 
of  those  of  interstitial  nephritis. 

Dose  and  Method  of  Administration  : We  use  almost  always  the 
three  first  triturations  of  the  Iodide  of  sodium.  Administered,  as 
we  have  said,  in  the  case  of  Apium  virus.  In  rebellious  cases,  we 


bright’s  disease. 


817 


have  found  it  well  to  administer  several  centigrammes  (a  centi- 
gramme equals  about  one-sixth  of  a grain)  of  the  crude  drug. 

We  have  not  mentioned  Fuchsine,  nor. Methyl  blue,  nor  so  many 
other  substances,  heralded  as  panaceas  in  Bright’s  disease,  which 
have  been  forgotten  as  soon  as  discovered. 

Treatment  of  Ursemic  Accidents. — Sometimes  we  do  not 
hesitate  to  prescribe  copious  bleeding  when  eclampsia  or  ursemic  coma 
shows  itself  in  strong  patients,  and  in  those  who  are  still  in  the 
acute  period  of  the  disease. 

Moreover,  this  practice  had,  and  still  has,  its  very  earnest  advo- 
cates for  ursemic  accidents  which  show  themselves  during  pregnancy. 
We  do  not  absolutely  condemn  its  use,  but,  not  understanding  en- 
tirely its  mode  of  action,  we  never  employ  it. 

Chloroform,  Belladonna,  and  its  succedaneum,  Opium,  and,  lastly, 
in  certain  cases,  purgatives,  indications  for  which  we  shall  try  to  de- 
termine, constitute  the  means  which  we  habitually  use  in  the  treat- 
ment of  ursemic  accidents. 

1.  Chloroform.  — Chloroform  is  an  heroic  remedy  for  attacks  of 
eclampsia,  to  which  it  is,  moreover,  absolutely  Homoeopathic.  It  is 
universally  accepted  by  physicians  and  accoucheurs. 

Dose  and  Method  of  Administration  : The  most  energetic  method 
of  administering  Chloroform  consists  in  giving  inhalations  so  as  to 
produce  ansesthesia.  Suspend  administration  of  the  drug  when  con- 
vulsions have  ceased,  beginning  again  when  they  commence  in  turn. 
In  practice,  Chloroform  is  often  replaced  by  Chloral,  because  the 
presence  of  a physician  is  not  required  for  the  administration  of  this 
latter  remedy.  It  is  more  convenient  to  administer  it  in  eneraata* 
in  doses  of  4 grammes  (about  62  grains),  in  the  case  of  adults.  The 
action  of  Chloral  is  slower  and  also  more  prolonged  than  that  of 
Chloroform.  Its  administration  may  be  renewed  whenever  the 
anaesthetic  sleep  ceases  and  convulsions  begin  again. 

2.  Belladonna , ^Ethusa  Cynapium. — These  were  our  two  princi- 
pal remedies  before  the  discovery  of  Chloroform. 

Belladonna  and  .ZEthusa  are  indicated  in  the  eclamptic  form  of 
uraemia.  Moreover,  Belladonna  is  still  indicated  during  uraemic 
coma,  when  the  pupil  is  dilated,  the  face  pale,  and  the  pulse  fre* 
quent.  In  the  cases  in  which  delirium  comes  on,  then  again  we 
must  have  recourse  to  Belladonna. 

Dose  and  Method  of  Administration:  The  three  first  decimal  dF 

52 


818 


world’s  homceopathic  congress. 


lutions,  one  drop  every  quarter  of  an  hour,  in  cases  of  eclampsia; 
in  other  cases,  one  drop  every  two  hours. 

3.  Opium. — This  drug  is  indicated  in  uraemic  coma,  with  con- 
tracted pupils,  red  face,  pulse  full  and  slow.  It  is  also  indicated  in 
uraemic  dyspnoea. 

Dose  and  Method  of  Administration  : I prescribe  usually  the  first 
triturations,  twenty  centigrammes  (about  three  grains)  in  a hundred 
grammes  (about  three  fluidounces)  of  water.  A teaspoonful  every 
two  or  three  hours.  In  cases  in  which  patients  cannot  swallow,  or 
swallow  with  difficulty,  I have  found  it  well  to  inject,  by  the  hy- 
podermic method,  Tincture  of  opium,  one  in  one  hundred  ; that  is  to 
say,  the  first  dilution,  this  dilution  being  made  in  distilled  water. 

In  uraemic  dyspnoea  it  is  preferable  to  inject  eight  or  ten  drops  of 
a solution  of  Morphine,  one  in  one  hundred,  this  drug  being  absolutely 
Homoeopathic  to  dyspnoea.  Injections  may  be  renewed  every  two  or 
four  hours. 

Jaborandi  and  its  alkaloid,  Pilocarpine,  and  also  tranfusion  of 
blood,  have  been  lauded,  but  these  are  agents  which  are  essentially 
dangerous. 

4.  Drastic  Purgatives. — Although  treatment  by  drastic  purgatives 
has  nothing  Homoeopathic  about  it,  and  although  it  is  solely  a ques- 
tion of  their  physiological  action,  which  is  to  withdraw  a great 
quantity  of  water  from  the  system,  w7e  should,  nevertheless,  not 
reject  them  entirely,  and  in  desperate  cases,  in  which  standard  reme- 
dies have  been  without  effect,  purgation  may  lead  to  a considerable 
amelioration,  especially  when  ursemic  accidents  are  characterized  by 
coma  and  very  general  anasarca. 

As  a rule,  use  of  purgatives  has  only  a palliative  effect,  and  the 
amelioration  it  produces  has  but  slight  duration. 

Method  of  Administration  : We  use  usually  German  brandy,  forty 
grammes  (a  little  over  a fluidounce)  sweetened  with  twenty  grammes 
(a  little  less  than  a fluidounce)  of  syrup  of  Nerprun  (Buckthorn). 

Diet  and  Hygienic  Precautions  in  Bright’s  Disease. — Abso- 
lute milk  diet  is  perfection  in  acute  Bright’s  disease,  and  also  during 
the  outbreaks  which  come  on  in  the  course  of  the  disease,  when  the 
nephritis  has  passed  into  the  chronic  state.  The  patient  should  take 
three  or  four  litres  (about  three  or  four  quarts)  of  milk  a day,  in 
small  doses  repeated  every  two  hours;  the  milk  may  be  boiled  or 
not,  salted,  sweetened  or  natural. 


bright’s  disease. 


819 


It  is  carrying  matters  to  a dangerous  extreme  to  prescribe  an  ab- 
solute milk  diet  for  patients  in  all  stages  and  in  all  forms  of  Bright’s 
disease. 

When  the  patient  is  better — when  his  health  has,  at  least,  appa- 
rently returned — we  should  advise  the  mixed  milk  diet,  which  con- 
sists in  the  administration  of  one  or  two  litres  of  milk  diluted  in 
part  in  the  form  of  soup.  We  may  allow  at  the  same  time  poultry, 
ham,  fish,  and  also,  a little  later,  mutton  and  beef.  Eggs  may  also 
be  allowed  albuminuric  patients,  except  during  the  acute  period. 

Alcohol  should  be  absolutely  forbidden.  In  the  purely  chronic 
period  we  may,  however,  permit  a little  white  wine,  red  wine  or 
cider  diluted  with  water. 

Finally,  the  physician  has  an  accurate  thermometer  for  guiding 
him  in  the  alimentation  of  his  patients,  namely,  the  condition  of  the 
urine.  If  the  urine  reached  a litre  and  a half  or  two  litres  (three 
to  four  pints),  if  the  urea  approaches  its  normal  quantity,  if  albu- 
min is  diminishing,  we  may  relax  the  diet  much.  But  if,  on  the 
contrary,  the  urine  diminishes  much,  while  at  the  same  time  the 
specific  gravity  falls  below  1010,  and  the  albumin  increases  in 
quantity,  it  becomes  necessary  to  return  to  the  absolute  milk  diet. 

The  patient  should  keep  up  the  functions  of  the  skin,  and  conse- 
quently its  cleanliness,  by  washing  and  by  hot  baths.  He#  should 
shun  damp  cold,  and,  if  it  is  possible,  spend  the  winter  in  hot  coun- 
tries. He  should  take  moderate  exercise,  and  should  shun  prolonged 
muscular  efforts. 

Hydrotherapy , which  has  been  advised  by  several  physicians,  has 
has  not  kept  good  the  promises  which  were  made  in  its  name,  and  I 
do  not  venture  to  advise  its  use. 

Discussion. 

Geo.  M.  Dillow,  M.D. ; I am  sorry  that  circumstances  have  so 
shaped  themselves  as  to  make  it  too  difficult  for  me  to  attend  the 
Congress  and  thus  to  fulfil  my  provisional  promise  to  commem  on 
Dr.  P.  Jousset’s  paper  on  Bright’s  disease.  My  regret  is  the  greater 
because  the  importance  and  ability  of  the  paper  should  command  the 
highest  respect  I could  offer.  I should  find  it  difficult,  however,  to 
compress  the  little  that  might  interest  in  a ten  minutes’  speech,  for 
my  views  differ  in  many  respects  from  those  of  the  learned  author 
of  the  paper,  and  I could  not  express  them  satisfactorily  even  in  a 
much  longer  space  of  time.  But  I wish  to  offer  something  which 


820 


world’s  homoeopathic  congress. 


you  can  use  in  part  or  whole  at  your  pleasure,  in  case  there  is  no 
other  speaker  to  fill  my  place. 

Let  me  say  that,  as  regards  the  main  contention,  the  present  state 
of  knowledge  does  not  appear  to  me  to  warrant  restriction  of  the 
term,  Bright’s  disease,  to  any  one  of  the  recognized  forms  of  nephri- 
tis, and  that  it  seems  less  likely  to  lead  to  further  confusion  if  we 
keep  the  term,  as  most  generally  used,  in  the  generic  sense,  to  cover 
all  forms  of  primitive  renal  inflammation  which  suppress  the  func- 
tion of  the  kidney  by  destruction  of  its  essential  element,  viz.,  the 
glomerulo-tubular  system.  By  whatever  name  the  process  may  be 
called,  and  wherever  beginning,  this  is  the  ultimate  result  of  every 
form  of  nephritis,  and  it  is  to  the  result,  and  largely  by  reason  of  its 
gravity,  that  the  term  Bright’s  disease  specially  applies.  One  has 
only  to  be  familiar  with  many  authorities  and  to  follow  up  diagnosis 
by  post-mortem  investigation  to  realize  that  schematic  descriptions 
do  not  so  often  correspond  with  the  anatomical  types  predicted  and 
pathological  processes  predicated.  Instead  of  the  so-called  typical 
kidneys,  we  often  find  many  departures;  and  if,  as  histologists,  we 
search  them  all,  we  find  always  inflammatory  changes  involving  all 
the  elements  of  the  cortex,  tubules,  glomerulus,  interstitial  structure, 
and  bloodvessels,  though  present  in  different  degrees,  combined  in 
different  ways,  and  associated  more  or  less  with  degenerative  lesions. 
Whether  there  are  one,  two,  or  more  distinct  pathological  processes 
involved,  or  whether  there  is  only  one,  modified  by  many  setiological 
factors,  which  act  in  such  a way  as  to  determine  varying  evolution, 
duration,  intensity,  extent  and  degeneration,  thus  giving  rise  to  a 
varying  symptomatology,  I do  not  feel  prepared  to  say,  but,  as 
practical  clinicians,  it  is  safer  to  leave  the  pathologists  to  fight  out 
their  battle  to  the  finish  before  we  preoccupy  our  minds  with  the 
partisan  views  of  any  one  of  the  contending  authorities.  We  cannot 
say  with  some  that  interstitial  nephritis  only  is  Bright’s  disease ; or 
with  others,  that  parenchymatous  nephritis  only  is  Bright’s  disease; 
or  that  Bright’s  disease  does  not  include  other  intermediate  and 
mixed  forms.  It  is  best  to  regard  it  as  an  ensemble  of  symptoms 
and  lesions,  variously  combined,  differing  in  evolution,  but  always 
presenting  a family  resemblance  in  albuminuria  and  uraemic  mani- 
festations, and  in  glomerular  and  tubular  destruction. 

The  confusion  into  which  we  would  be  thrown  by  accepting  Dr. 
Jousset’s  position  is  well  illustrated  by  the  effects  of  lead  upon  the 
kidneys.  Using  the  term  parenchymatous  nephritis  in  its  purely 
pathological  sense,  we  would  understand  an  inflammation  where  the 
initial  lesions  are  primarily  in  the  tubal  epithelia,  which  we  take  to 
be  the  parenchyma  of  the  kidney.  It  is  a curious  fact  that  the  best 
established  example  of  this  parenchymatous  process  should  be  the 
so-called  simple  interstitial  nephritis  of  lead-poisoning,  which  Dr. 
Jousset  rules  out  of  the  category  of  Bright’s  disease.  Charcot  and 


821 


bright’s  disease. 

Gambault  have  demonstrated  that  the  lesions  first  observed  in  ani- 
mals poisoned  by  repeated  fractional  doses  of  white  lead  are  in  the 
epithelia  of  Henle’s  loops,  rapidly  passing  later  into  the  epithelia  of 
the  convoluted  tubules  and  of  Bowman’s  capsule.  The  epithelia 
swell,  flatten  through  mutual  pressure  in  distended  tubules,  break 
down  into  embryonal  (inflammatory)  corpuscles;  or  in  other  words, 
proliferate,  whence  follow  atrophy  and  collapse  of  the  tubes  with 
growth  of  connective  tissue.  The  large  vessels  show  no  lesions. 
The  arterioles,  only  in  the  later  period,  are  affected  in  their  outer 
coat,  and  the  glomerular  capillaries  remain  intact  during  nearly  the 
whole  duration  of  the  experimental  disease.  Here,  then,  is  a typical 
parenchymatous  inflammation,  the  lesion  of  the  glandular  structure 
being  primary,  and  the  interstitial  and  vascular  lesions  being  sec- 
ondary; and  yet  here  also  is  the  purest  type  of  so-called  interstitial 
nephritis,  which  end  in  the  small,  red,  granular  kidney,  and  an  in- 
flammation which  is  also  claimed  to  be  dependent  upon  arterio- 
sclerosis. 

Time  does  not  permit  me  to  analyze  the  author’s  descriptions  of 
the  two  types  of  nephritis  presented,  which,  for  so  brief  a paper,  are 
most  admirably,  if  too  rigorously,  summarized.  I cannot,  however, 
permit  the  opportunity  to  pass  without  expression  of  dissent  from 
bis  view  of  the  relations  of  the  cardio-vascular  system  to  both  pa- 
renchymatous and  interstitial  nephritis.  In  his  parenchymatous 
nephritis  (I  have  to  say  his  to  distinguish  it  from  the  parenchyma- 
tous nephritis  of  some  other  authors),  which  includes  the  large  and 
small  white  kidneys  and  also  the  mixed  forms  of  kidneys,  common 
in  practice,  observation  of  the  heart  and  arterial  tension  furnishes 
clues  for  diagnosis,  prognosis,  and  treatment  not  second  in  value  to 
any  other  source  of  information.  In  his  interstitial  nephritis,  while 
I recognize  that  some  cases  are  joined  to  (lied)  generalized  arterio- 
sclerosis, I believe  that  oftener  the  two  processes  run  concurrently 
under  the  action  of  a common  cause,  and  that  still  more  often  the 
renal  inflammation  precedes  the  general  arterio-sclerosis  and  cardiac 
hypertrophy,  of  which  it  is  the  inducing  factor.  Even  upon  his 
own  statement  the  balance  of  experimental  evidence  is  in  favor  of 
the  production  of  cardiac  hypertrophy  (and  so  presumably  high  arte- 
rial tension)  by  tying  of  the  renal  artery  and  removal  of  a kidney, 
and  if  we  add  to  his  experiments  by  ligature  of  the  ureter,  we  find 
cardiac  hypertrophy  following  the  nephritis  thereby  induced.  But, 
leaving  experiment  aside,  the  clinical  facts  are  against  his  position. 
High  arterial  tension  and  dilatation  of  the  heart  are  common,  even 
almost  constant,  in  certain  stages  of  acute  and  chronic  parenchyma- 
tous nephritis;  early  hypertrophy  even  occurs  in  scarlatinal  nephri- 
tis occasionally,  and  the  very  statistics  cited  by  Dr.  Jousset  indicate 
that  hypertrophy  was  not  exceptional  in  the  cases  under  examina- 
tion. His  appeal  to  Bamberger’s  cases  does  not  sustain  his  position 


822 


world’s  homoeopathic  congress. 


of  exceptional  occurrence.  Bamberger’s  344  hypertrophied  hearts 
existed  in  a total  of  807  cases  of  “ primitive  Bright’s  disease,” 
“acute,”  “ chronic,”  and  “ atrophic;”  207  of  these  344  hypertro- 
phies were  with  “ atrophic”  kidneys;  122  with  “chronic,”  probably 
large  (parenchymatous)  kidneys ; and  15  with  “acute;”  but  what 
proportion  the  several  “acute,”  “chronic,”  and  “atrophic”  cases 
bore  to  the  whole  807,  and  in  what  percentage  of  each  form  hyper- 
trophied hearts  existed,  cannot  be  inferred.  All  that  we  can  say  is, 
that  122  hypertrophies  argue  not  exceptional  but  frequent  occur- 
rence ; and  that,  had  we  the  data  for  reaching  a proper  estimate,  Bam- 
berger’s statistics  probably  would  show  a proportion  approximating 
one-half  cardiac  hypertrophies  to  the  whole  number  of  parenchy- 
matous cases.  But  putting  aside  the  argument  from  Bamberger  as 
not  being;  conclusive,  we  find  that  Dr.  Jousset  has  misconceived  Gala.- 
bin’s  statistics.  Galabin’s  101  cases  numbered  65  hypertrophied 
hearts  instead  of  34,  as  the  author  of  the  paper  asserts;  66  of  the 
101  were  granular  kidneys,  with  53  cardiac  hypertrophies;  22 
were  examples  of  tubal  (parenchymatous)  nephritis,  of  which 
' 11  had  cardiac  hypertrophy;  13  were  waxy  kidneys,  with  1 

hypertrophied  heart.  Vius  showed  14  hypertrophies  out  of  20 
cases  of  parenchymatous  nephritis;  Ewald  (not  cited  in  the  pa- 
per), 5 out  of  10.  Thus,  according  to  the  statistics  appealed  to, 
fully  one-half  the  cases  of  chronic  parenchymatous  nephritis  had 
cardiac  hypertrophy.  If,  now,  with  this  correction,  we  accept 
Labadie-Lagrave’s  assertion  that  dilatation  is  the  rule  in  parenchy- 
matous nephritis,  we  arrive  at  the  conclusion  that  either  dilatation 
or  hypertrophy,  or  both,  obtain  more  commonly  than  a heart  of 
normal  size  in  chronic  parenchymatous  nephritis.  This  is  substan- 
tially the  conclusion  of  Lecorche  and  Salamon.  Familiarity  with 
their  work  makes  it  difficult  for  me  to  conceive  how  the  author  of 
the  paper  could  have  so  misconceived  their  meaning  as  to  write  that 
“they  plainly  exaggerate  when  they  speak  of  hypertrophy  of  the 
heart  as  a constant  lesion  in  this  disease”  (parenchymatous  nephri- 
tis). I have  been  unable  to  find  anywhere  in  this  book  any  such 
assertion,  and  such  exaggeration  as  there  may  be  is  on  the  side  that 
claims  that  it  is  exceptional.  What  Lecorche  and  Silamon  have 
stated  is  exemplified  in  the  following  extract  from  their  work  (pp. 
624,  625) : 

“ In  the  question  of  diagnosis,  determination  of  the  state  of  the 
heart  is  one  of  the  principal  points.  In  a general  way,  it  can  be 
said  that  the  degree  of  hypertrophy  measures  the  degree  of  atrophy 
of  the  kidney.  When  the  left  ventricle  only  is  increased  in  size,  it 
can  be  affirmed  that  the  Bright’s  disease  is  old,  whatever  may  be 
the  acute  appearances  revealed  by  the  actual  episode,  and  that  a slow 
and  latent  phase  of  atrophy  has  preceded  the  acute  attack  under 
observation.  Two  great  categories  of  Bright’s  disease  can  be  estab- 


bright?s  disease. 


823 


lished  according  to  whether  or  not  cardiac  hypertrophy  is  associated 
with  the  symptoms  of  Bright’s,  whatever  may  be  these  symptoms, 
and,  in  particular,  the  physical  and  chemical  character  of  the  urine. 

“ If  the  heart  is  normal,  or  simply  dilated,  it  is  surely  a matter 
of  a large  kidney,  soft,  red,  mottled  or  white. 

“If  a middling  (moderate)  hypertrophy  of  the  heart  exists,  the 
anatomical  characters  of  the  kidney  are  those  of  one  of  the  forms 
which  we  have  described  under  the  name  of  intermediate  evolution- 
ary forms,  or  a small  kidney  atrophied  rapidly  by  successive  attacks 
close  together — this  kidney  showing  the  appearance  of  a red  granu- 
lar kidney,  and  more  often  of  a white  contracted  kidney. 

“ If,  finally,  the  cardiac  hypertrophy  is  enormous,  there  is  no  doubt 
of  the  small  red  kidney,  contracted  by  slow  and  progressive  atrophy. 

“ These  rules  are  true,  and  ought  to  guide  in  the  immense  major- 
ity of  cases.  But,  as  with  every  pathological  law,  one  should  not 
lose  sight  of  exceptions.  Cardiac  hypertrophy  can  develop  rapidly 
in  the  course  of  acute  and  subacute  nephritis,  as  has  been  noted 
apropos  of  scarlatinal  nephritis.  In  these  precocious  hypertrophies 
dilatation  outweighs  the  hypertrophy,  properly  speaking;  but  clini- 
cally it  is  not  easy  to  make  the  distinction,  and  by  relying  on  obser- 
vation of  the  heart,  it  is  easy  to  deceive  one’s  self  upon  the  duration 
and  real  appearance  of  the  renal  lesions. 

“ In  the  second  place,  there  may  be  the  following  ensemble  of  symp- 
toms : considerable  hypertrophy  of  the  heart  without  valvular  le- 
sions; generalized  atheroma-traces  of  albumin  in  the  urine,  which 
is  pale,  poor  in  urea  and  solids.  Clinically,  it  is  difficult  to  avoid 
error.  * There  are  the  symptoms  of  the  small,  contracted  kidney  by 
progressive  atrophy,  and  yet  the  autopsy  shows  large  red  kidneys, 
smooth  and  of  normal  appearance.  Shall  it  be  said  that  because 
the  microscope  shows  a few  glomerulic  and  tubular  lesions,  that  it 
is  Bright’s  disease?  No;  we  must  recognize  that  the  clinician  has 
been  deceived,  and  that  it  is  only  a slight  nephritis  and  an  albumi- 
nuria, which  has  nothing  to  do  with  Bright’s  disease  in  an  athero- 
matous subject  whose  cardiac  hypertrophy  is  explained  by  generalized 
arterio-sclerosis,  and  which  has  no  connection  with  the  state  of  the 
kidneys. 

“ Finally,  hypertrophy  of  the  heart  may  rarely  be  absent  in  very 
pronounced  granular  atrophy.” 

The  points  which  I have  intended  to  suggest  in  discussion  have 
been  the  following : 1.  That  the  field  of  Bright’s  disease  is  larger 
than  so-called  parenchymatous  nephritis;  2.  That  it  includes  so- 
called  interstitial  nephritis;  3.  That  Bright’s  disease  is  more  plural 
than  dual  or  single  in  its  anatomical  forms  of  kidneys;  4.  That  its 
fundamental  process  or  processes  may  be  essentially  single  rather 
than  dual  or  plural,  its  evolution  and  varieties  depending  upon  the 
setiological  factors  at  work  in  the  individual  case  ; 5.  That  interstitial 


824 


world’s  homceopathic  congress. 


nephritis  is  not  commonly  a late  episode  of  a general  arterio-sclerosis ; 
6.  That  arterio-sclerosis  is  itself  a result  of  the  nephritic  lesions  of 
Bright’s  disease.  7.  That  the  heart  and  vascular  tension  are  altered  in 
all  the  forms  of  Bright’s  disease.  I should  also  like  to  emphasize  the 
thought,  which  has  grown  upon  me  with  experience,  that  behind  the 
cases  which  we  diagnosticate  as  parenchymatous  nephritis,  acute  or 
chronic,  appearing  without  assignable  cause,  there  has  been  a silent, 
latent  period  of  renal  atrophy  similar  to  that  demonstrated  in  ex- 
perimental lead-poisoning,  though  not  necessarily  confined  in  its 
causes  to  lead,  syphilis  or  gout;  that  there  has  been,  in  reality,  a 
disease  of  long  duration,  which  has  been  evolving  by  minor  local- 
ized attacks  of  slight  nephritis,  remitting,  renewing,  slowly  progress- 
ing, gradually  disabling  the  kidneys  part  by  part,  yet  without  appa- 
rent disturbance  of  the  general  health,  until,  through  some  new 
exciting  factor  or  an  intensification  of  some  cause  previously  exist- 
ing, the  remaining  healthy  portions  of  the  renal  parenchyma  are 
extensively  invaded  by  a more  intense  inflammation,  when  renal 
obstruction  becomes  manifest  by  circulatory  symptoms,  often  includ- 
ing dropsy,  and  renal  inadequacy  shows  itself  in  some  of  the  mani- 
fold phenomena  of  uraemia.  In  thus  suggesting  that  the  so-called 
interstitial  process  may  oftentimes  precede  the  so-called  parenchy- 
matous process,  and  that  the  complex  results  of  both  processes,  either 
singly  or  variously  combined,  is  what  we  call  Bright’s  disease,  there 
is  the  clinical  inference  that  attentive  examination  of  the  urine  for 
renal  inadequacy  and  close  observation  of  the  cardio-vascular  system 
should  go  hand  in  hand  for  correct  diagnosis  in  all  the  forms  of  the 
disease. 


THE  SCIENTIFIC  CLINICIAN. 


825 


THE  SCIENTIFIC  CLINICIAN. 

By  J.  P.  Sutherland,  M.D.,  Boston,  Mass. 


The  average  meeting  of  local,  or  even  of  national,  medical  socie- 
ties is  given  up,  as  a rule,  and  justly  and  wisely  enough,  to  the  dis- 
cussion of  themes  of  immediately  practical  interest,  and  to  the  rela- 
tion of  personal  experience  in  medical  fields.  “In  a short  hour,  a 
short  journey/’  says  the  proverb.  The  hours  which  the  busy  prac- 
titioner can  give  to  friendly  meetings  for  mutual  counsel  are  short 
indeed,  and  it  is  quite  natural  that  the  object  of  the  short  journeys 
these  short  hours  make  possible  should  be  the  reaping  of  practical 
hints  as  to  how  to  meet  every-day  perplexities.  But  the  present 
occasion  is  an  exceptional  one.  “ World’s  Congress”  is  a phrase  of 
wide  promise,  and  from  it  the  essayist  of  the  hour  may  take  privi- 
lege to  journey  a little  afield  from  the  familiar  highway  of  experi- 
ence toward  the  virgin  forests  of  theory.  This  is  my  excuse  for 
bringing  here,  where  others  are  unfolding  from  their  rich  stores 
things  new  and  old  in  the  way  of  clinical  experience  and  of  clinical 
fact,  a few  crude  guesses  as  to  what  like  should  be  the  clinician  him- 
self— the  scientific  clinician — which,  as  matters  now  stand  in  the 
medical  world,  I fear  is  but  another  name  for  the  ideal  clinician. 
To  pursue  the  ideal  is  not,  after  all,  so  unpractical  an  occupation  as 
it  at  first  seems.  We  may  not  overtake  it,  but  we  may  glimpse  it, 
and  it  is  only  by  glimpses  of  the  ideal  that  we  can  be  helped  to  shape 
the  actual  to  better  uses. 

What  is  a clinician?  Foster,  prince  of  makers  of  medical  dic- 
tionaries, defines  the  clinician  as  “ one  whose  observations,  inferences, 
and  methods  of  treatment  are  based  on  clinical  work,  i.e.,  on  experi- 
ence in  the  care  of  living  subjects  as  distinguished  from  the  study 
of  morbid  specimens  or  of  the  writings  of  others.”  A fine,  succinct 
definition  this,  and  one  that,  but  for  one  fact,  might  well  stand  not 
only  for  the  clinician,  generally  speaking,  but  for  the  scientific  clini- 
cian, to  define  whom  is  the  object  of  this  paper.  That  disqualifying 


826 


world’s  homoeopathic  congress. 


fact  is  that  Foster’s  definition  says  nothing  about  the  quality  of  the 
clinical  work  on  which  the  physician  founds  his  “ observations,  in- 
ferences, and  methods  of  treatment.”  Here  is  exactly  our  point  of 
departure.  In  proportion  as  that  work  is  done  in  the  true  scientific 
spirit,  which  is  that  of  broad-minded  receptivity  guarded  by  the  un- 
sleeping demand  for  all  attainable  accuracy;  in  proportion  as  that 
work  is  done  according  to  scientific  methods,  which  are  those  of  pa- 
tient, exact,  intelligent  experimentation,  will  the  work  be  scientific 
work,  and  the  clinician  a scientific  clinician. 

No  scientific  clinician  is  an  empiricist.  Every  clinician  is,  to  the 
end  of  his  working  days,  inevitably  and  in  some  sense  an  empiricist, 
but  he  is  a scientific  clinician  exactly  in  proportion  as  he  recognizes 
his  empiricism  and  is  in  the  effort  to  emancipate  himself  from  it. 
One  often  finds,  among  Homoeopath ists,  the  idea  almost  drolly  prev- 
alent that  an  empiricist  in  medicine  means  a physician  who  gives 
Old-School  medicines  according  to  the  needs  of  Old-School  experi- 
ence. In  point  of  fact  there  are  very  nearly  if  not  quite  as  many 
empiricists  among  Homoeopathists  as  anywhere  else.  For  an  empiri- 
cist is  not  such  by  virtue  of  practicing  under  this  or  that  therapeutic 
rule  or  lack  of  therapeutic  rule,  but  by  virtue  of  accepting  and  act- 
ing on  a thing  because  somebody  else  has  told  him  it  is  true,  and  not 
because  he  has  seen  for  himself  that  it  is  true  and  why  it  is  true. 
It  is  an  unsavory  dose  for  professional  vanity  to  swallow,  but  it  is 
well  for  our  growth  in  science  for  us  to  remember  that  the  girl  who 
buys  cuticura  soap  because  the  advertising  testimonials  in  the  news- 
papers tell  her  it  is  good  for  her  complexion,  is  no  more  an  empiri- 
cist than  the  Allopathic  physician  who  gives  Morphia  for  every 
kind  of  pain  because  he  has  been  told  it  is  the  proper  thing  to  do? 
or  than  the  Homoeopathist  who  cheerfully  administers  inert  sub- 
stances whose  potency  he  has  never  once  tested  on  himself  or  for 
himself  because  he  has  read  in  one  of  his  journals  that  certain  symp- 
toms have  been  created  and  are  controlled  by  them.  The  prevalence 
of  empiricism  in  the  Homoeopathic  school  would  make  a subject— 
and  a very  melancholy  subject — for  the  essayist  taken  by  itself,  and 
where  the  empiricist  reigns  the  scientific  clinician  will  rarely  be. 
Empiricism,  let  me  again  remind  you,  just  means  the  unreasoning 
acceptance  of  hearsay  and  the  acting  upon  second-hand  knowledge. 
We  are,  therefore,  empiricists,  and  nothing  else,  when  we  take  our 
materia  medica,  as  it  stands,  on  hearsay,  and  make  no  effort  to  satisfy 


THE  SCIENTIFIC  CLINICIAN. 


827 


ourselves,  as  with  a little  time  and  trouble  we  can  quite  easily  satisfy 
ourselves,  which  drugs  hold  their  place  there  by  r’ght  of  reliable 
and  satisfactory  provings,  and  which  are  there — and  a very  great 
many  are  there — merely  by  acceptance  of  empirical  hearsay,  and 
therefore  have  no  right  there  whatever.  The  scientific  clinician 
never  employs  a drug  whose  pathogenetic  power  he  does  not  know 
all  about  that  can  be  known  by  personal  experimentation  if  possi- 
ble ; at  all  events,  from  evidence  so  direct,  manifold,  and  solidly 
convincing  that  hearsay  has  no  place  in  it.  The  acceptance  of  this 
rule  is  the  first  step  taken  by  the  Homoeopathist  toward  becoming  a 
scientific  clinician.  The  administration  for  the  relief,  in  the  sick,  of 
certain  symptoms  which  the  drug  administered  can  be  proved  to 
cause  in  the  healthy  organism — this,  and  nothing  else,  is  Homoeop- 
athy. To  administer,  to  the  sick, drugs  whose  power  over  the  healthy 
organism  is  neither  known  nor  demonstrable,  is  to  be  neither  Hom- 
oeopathist nor  scientific  clinician,  but  an  empiricist,  pure  and  simple. 
A convincing  instance  of  what  hold  empiricism  has  upon  Homoeop- 
athy is  the  prevalence,  in  so-called  Homoeopathic  practice,  of  what  is 
known  as  Schiisslerism.  The  Schiissler  remedies  beyond,  in  a few 
instances  bearing  the  names  of  drugs  known  to  our  materia  mediea, 
and  being  recommended  for  administration  in  small  doses,  have  no 
more  in  common  with  Homoeopathic  treatment  than  have  “safe” 
kidney  cures  and  “ infallible  ” spring  tonics.  One  would  suppose 
this  fact  would  be  recognizable  at  a glance  ; yet  so  widespread  and 
insidious  is  the  influence  of  empiricism  that  there  are  Homoeopath ists 
the  conntry  over  who  employ  the  Schiissler  remedies  in  absolute  ig- 
norance of  their  pathogenetic  power  or  if  they  possess  any  such. 
Such  possibilities  must  cease  to  exist  before  we  can  hope  to  become 
a school  of  scientific  clinicians. 

To  accept  nothing  on  hearsay,  to  investigate  personally  when  per- 
sonal investigation  is  possible,  and  in  any  case  to  demand  evidence 
of  a thoroughly  reliable  sort  before  acting  in  any  given  direction, 
that  is  the  first  qualification,  that  is  the  very  hall-mark  of  the  scien- 
tific clinicism.  For  the  rest,  he  must  be  a trained  observer,  a logi- 
cal reasoner,  an  unbiassed  thinker,  a truth-seeker  of  such  high  cali- 
bre that  no  theory,  however  cherished,  will  be  respected  by  him 
when  he  finds  it  opposed  by  demonstrable  fact. 

He  must  be  a trained  observer.  In  our  craft,  as  elsewhere,  there 
are  certain  inborn  aptitudes  the  possession  of  which  is  invaluable  to 


828 


world’s  homoeopathic  congress. 


the  craftsmen,  as  helping  him  toward  the  ideals  of  his  work.  Keen- 
ness of  the  natural  senses  is  a fortunate  possession  for  the  clin- 
ician. Smell,  touch,  sight,  hearing,  taste — these  in  the  clinician, 
who  must  be  an  acute  diagnostician,  should  be  as  carefully  trained, 
as  instantly,  involuntarily  serviceable,  as  they  are  in  the  woodsman 
and  the  plainsman.  Listen  to  Milner  Fothergill,  whose  inspired 
common-sense  every  student  of  medicine  would  do  well  to  profit  by. 
“ When  a patient  comes,  the  first  thing  to  do  is  to  look  at  him. 
Some  varieties  of  information  may  be  safely  left  in  the  library,  and 
it  is  quite  enough  for  the  busy  practitioner  to  know  where  to  find  it 
when  he  wants  it;  but  there  is  other  information  which  is  required 
several  times  every  day.  The  more  the  eye  learns  to  see,  the  more 
it  can  see  and  will  see.  There  is  nothing  worth  knowing  that  is  got 
without  trouble.  So  is  it  with  the  education  of  the  eye.  The  edu- 
cation of  the  eye  is  most  important  to  a medical  man  ; it  cannot 
be  forgotten  or  mislaid  like  an  instrument;  it  is  of  incalculable 
value  when  the  patient  is  unconscious  or  deaf,  or  a foreigner  whose 
language  the  doctor  does  not  know.  A scar  at  the  corner  of  the 
mouth  will  reveal  the  secret  of  malnutrition  in  a child  who  has 
hitherto  resisted  all  remedial  measures;  a little  puffiness  under  the 
lower  eyelid  may  indicate  the  chronic  Bright’s  disease  underlying 
the  bronchitis  for  which  the  doctor  is  consulted;  the  hue  of  the  skin 
will  very  often  furnish  the  clue  to  the  malarial  neuralgia  which  is 
very  troublesome;  a tortuous,  visibly  pulsating  temporal  artery  will 
tell  in  all  but  articulate  language  of  the  gouty  heart  and  its  associ- 
ated conditions.  These  are  a few  instances  of  what  the  eye  can  do 
in  the  way  of  diagnosis.”  What  the  trained  ear  can  do,  especially 
in  cases  of  pulmonary  and  cardiac  diseases,  to  aid  accurate  diagnosis 
needs  no  dwelling  upon.  Touch  has  acquired  infinite  significance, 
since  we  have  learned  what  accurate  diagnoses,  even  in  complicated 
cases,  can  be  made  by  the  exquisitely  trained  and  sensitive  touch  of 
the  totally  blind.  “ When  the  sense  of  smell  is  sufficiently  devel- 
oped”— to  again  quote  Fothergill — “it  is  of  definite  aid  to  the  diag- 
nostician. In  the  exanthemata  a certain  animal  odor,  often  amount- 
ing to  a positive  stench,  is  emitted.  Certain  lunatics  and,  markedly, 
general  paralytics,  possess  a very  disagreeable  odor.  In  pyaemia  the 
breath  carries  with  it  a characteristic  smell,  described  as  that  of  hay 
or  earth.” 

These  few  examples  instance  how  invaluable  special  training  of 


THE  SCIENTIFIC  CLINICIAN. 


829 


the  natural  senses  may  be  to  the  scientific  clinician  in  his  capacity  of 
diagnostician.  That  he  must  be  expert  as  a diagnostician  should  go 
without  saying.  It  may  be  true  that  the  Homoeopathic  clinician  is 
safe  in  selecting  the  same  drug  to  meet  the  same  symptoms,  from 
however  widely  different  diseased  conditions  the  symptoms  may 
have  rise.  But  it  is  certainly  true  that  the  hygienic  and,  above  all, 
the  dietetic  treatment  prescribed  must,  to  be  efficient,  vary  widely 
with  the  pathological  condition  for  which  it  is  prescribed,  and  exact 
apprehension  of  which  is  therefore  a prime  requisite  of  the  scientific 
clinician. 

Again,  he  must  be  a logical  reasoner.  Without  the  power  of  rea- 
soning logically,  closely,  clearly,  the  physician  may  be  an  exceedingly 
popular  and  successful  practitioner,  but  he  can  never  be  a scientific 
clinician.  One  infallible  sign  of  the  clinician  who  is  a logical  rea- 
soner is  the  infrequency  with  which  the  word  “ cure  ” is  heard  upon 
his  lips.  He  may  and  will  speak  often  and  gratefully  of  recoveries, 
but  only  in  rare  instances  refer  to  them  as  “ cures.”  The  reverent 
saying  of  the  great  surgeon — I dressed  his  wound,  and  God  healed 
the  man  ” — represents  the  habitual  attitude  of  the  logical  thinker 
toward  the  recoveries  that  take  place  under  his  treatment.  “ I gave 
the  drug,  and  the  man  was  healed;”  that  is  the  utmost  he  will  often 
venture  to  say.  Data  alike  concerning  the  origin  and  natural  course 
of  disease  and  the  power  of  drugs  over  diseased  conditions  are  far 
too  scant,  far  too  unreliable  for  us  to  pronounce  from  them,  in  most 
cases,  what  power  was  instrumental  in  a patient's  recovery.  We 
know  in  how  many  cases  of  acute  and  infectious  diseases  the  ten- 
dency is  toward  spontaneous  recovery  entirely  without  medical  as- 
sistance— measles,  for  instance,  croup,  pneumonia,  typhoid  fever. 
We  know  how  many  diseases,  distinctly  malignant,  will  most  cer- 
tainly cause  death  in  the  patients  who  are  their  prey,  in  spite  of 
every  known  medical  resource — phthisis,  diabetes,  locomotor  ataxia, 
sarcoma,  tubercular  meningitis.  Knowing  these  things,  surely  the 
scientific  clinician  will  content  himself  with  adding,  so  far  as  he 
can,  from  the  fruits  of  his  conscientious  and  impartial  observation, 
to  the  data  from  which,  in  the  far  future,  reliable  deductions  may  be 
made  as  to  the  power  of  drugs  over  diseases,  but  will  modestly  real- 
ize, meantime,  that  the  only  class  of  cases  to-day  from  which  such 
deductions  can  be  safely  made  are  cases — like  those  of  skin  disease 
or  of  neurasthenia — which  are  known  to  be  benign,  and  yet,  with- 
out medical  interference,  to  persist  indefinitely,  apparently  insus- 


830 


world’s  homoeopathic  congress. 


ceptible  of  spontaneous  cure.  He  will  study  unweariedly,  not  only 
in  man  but  in  the  lower  animals — where  frequent  spontaneous  recov- 
ery from  illness  furnishes  such  suggestive  instances  of  the  power  of 
the  vis  medicatrix  naturse — the  phenomena  of  disease,  recovery  and 
cure.  He  will  learn  to  look  upon  the  patient  under  his  care  as  a 
unit  made  up  of  many  complexities — a creature  made  up  of  body, 
mind  and  will — and  who  can  only  be  successfully  treated  by  the 
physician  who  has  at  command  not  only  the  drugs  that  act  upon  the 
body,  but  the  resources  of  those  mental  and  psychological  therapeu- 
tics whose  potency  for  the  “ mind  diseased”  is  every  day  more  intel- 
ligently recognized. 

Finally,  the  scientific  clinician  will,  with  every  year  of  experi- 
ence of  its  value  and  its  usefulness,  lean  more  and  more  thankfully, 
as  time  goes  on,  upon  the  guiding  law  of  Homoeopathy.  To  know 
the  exact  pathogenetic  scope  of  drugs;  to  choose,  with  sensitive  dis- 
crimination, the  closest  similimum  to  the  diseased  condition  present- 
ing; to  administer  this  drug  with'full  realization  how  potent  and 
beneficent  is  the  milde  macht ; this  to  do  is  to  follow  the  only  chan- 
nel through  which,  among  the  hundred  shifting  currents  of  medical 
empiricism,  among  the  dangerous  shoals  and  quicksands  of  medical 
commercialism,  one  may  reasonably  hope  to  steer  to  the  harbor  of 
safety  and  success. 

Action  from  first-hand  experience  and  not  from  hearsay ; logical 
reasoning ; acute  and  trained  observation ; the  modesty  which  hesi- 
tates as  long  to  say  “ I cured,”  in  event  of  a patient’s  recovery,  as 
in  event  of  a patient’s  death  it  would  hesitate  to  say  “I  killed;” 
wide  sympathy ; mastership  of  many  resources;  such  consistent  ad- 
herence to  the  strict  principles  of  Homoeopathy  as  forbids  experiment 
upon  the  human  body  in  disease  with  any  substance  whose  effects 
upon  the  human  body  in  health  are  not  thoroughly  demonstrated 
and  forever  demonstrable;  these  are  the  signs  by  which  men  may 
know  the  scientific  clinician.  They  may  or  may  not  mark  the  suc- 
cessful practitioner,  since  what  pleases  the  patient  is  not  infrequently 
preferred  over  what  helps  the  patient.  But  they  will  mark  the  hon- 
orable practitioner,  and  perhaps,  in  the  long  last,  that  is  best. 

Discussion. 

George  B.  Peck,  M.D. : The  paper  to  which  we  have  just  list- 
ened in  its  entirety,  and  with  the  signification  the  author  in  its  clos- 
ing paragraphs  clearly  indicates  his  intention  to  convey,  is  entitled 


THE  SCIENTIFIC  CLINICIAN. 


831 


to  our  unqualified  approval.  It  accurately  delineates  that  ideal 
whose  realization  should  be  our  constant  endeavor.  And  yet  his 
discussion  of  empiricism  is  so  confusing  and  indeed  so  contradictory 
I fear  much  of  the  good  that  otherwise  might  have  been  secured  to 
the  junior  members  of  the  profession  has  been  lost. 

Webster  tells  us  that  an  empiric  is  one  whose  knowledge  is  fouuded 
exclusively  on  personal  experience,  and  that  any  procedure  is  empir- 
ical that  is  unwarranted  by  science.  But  the  essayist  declares  that 
the  “ empiricist  is  not  such  by  virtue  of  prescribing  under  this  or 
that  therapeutic  rule,  or  lack  of  therapeutic  rule ; but  by  virtue  of 
accepting  and  acting  on  a thing  because  somebody  else  has  told  him 
it  is  true,  and  not  because  he  has  seen  for  himself  that  it  is  true  and 
why  it  is  true ; that  the  girl  who  buys  cuticura  soap  because  the  ad- 
vertising testimonials  in  the  newspapers  tells  her  it  is  good  for  her 
complexion,  is  no  more  an  empiricist  than  the  Hornoeopathist  who 
cheerfully  administers  inert  substances  whose  potency  he  has  never 
once  tested  on  himself  or  for  himself  because  he  has  read  in  one  of 
his  journals  that  symptoms  have  been  created  and  are  controlled  by 
them;  and,  finally,  that  we  are  empiricists  and  nothing  else  when  we 
take  our  materia  medica  as  it  stands  on  hearsay.”  He  further  states 
that  “ the  scientific  clinician  never  employs  a drug  whose  pathoge- 
netic power  he  does  not  know  all  about  that  can  be  known.”  Then 
the  scientific  clinician  must  content  himself  with  a contemptibly 
small  number  of  remedies  or  be  the  fortunate  possessor  of  an  unri- 
valled intellect. 

Who  knows  all  that  can  be  known  on  any  subject  or  anything? 
What  science,  what  knowledge  does  not  depend  on  statements  by 
others  that  it  is  impossible  for  us  to  verify  in  any  particular?  Do 
we,  therefore,  discard  the  one  and  dispute  the  other?  Establish  the 
integrity  and  the  opportunity  for  knowing  of  a witness  and  you  must 
accept  his  testimony.  That  sort  of  evidence  which  might  send  you 
or  me  to  the  electric  chair  upon  occasion  is  good  enough  to  risk  our 
own  lives  and  the  lives  of  our  patients  upon.  At  all  events,  it  is  the 
only  kind  of  evidence  you  ever  will  or  ever  can  obtain.  Nothing 
has  impressed  me  more  in  scanning  the  pages  of  Allen’s  Cyclopaedia 
than  the  number  of  symptoms  of  unquestioned  value  that  have  been 
noted  only  by  single  provers,  though  a dozen  or  more  tested  the 
drug.  He  is  no  empiric  but  a strict  scientist  who  administers  Lyco- 
podium or  any  other  so-called  inert  substance  properly  attenuated 
for  the  removal  of  a group  of  symptoms  alleged  to  have  been  pro- 
duced by  that  substance,  even  though  only  upon  a single  creditable 
experimenter,  whether  the  statement  is  to  be  found  only  in  the  Cy- 
clopaedia of  Drug  Pathogenesy , Allen’s  Cyclopaedia , or  the  last  issue 
of  some  magazine,  for  it  is  based  upon  an  unchanging  and  unalter- 
able law  of  nature  and  not  upon  a fickle  whim  of  the  prescriber. 

The  essayist  states  that  “ data  alike  concerning  the  origin  and 


832  world’s  homoeopathic  congress. 

natural  course  of  disease,  and  the  power  of  drugs  over  diseased  con- 
ditions, are  far  too  scant,  far  too  unreliable  for  us  to  pronounce  from 
them  in  most  cases  what  power  was  instrumental  in  a patient’s 
recovery.”  I dissent  emphatically  from  that  proposition.  While 
no  honorable  practitioner  will  boast  of  his  cures  through  the  restraints 
alike  of  modesty  and  dignity,  if  a man  does  not  know  in  most  cases, 
I had  almost  said  in  all,  whether  he  cures  or  fails  to  cure,  he  lacks 
the  first  essential  of  the  physician — sound  judgment — and  is  there- 
fore unfit  for  that  vocation. 

In  conclusion -I  wish  to  quote,  with  my  hearty  endorsement,  the 
statements  that  the  scientific  clinician  “ must  be  a trained  observer, 
a logical  reasoner,  an  unbiassed  thinker,  a truth-seeker  of  such  high 
calibre  that  no  theory,  however  cherished,  will  be  respected  by  him 
when  he  finds  it  opposed  by  demonstrable  fact,  and  that  he  will  with 
every  year  of  experience  of  its  value  and  usefulness  lean  more  and 
more  thankfully  as  time  goes  on  upon  the  guiding  law  of  Homoeop- 
athy !” 


BILIOUSNESS. 


833 


BILIOUSNESS. 

By  F.  H.  Orme,  M.D.,  Atlanta,  Ga. 


There  is  probably  no  term  designed  to  express  an  abnormal  con- 
dition, that  greets  the  eye  or  the  ear  of  the  physician  more  frequently 
than  does  the  vague  and  nondescript  one  of  multifarious  signification  , 
“biliousness/’  Like  the  ubiquitous  “cold,”  which  is  said  to  have 
been  “taken,”  it  is  the  cause  of,  or  is  combined  with,  a large  portion 
of  the  extensive  list  of  ailments  which  afflict  humanity.  It  answers, 
or  is  expected  to  answer,  as  a description  of  indefinite  states  induced 
by  unavoidable  or  avoidable  causes.  Its  only  synonym  would  be 
indefinableness. 

The  debauchee  ascribes  to  this  unknowable  influence  his  post- 
prandial or  post-bacchanal  troubles ; the  overworked  business  man 
finds  in  it  the  explanation  of  his  ill-feeling;  the  traveller  who  has 
been  exposed  to  noxious  miasmata  has  feelings  which  he  must  use 
the  word  “bilious”  to  express;  while  the  general  feeling  of  malaise 
attending  the  incipient  stage  of  so  many  acute  or  chronic  affections 
comes  under  that  all-comprehending  expression. 

When  analyzed,  what  does  “biliousness”  mean?  Who  could 
answer  this  without  writing  a book?  It  means,  in  part,  according 
to  the  various  conditions  to  which  it  is  applied,  a “ bad  ” feeling,  a 
“mean”  feeling,  a “sluggish”  feeling,  a “sickish”  feeling,  “qualm- 
ishness,” “ ane  ne  sais  quoi,”  “ indefinable,”  “don’t-know-what-to-call- 
it  ” feeling.  As  to  the  extent  to  which  bile  has  anything  to  do  with 
it,  of  course  our  patients  cannot  know  this,  and  it  must  be  confessed 
that  often  we  have  little  the  advantage  of  them  in  this  respect.  It 
is  a semi-technical  term  in  popular  and  in  professional  nomenclature, 
as  often  signifying  a deficient  as  an  excessive  action  of  the  liver,  and 
the  patient  in  this  sad  condition,  whatever  it  may  be,  usually  pleads 
for  something  to  “ touch  up  the  liver,”  when,  perhaps,  that  much- 
accused  and  much-abused  organ,  the  largest  and  best-able-to-take- 
care-of- itself  gland  in  the  body,  is  all  the  while  overworked  and 
innocent  of  any  peccancy  ! 


53 


834 


world’s  homceopathic  congress. 


An  organ  whose  usual  function,  in  the  average  man,  is  to  secrete 
about  forty  ounces  of  bile  in  twenty-four  hours,  may  well  vary  a 
few  ounces  in  a day  within  normal  limits,  and  it  is  rarely  that  there 
is  really  excessive  variation  in  the  amount  of  secretion,  one  way  or 
another,  in  those  cases  which  are  with  much  emphasis  denominated 
“ bilious.”  The  throwing  up  of  a tablespoonful  of  bile,  which, 
mingled  with  the  fluids  of  the  stomach,  seems  like  a gill,  is  consid- 
ered proof  of  biliousness,  while  in  truth,  instead  of  proving  exces- 
sive secretion,  it  is  only  evidence  that  this  important  digestive  or 
emulsifying  fluid  is  taking  the  wrong  direction — by  regurgitation — 
and  is  wasted. 

Given  a case  of  ordinary  flow  of  bile,  with  a reversed  action  of 
duodenum  and  stomach,  half  an  ounce  or  an  ounce  can  easily  be 
caught  from  the  current  that  actively  flows  from  the  ductus  commu- 
nis choledochus.  Yet  what  serious  importance  is  sometimes  ascribed 
to  this!  A seasick  person  is  often  a good  illustration  of  the  really 
slight  significance  of  the  ejection  of  a little  bile.  Active  emesis, 
from  almost  any  cause,  is  liable  to  furnish  this  fluid  in  abundance. 

Icteroid  conditions  are  spoken  of  as  “ bilious,”  with  more  of  rea- 
son, indeed;  for  there  is  in  jaundice  an  excess  of  bile  in  the  system, 
although  not  necessarily  an  excess  of  secretion.  An  obstruction  of 
the  main  bile-duct  by  calculi  will  certainly  cause  a surcharging  of 
the  system  with  absorbed  bile ; but  this  appears  to  be  of  itself  of 
little  disadvantage — at  least,  illness  does  not  seem  to  be  in  propor- 
tion to  the  extent  of  this;  for  after  the  absorption  of  bile  has  been 
discontinued,  it  is  often  long  before  the  deposit,  at  least  of  the  pig- 
ment, can  be  eliminated,  even  after  a fair  degree  of  health  has  been 
recovered.  A considerable  amount  of  bile-pigment  in  the  skin 
seems  to  be  not  incompatible  with  medium  health.  Such  conditions 
are,  of  course,  abnormal,  and  are  concomitant,  at  times,  with  serious 
functional  disorder,  but  do  not  necessarily  produce,  and  are  not  at- 
tended by,  the  feelings  or  conditions  described  as  “ biliousness.” 

The  bitter  taste  in  the  mouth  which  causes  some  to  think  them- 
selves bilious  may  be  due  to  the  taurocholic  acid  of  the  bile,  which 
is  intensely  bitter,  in  the  blood,  or  in  the  secretions  of  the  mouth 
(the  bile  pigments  are  tasteless),  but  it  may  also  be  due  to  hallucina- 
tion of  the  nerve  of  taste  at  times,  instead  of  the  bile  acids.  As 
we  have  hallucination  of  the  sense  of  sight  in  the  phenomena  of 
muscse  volitantes , and  of  the  sense  of  hearing  -in  the  way  of  tinnitus 


BILIOUSNESS. 


835 


aurium , and  of  the  sense  of  touch  or  general  sensation  as  in  formi- 
cation, so  we  may  have  hallucination  of  the  sense  of  taste  in  the 
form  of  acid,  sweet,  salty,  bitter  or  other  taste,  when  the  secretions 
of  the  mouth  would  be  void  of  any  such  actual  conditions.  This 
bitter  taste  is  often  found  in  connection  with  a clean  tongue,  while  a 
foul  or  coated  tongue,  with  bad  taste  and  pasty  feeling,  is  regarded 
as  one  of  the  most  usual  indications  of  biliousness. 

The  most  customary  feelings  of  one  calling  himself  bilious,  beside 
that  just  mentioned,  are  probably  those  of  sluggishness,  especially 
of  the  bowels,  with  fulness  of  or  pain  in  the  head;  loss  of  appetite  and 
of  spirits;  indisposition  to  exertion  at  labor  or  amusement — suggest- 
ing loss  of  proper  functional  action  of  the  system  generally — which 
is  what  biliousness  most  commonly  means.  This  is  the  feeling  that 
seems,  in  the  amateur  fancy,  to  call  for  a “ touching  up  of  the  liver/7 
and  by  this  touching  up  is  meant  a general  stimulation  of  the  whole 
digestive  system,  including  the  secretions  of  the  alimentary  canal. 

From  this  state  of  impairment  of  function  and  general  sluggish- 
ness the  system  sometimes  spontaneously  reacts,  often  with  excessive 
secretion  and  increased  peristaltic  action  of  the  intestines,  which  is 
at  times  followed  by  an  improved  condition  of  the  feelings.  It  is, 
doubtless,  from  this  hint  that  grew  the  general  practice,  carried  to 
an  extreme,  of  using  purgative  medicines  for  this  biliousness.  That 
benefit  has  sometimes  followed  a judicious  course  of  this  sort  can 
scarcely  be  denied,  and  that  there  has  been  an  abuse  of  it  in  prac- 
tice does  not  argue  against  the  idea  that  a properly  directed  physio- 
logical stimulation  of  organs  perhaps  in  a state  of  passive  congestion 
or  inertia  may  at  times  be  of  advantage.  A stupid  fallacy  it  is, 
however,  which  gives  delight  to  many  when  they  see  a free  How  of 
bile  as  a result  of  the  hobby  dose  of  calomel,  as  though  bile  was 
produced  to  be  wasted  in  this  manner! 

Various  indeed  are  the  causes  assigned,  justly  or  fancifully,  for 
the  state — the  concurrent  of  so  many  diseases — called  biliousness. 
Malaria — whatever  that  may  mean — comes  in  as  a principal  factor. 
Indigestion  is  a prolific  cause.  Pregnancy  gives  a rich  assortment 
of  “ bilious”  symptoms.  Whiskey  and  tobacco  and  their  congeners 
are  exceedingly  active.  Beer  and  similar  disturbing  drinkables  fol- 
low closely.  The  bon  vivant  who  has  indulged  late  at  night  in  too 
much  lobster  salad,  brandy,  cigars,  etc.,  is  apt  to  report  himself  to 
his  physician  in  the  morning  as  “ bilious.”  Depression  of  spirits 


836 


world’s  homoeopathic  congress. 


from  frustrated  plans  in  love,  war  or  business,  or  other  serious  dis- 
appointments are  very  bilious  in  their  effects.  Of  course,  trauma- 
tism, orificial  troubles,  uric  acid  in  the  blood,  or  some  serious  renal, 
nervous  or  cerebral  difficulty  may  be  the  basis  of  some  of  these 
feelings. 

Fancies  are  numerous  as  to  what  has  bilious  tendencies,  often  from 
the  fact  that  the  condemned  articles  were  at  some  time  taken  inop- 
portunely or  in  excessive  quantity.  Even  the  most  innocent  of 
foods,  milk,  is  charged  with  a bilious  effect,  and  idiosyncrasies  at 
times  render  every  edible  and  potable  article  “ bilious.”  Whatever 
may  chance  to  derange  the  stomach  at  some  time  is  accused  of 
exciting  this  abhorred  condition,  and  people  who  are  imprudent  in 
eating  and  drinking  are,  as  a rule,  most  subject  to  “ bilious  at- 
tacks.” Improved  sanitation  and  hygiene  would  prevent  many  such 
cases. 

As  an  illustration  of  the  strange  use  sometimes  made  of  the  term 
“ biliousness,”  may  be  given  the  case  of  a small  boy  who  had  sev- 
eral severe  “ bilious”  attacks  during  twenty-four  hours,  violent 
vomiting  coming  on  suddenly,  with  bile,  and  as  suddenly  sub- 
siding. No  other  cause  being  apparent  to  the  family,  of  course 
it  was  “ biliousness.”  On  the  second  day,  after  an  unusually 
severe  paroxysm  of  vomiting,  beside  some  bile  and  some  blood, 
which  fell  upon  the  towel  over  his  chest,  appeared — what  aston- 
ished the  writer  as  well  as  the  mother  of  the  child— a carpet  tack  ! 

Biliousness,  so  called,  is  the  result  of  almost  every  conceivable  in- 
discretion, and  is  really  synonymous  with  ft  sickness  ” in  a large  class 
of  cases,  so  that  those  who  prescribe  for  a name  with  a hobby  remedy 
will  have  a varied  if  unsuccessful  experience. 

What  bushels  of  compound  cathartic  pills;  what  tons  of  Mer- 
cury, in  the  shape  of  Blue  mass,  Calomel,  etc. ; what  cargoes  of  ad- 
vertised vegetable  and  antibilious  pills;  and  what  oceans  of  open- 
ing draughts  have  been  used  in  contending  with  this  most  general 
complaint — biliousness.  What  slight  ailments  have  been  made 

serious,  what  millions  of  teeth  have  been  loosened,  what  lives  have 
been  destroyed  by  this  indiscriminate  “doctoring”  for  this  vague 
and  undefined  condition? 

Well  indeed,  is  it,  that  Homoeopathy  has  come  in  vogue  to  change, 
at  least  to  some  degree,  this  vicious  system.  The  milder  method, 
with  the  specialization  of  cases,  has  done  much  toward  breaking  up 


BILIOUSNESS. 


837 


the  random,  haphazard  plan  of  scouring  the  interior — “ cleansing 
the  primae  vise ” as  our  Old-School  friends  have  had  it — ad  nauseam , 
and  still  there  is  much  to  do  in  this  direction.  Routinism  is  still 
the  evil  of  the  day  ; individualization,  a special  feature  in  Homoeo- 
pathic practice,  is  the  method  of  the  advanced  school  and  of  the 
future.  Let  us  avoid  the  empirical  snare  of  hobbyism  and  follow 
the  index  of  scientific  specialization ; so  shall  we  succeed  in  dealing 
with  even  this  protean  disorder — biliousness , 


838 


world’s  homoeopathic  congress. 


THE  CURATIVE  ACTION  OF  HOMCEOPATHIC 
REMEDIES  IN  CASES  OF  ORGANIC 
DISEASE  OF  THE  HEART. 

By  John  H.  Clarke,  M.D.,  London,  England. 


The  common  notion  that  disease  of  the  heart  is  incurable  should 
be  in  every  way  discountenanced  by  Homoeopathists.  Many  forms 
of  heart  disease  are  completely  curable,  and  the  sooner  the  popular 
ideas  on  the  subject  are  corrected,  the  better  it  will  be  for  those  who 
suffer  from  any  kind  of  heart  affection.  It  is  true  that  old-estab- 
lished valvular  disease  cannot  be  altered,  destroyed  valves  cannot  be 
restored,  but  even  in  these  cases  much  may  be  done  by  remedies  to 
restore  the  power  of  the  heart  when  it  is  defective,  and  to  bring 
about  proper  compensation,  which  is  practically  a cure.  In  recent 
cases  of  valve  affection  it  has  frequently  been  my  lot  to  observe  the 
disappearance  of  all  signs  of  disease  under  treatment.  In  my  book 
on  Rheumatism  I have  mentioned,  among  others,  a case  of  this  kind 
which  particularly  struck  me  when  I was  resident  medical  officer  at 
the  London  Homoeopathic  Hospital.  It  was  that  of  a young  girl 
who  had  a severe  attack  of  acute  rheumatism,  with  both  pericarditis 
and  endocarditis.  Under  treatment,  the  friction  sounds  of  the  peri- 
cardial inflammation  quite  disappeared,  and  when  these  had  gone 
the  bruits  indicating  endocardial  mischief  also  subsided. 

One  of  the  chief  difficulties  in  the  treatment  of  endocarditis  occur- 
ring in  connection  with  rheumatic  fever  lies  in  the  fact  that  there  are 
so  few  symptoms  indicating  the  mischief.  Pericarditis  has  generally 
abundance  of  symptoms,  hence  it  is  a much  easier  matter  to  cure 
cases  of  this.  On  the  other  hand,  there  may  be  very  extensive  endo- 
carditis and  no  sign  be  given  except  on  physical  examination.  In 
such  cases  the  only  thing  to  be  done  is  to  take  the  totality  of  the 
symptoms  and  to  prescribe  accordingly.  If  there  are  no  symptoms 
elsewhere  to  guide,  such  medicines  as  have  been  found  in  practice  or 
in  provings  to  have  an  affinity  for  the  lining  membrane  of  the  heart 


CURATIVE  ACTION  OF  HOMCEOPAIHIC  REMEDIES.  839 


and  arteries  should  be  thought  of,  when  the  constitution  of  the  pa- 
tient and  his  previous  medical  history,  with  any  former  symptoms 
lie  may  have  had,  will  serve  to  distinguish  the  most  similar. 

Case  I. — Quite  recently  a little  girl,  aged  5,  came  under  my  care 
in  the  Homoeopathic  Hospital  suffering  from  rheumatic  fever,  affect- 
ing a number  of  joints,  and  complaining  of  pain  in  her  chest.  I 
found  extensive  effusion  into  the  pericardium,  and  a marked  mitral 
systolic  bruit  as  well.  She  had  received  Chelidoniwm  and  afterwards 
Aconite  before  I saw  her,  but  without  benefit.  There  was  great  irri- 
tability of  temper,  white  tongue,  heavy  perspirations,  and  marked 
nightly  aggravation  of  the  symptoms,  causing  her  to  scream  the 
greater  part  of  the  night.  I prescribed  Merc.  viv.  12,  and  the  symp- 
toms at  once  abated.  The  temperature  fell  to  normal,  the  effusion 
disappeared,  and  in  a few  days  the  patient  was  convalescent.  How- 
ever, the  bruit  persisted.  But  there  were  no  symptoms  whatever. 
The  child  was,  in  all  other  respects,  perfectly  well.  As  her  feet 
were  somewhat  cold  and  clammy,  I prescribed  Calc,  c.,  but  I could 
not  trace  any  effect  on  the  valve  to  this ; and  as  the  patient  had  to 
leave  the  hospital  I was  unable  to  follow  the  case  further.  Com- 
pensation, however,  was  fully  established  before  she  left. 

During  last  summer  a number  of  cases  of  endocarditis  came  under 
my  observation  in  connection  with  acute  fevers.  There  was  at  the 
time  an  extensive  epidemic  of  German  measles,  and  the  first  case  I 
shall  describe  is  that  of  a young  lady  aged  nineteen  who  was  one  of 
its  victims. 

Case  II. — On  June  15,  1892,  I called  to  see  Miss  L.,  who  had 
been  somewhat  ill  for  four  days.  I found  the  rash  of  German 
measles,  sore  throat,  the  right  tonsil  being  enlarged.  There  was  a 
cough,  and  she  raised  a good  deal  of  phlegm.  There  was  some  fever. 
The  monthly  period  was  on  at  the  time.  The  pulse  was  72.  On 
listening  to  the  heart  I found  a systolic  mitral  bruit.  She  had  cold, 
clammy  feet.  Under  Belladonna  30  the  symptoms  of  the  fever  left 
her,  but  the  bruit  remained.  On  the  22d  June  the  bruit  was  audible 
in  the  mitral,  tricuspid  and  left  auricular  areas  when  she  was  lying 
down,  but  disappeared  when  she  sat  up.  There  was  slight  giddi- 
ness when  walking  and  she  was  tired  in  sitting  up.  I gave  her 
Spigelia  30,  and  in  a few  days  the  bruit  became  less  distinct.  She 
afterwards  received  Nat.  mur . and  then  Arsen,  for  other  indications ; 
but  on  June  29th,  after  a restless  night,  hot  and  perspiring,  the  pulse 


840 


world’s  homoeopathic  congress. 


was  84,  the  mitral  bruit  was  very  distinct,  and  heard  in  all  the  areas 
of  the  heart,  and  the  patient  felt  “ queer,”  so  I again  gave  Spigelia 
30.  Two  days  after  this  I found  her  feeling  much  better,  and  I 
could  not  hear  the  bruit  A few  days  later  I listened  again,  but 
could  hear  nothing  of  it,  so  I let  her  leave  town  for  the  seaside. 

Case  III. — About  the  same  time  I was  attending  another  Ger- 
man measles  patient,  also  a young  lady,  who  developed  in  the  course 
of  it  a similar  affection  of  the  mitral  valve.  Eventually  this  also 
disappeared,  but  as  this  case  was  more  complicated,  the  attack  hav- 
ing supervened  on  a long  period  of  over- work  and  mental  strain, 
much  longer  time  was  required.  The  medicine  which  had  most 
effect  on  the  heart  symptoms  in  this  case,  was  Baryta  carb .,  which 
was  given  in  two-grain  doses  of  the  3x.  The  sensations  she  com- 
plained of  were  a strained  feeling  referred  to  the  base  of  the  heart 
and  a sharp  pain  about  the  apex.  The  3x  appeared  to  have  more 
decided  action  in  this  case  than  the  30th  which  was  given  first. 

Case  IV. — Charlie  W.,  aged  10,  had  an  attack  of  English  measles 
in  May,  1892.  I saw  him  on  the  28th,  and  all  the  classical  symp- 
toms of  the  disease  were  present,  and  in  addition,  a mitral  systolic 
bruit.  There  were  no  symptoms  arising  from  the  latter,  and  I 
treated  the  case  according  to  the  symptoms  in  the  ordinary  way. 
Under  Bell.  30,  Merc.  sol.  30,  and  Sulph.  30,  the  disease  ran  a 
mild  course,  leaving  the  boy  well,  except  for  the  bruit.  On  May 
7th,  as  there  were  no  symptoms,  I put  him  on  Lycopus  virginicus  lx, 
which  has  a reputation  in  valvular  disease.  I could  trace  no  effect 
to  this,  nor  to  Spongia  30,  with  which  I followed  it.  On  17th  of 
May,  taking  into  consideration  that  he  came  of  a consumptive  family 
on  one  side  of  the  house,  and  guided  by  the  crenated  appearance  of 
his  teeth,  which  Dr.  Burnett  has  shown  is  an  indication  for  the 
medicine,  I gave  one  dose  of  Tuberculinum  (Heath)  200,  and  as  he 
had  cold,  clammy  feet,  I followed  this  with  Calc,  carb . Under  this 
treatment  he  made  good  progress,  and  on  the  10th  of  June  I ceased 
attending.  The  bruit  was  then  inaudible  when  he  stood  up  but 
could  be  heard  if  he  lay  down. 

On  December  14th  I saw  him  again  for  something  else,  and  had 
the  opportunity  of  examining  the  heart.  He  told  me  he  had  no 
shortness  of  breath  on  running  up  stairs,  and  he  could  run  as  well 
as  ever  he  could.  The  apex  beat  was  felt  in  the  fifth  space,  further 
to  the  left  than  normal,  and  the  area  of  cardiac  dulness  was  greater 


CURATIVE  ACTION  OF  HOMCEOPATHIC  REMEDIES.  841 


than  normal.  On  standing,  no  bruit  was  audible;  there  was  a little 
accentuation  of  the  first  sound  at  the  apex,  and  of  the  second  over  the 
pulmonary  artery.  On  making  him  lie  down  I found  that  the  bruit 
reappeared  in  all  the  areas,  loudest  over  the  apex,  and  the  action  of 
the  heart  became  irregular.  I have  not  been  able  satisfactorily  to 
account  to  myself  for  this  condition  in  which  there  is  competence  of 
the  valve  in  the  erect,  and  incompetence  in  the  recumbent  position, 
but  it  is  a condition  I have  often  observed.  In  one  case,  that  of  a 
child  who  had  at  one  time  unmistakable  mitral  incompetence  with 
attacks  of  violent  palpitation  and  flushing  of  eyes  and  face  following 
whooping-cough,  I found,  after  some  years,  that  the  bruit  could 
only  be  heard  when  she  lay  down  ; and  still  later  it  could  not  be 
heard  at  all.  There  was  no  anaemia  in  this  case.  Some  defect  of 
the  posterior  flap  of  the  valve,  or  irregular  action  of  the  columnae 
cardiae  may  possibly  account  for  it. 

Case  V. — On  the  22d  June,  1880,  James  T.,  a chimney-sweep, 
aged  44,  came  to  my  hospital  clinic  on  the  recommendation  of  a 
private  patient  of  mine  who  had  persuaded  him  to  try  Homoeopathy. 
When  he  entered  my  out-patient’s  room  it  was  easy  to  see  he  was 
exceedingly  ill.  Like  most  of  his  class  he  had  led  a hard,  reckless 
life.  He  commenced  chimney-sweeping  as  a tiny  boy  in  the  days 
when  boys  were  sent  up  the  flues  instead  of  the  machine-brushes 
now  used.  Naturally,  he  was  a man  of  powerful  physique;  but 
now  it  had  been  with  the  greatest  difficulty  that  he  had  succeeded 
in  reaching  the  hospital.  He  had  the  blurred,  heavy  look  of  coun- 
tenance— a sort  of  indistinctness  of  features — often  noticed  in  suf- 
ferers from  heart-disease.  He  felt  just  as  ill  as  he  looked,  for  he 
afterwards  told  me  that  he  never  expected  to  reach  home  again  alive. 

Fourteen  days  before,  he  had  taken  cold  from  getting  wet  during 
a trip  to  Oxford  on  the  river.  This  was  followed  by  a cough  with 
raising  of  thick  phlegm,  the  cough  being  so  painful  that  he  had  to 
hold  himself,  and  this  had  continued.  The  chief  thing  he  now  com- 
plained of  was  a pain  at  the  heart  as  if  it  were  swelling  up.  The 
pain  gradually  moved  down,  and  the  night  before  his  visit  to  me 
was  in  the  left  flank ; then  it  moved  up  to  the  heart  again.  Sensa- 
tion as  if  a big  knife  went  through  it,  aggravated  on  taking  a breath. 
The  pain  prevented  him  from  sleeping;  it  was  impossible  for  him  to 
lie  on  the  left  side.  Tongue  white  ; appetite  good,  but  he  could  not 
eat,  because  eating  brought  on  the  pain.  Bowels  confined,  he  had 


842 


WORLD  S HOMOEOPATHIC  CONGRESS. 


a choking  sensation  in  the  epigastrium,  and  a dizziness  in  the  eyes. 
He  was  excitable. 

On  examining  the  heart  I found  there  was  increase  in  size,  a peri- 
cardial rub,  and  bruits  in  aortic  and  mitral  areas ; that  is  to  say, 
there  was  pericarditis  with  effusion  and  endocarditis  as  well. 

The  knife-like  pain  in  the  heart  singled  out  Spigelia  from  all  the 
other  medicines  related  to  his  condition,  so  I gave  it  him  in  the  3d 
centesimal  dilution,  a dose  every  hour. 

He  slept  well  that  night,  as  he  was  able  to  breathe  better.  The 
next  day  I called  at  his  house,  and  I found  a decrease  in  the  pericar- 
dial rubbing  sound,  and  a diminution  in  the  area  of  cardiac  dulness. 

June  24th. — Still  better;  sleeps  well;  has  no  pain  ; appetite  good. 
On  this  day  I made  the  following  note  of  the  state  of  the  heart: 

Slight  rub  heard  over  centre  of  heart. 

Mitral  area : double  bruit,  the  systolic  portion  being  heard  in  the 
axilla. 

Tricuspid  area  (right  border  of  sternum  on  level  of  fourth  rib); 
a double  rough,  grating  sound. 

Aortic  area  : a double  bruit. 

On  the  night  of  the  25th-26th  (as  his  wife  informed  me)  his 
breathing  seemed  to  be  arrested  ; it  began  again  with  a gasp. 

The  Spigelia  3 was  continued  all  this  time,  though  it  was  not  given 
so  frequently  as  at  first.  From  the  25th  it  was  given  every  two  hours. 

A few  weeks  after  this  he  mentioned  a circumstance  which  oc- 
curred during  the  time  he  was  taking  Spigelia — the  loss  of  a pain 
in  the  right  knee  which  had  troubled  him  for  eighteen  months.  If 
he  knelt  on  it  he  was  unable  to  get  up  without  going  down  on  the 
other  knee  as  well,  and  then  stretching  out  the  right  leg.  The  pain 
was  as  if  the  knee  got  out  of  joint.  He  had  been  sometimes  for 
hours  at  night  before  he  could  get  it  into  the  right  position  in  bed. 
He  asked  me  if  my  medicine  could  have  had  anything  to  do  with 
its  disappearance ; for  as  he  had  not  told  me  anything  about  it  before, 
he  did  not  see  how  I could  have  cured  it.  On  referring  to  Allen,  I 
found  this  in  italics:  Tearing  pain,  like  a sprain,  in  the  knee-cap, 
only  when  walking,  so  that  at  times  he  limped,  since  he  could  not  bend 
the  knee  as  usual.  Other  similar  symptoms  refer  to  the  right  knee 
and  both  knees.  That  the  Spigelia  must  have  the  credit  of  this 
bye-cure  I proved  later  on,  for  the  pain  in  the  knee  returned;  but 
a few  doses  of  the  Spigelia  lm  F.  C.  permanently  removed  it. 


CURATIVE  ACTION  OF  HOMOEOPATHIC  REMEDIES.  843 


But  to  go  back.  By  July  1st  he  was  quite  free  from  any  chest 
symptoms : he  could  lie  on  either  side.  But  he  was  weak  in  the 
calves,  had  giddiness,  and  suffered  from  constipation  with  straining. 
Nux  lm  relieved  the  latter  condition. 

On  July  3d  he  was  still  complaining  of  weakness  in  the  legs;  so 
I put  him  on  Baryta,  c.  lm,  after  which  there  was  rapid  improve- 
ment. He  continued  on  this  medicine,  with  a rest,  till  August  10th. 
Occasionally  he  had  palpitation  on  lying  down  at  night;  on  the  5th 
there  was  slight  pain  in  lower  part  of  left  chest;  on  the  12th  numb- 
ness of  left  shoulder  and  arm.  On  August  1st  he  had  an  attack  of 
giddiness  in  the  evening  whilst  walking  in  the  street.  He  resumed 
work  on  the  9th  of  August.  On  October  11th  he  declared  he  felt 
as  well  as  ever  he  did  in  his  life.  Being  an  enthusiastic  member  of 
the  volunteer  force,  he  had  been  testing  his  powers  by  practicing 
ball-firing.  The  following  Easter  he  went  through  the  fatigues 
and  exposure  of  the  Easter  Volunteer  manoeuvres,  indulging  him- 
self even  (without  asking  my  permission,  I need  hardly  say)  in 
bathing  in  the  cold  spring  sea. 

On  the  19th  of  March,  1893,  I called  upon  him  to  make  an  ex- 
amination of  his  present  condition.  For  the  last  eighteen  months 
he  has  been  better,  he  says,  than  for  years  before.  His  pulse  was 
72,  regular,  steady  and  of  good  force.  I append  his  sphygmogram, 
taken  from  the  left  radial,  standing,  with  a pressure  of  3J  ounces. 
It  does  not  differ  from  a normal  tracing  except,  perhaps,  in  the 
strength  and  sharpness  of  the  upstroke  and  sudden  though  quickly- 
arrested  return. 


Fig.  1. 


The  area  of  dulness  is  still  greater  than  normal ; the  apex  beat 
is  felt  in  the  sixth  interspace  and  more  to  the  left  than  normal. 
Coming  to  the  heart  sounds,  I found,  of  course,  no  pericardial  rub. 
Also  the  mitral  bruit  and  the  grating  sound  (probably  pericardial) 
in  the  tricuspid  area  were  no  longer  to  be  heard.  The  double  aortic 


844 


world’s  homoeopathic  congress. 


bruit  still  remains.  In  the  tricuspid  area  the  first  sound  is  clear, 
and  a soft  bruit  replaces  the  second.  This  is  probably  the  aortic 
diastolic  propagated  downwards.  In  the  mitral  area  the  first  sound 
is  somewhat  impure — not  the  clear,  sharp  click  of  a normal  valve — 
but  there  is  no  bruit,  showing  that  the  valve  is  competent. 

In  this  case  I conclude  that  under  the  treatment — that  is,  under 
the  action  of  Spigelia  and  Baryta  carb.  chiefly — the  inflammation  of 
the  heart,  which  affected  both  the  outer  and  inner  lining,  was  sub- 
dued, and  the  affection  of  the  mitral  valve  was  so  far  remedied  that 
it  has  been  restored  to  competence.  The  aortic  valves  remain  still 
as  they  were,  but  the  softness  of  the  systolic  portion  of  the  double 
bruit  shows  that  the  degree  of  obstruction  to  the  blood-flow  is  but 
slight,  and  the  softness  of  the  diastolic  part  that  the  regurgitation  is 
not  considerable.  This  shows  that  there  has  been,  at  any  rate,  an 
arrest  of  the  disease  process,  and  I am  disposed  to  think  that  the 
aortic  trouble  dates  from  before  the  time  when  I saw  him.  I may 
say  that  after  having  been  a very  heavy  drinker,  he  suddenly  gave 
up  alcohol  in  all  forms  seven  years  before  this  illness  began.  What 
made  him  give  it  up  was  that  he  lost  nerve  when  at  his  work  on 
roofs,  and  even  on  stepping  from  a curbstone  into  the  street  felt  as 
if  he  would  fall.  Afterwards  he  suffered  much  from  ‘‘indigestion,” 
and  in  the  night  violent  palpitation  and  sometimes  arrest  of  breath- 
ing, as  noticed  by  his  wife.  Loss  of  nerve  is  a very  common  symp- 
tom in  heart  affections,  and  the  probability  is  that  the  aortic  disease 
was  commencing  at  that  time. 

Before  leaving  the  acute  cases  I would  like  to  refer  to  a case  of 
ulcerative  endocarditis  following  pneumonia,  with  delirium  tremens, 
which  I published  in  the  November  number  of  The  Homoeopathic 
World  for  1884  (vol.  xix.,  p.  497).  The  case  ended  fatally,  but  the 
point  I wish  to  refer  to  was  made  evident  at  the  post-mortem  exami- 
nation. The  heart  weighed  thirteen  ounces.  On  the  under  surface 
of  the  aortic  valves  (which  were  competent)  grew  abundant  granu- 
lations like  cauliflower  excrescences,  exuding  purulent  matter.  These 
granulations  pressed  against  the  aortic  segment  of  the  mitral  valve, 
constricting  the  orifice  artificially.  The  mitral  valve  itself  was 
healthy,  except  that  the  appearance  of  an  old  deposit  was  found  be- 
tween its  laminae.  There  were  no  signs  of  the  heart  being  affected 
during  his  first  rheumatic  attack,  but  that  there  had  been  inflamma- 
tion of  the  valve  which  had  healed  without  causing  deformity,  the 
appearance  of  this  specimen  clearly  showed. 


CURATIVE  ACTION  OF  IJOMCEOPATHIC  REMEDIES. 


845 


I will  now  pass  on  to  speak  of  chronic  cases : 

At  the  Annual  Homoeopathic  Congress,  held  in  London  in  Sep- 
tember, 1884,  I read  a paper,  which  was  afterwards  published  in  a 
small  volume,  entitled  Iodide  of  Arsenic  in  Organic  Disease  of  the 
Heart  Iodide  of  arsenic  is  a drug  that  has  received  no  extensive 
proving,  and  my  prescription  of  it  in  the  series  of  cases  I narrated 
was,  to  a certain  extent,  based  on  general  considerations.  Since  that 
time  I have  had  many  opportunities  of  repeating  the  observations  I 
then  made,  especially  in  cases  where  pulmonary  or  bronchial  affec- 
tions complicate  heart  disease.  In  one  case  of  chronic  tobacco-heart 
it  was  the  remedy  that  gave  most  relief.  It  seems  to  act  when  the 
symptoms  of  either  of  its  elements  are  present,  but  I cannot  give 
any  markedly  characteristic  symptoms  that  indicate  it  in  preference 
to  other  drugs.  The  accompaniment  of  cough  with  expectoration 
sometimes  difficult  to  raise,  and  sense  of  oppression  at  the  chest  com- 
plicating valvular  disease,  are  perhaps  the  leading  indications,  but 
pain  at  the  heart,  breathlessness  on  movement,  faintness,  and  ner- 
vousness, occurring  independently  of  cough,  are  also  relieved  by  the 
Iodide.  In  all  cases  of  overburdened  or  overbalanced  heart  the 
drug  should  be  thought  of. 

But,  as  I mentioned  in  my  paper,  there  are  numbers  of  cases 
which  are  not  perceptibly  influenced  by  the  Iodide.  Homoeopathy 
has  no  specifics  for  diseases,  hence  a strict  attention  to  symptom- 
atology is  our  only  safe  rule  in  this  as  in  all  departments  of  our  art. 

Case  VI. — It  is  notable  how  frequently  cardiac  patients  complain 
more  than  anything  else  of  indigestion.  It  was  the  principal  thing 
the  patient,  James  T.,  complained  of  before  the  attack  which  brought 
him  under  my  care.  It  was  the  chief  trouble  in  two  of  the  cases 
still  to  be  mentioned.  In  the  case  I am  now  going  to  relate,  that  of 
Mrs.  W.,  an  octogenarian,  the  strictest  attention  to  dietetic  rules 
was  absolutely  necessary  to  keep  her  in  comfort. 

This  patient  had  survived  a number  of  illnesses,  including  a right- 
side  pleurisy  many  years  before,  which  had  left  her  with  a shrunken 
lung  and  curved  spine  and  a displacement  of  the  heart  to  the  right. 
The  heart  was  greatly  hypertrophied,  and  there  were  murmurs  to  be 
heard  at  every  orifice,  a double  aortic,  loud  systolic  at  mitral  and 
tricuspid.  The  heart’s  action,  was  very  irregular,  the  arteries  hard 
and  tortuous. 

I attended  her  through  a variety  of  illnesses,  diphtheritic  sore 


846 


world’s  homoeopathic  congress. 


throat,  bronchitis  on  various  occasions,  influenza  with  bronchitis, 
minor  urinary  troubles  and  psoriasis.  The  condition  of  the  heart 
dominated  everything.  There  was  great  swelling  of  the  feet,  which 
varied  in  degree  at  different  times.  But  her  chief  trouble  was  indi- 
gestion and  flatulence;  the  smallest  transgression  was  pretty  sure  to 
be  visited  by  an  “ attack  ” in  the  early  hours  of  the  morning.  The 
“ attack  ” was  a feeling  of  faintness,  a sensation  that  she  was  “ going,” 
violent  pain  at  times  in  the  region  of  the  heart’s  apex,  great  oppres- 
sion, the  symptoms  being  relieved  after  a greater  or  less  time  by  a 
copious  flow  of  colorless  urine.  Every  time  I was  called  to  her  in 
one  of  these  attacks  she  thought  she  was  dying,  and  was  almost 
angry  with  me  because  I refused  to  confirm  her  prognosis  and  pro- 
nounce the  viaticum. 

Aurum  metallicum  in  the  30th  or  lm  gave  prompt  relief  to  this 
feeling  of  impending  death  and  kept  her  reconciled  to  life  for  long 
periods  at  a time.  Kali  carb.  in  the  same  potencies  gave  her  great 
help  when  the  attacks  came  on  between  2 and  5 A.M.,  and  when 
there  was  a cough  with  aggravation  at  those  hours.  After  an  attack, 
when  there  was  much  palpitation  and  breathlessness  with  heart  dis- 
comfort, Baryt.  carb.  5 and  30,  gave  much  relief.  On  occasional 
courses  of  these  medicines  she  was  kept  in  tolerable  health  for  long 
periods.  When  I first  began  to  treat  her  I gave  the  Iodide  of  arsenic 
with  some  benefit;  but  it  was  not  nearly  so  marked  as  that  from  the 
more  definitely  indicated  remedies  in  higher  powers.  Aurum  lm 
(Boericke  & Tafel,  or  F.  C.),  had  the  most  prompt  action  when  the 
sensation  of  impending  death  was  marked. 

I will  place  beside  this  case  another  of  extensively  damaged  heart 
in  an  aged  patient,  in  which  there  were  practically  no  symptoms 
referable  to  the  heart  itself,  and  consequently  no  call  for  special 
treatment. 

Case  VII. — A stalwart  octogenarian,  Andrew  M.,  came  to  my 
out-patient  clinic  at  the  Homoeopathic  hospital  in  the  summer  of 
1882,  complaining  of  rheumatio  pains  in  various  parts  of  him.  Two 
years  before  he  had  been  laid  up  for  five  weeks  with  rheumatic  fever, 
and  for  a short  time  after  that  he  had  been  troubled  with  shortness 
of  breath  on  going  up  stairs,  but  had  got  over  that,  and  had  not 
been  troubled  with  any  heart  symptoms  since.  His  irregular  pulse, 
sharp  and  hard,  and  hard  tortuous  arteries  at  once  told  me  that 
damage  had  been  done.  Here  are  two  of  his  sphygmograras  : 


CURATIVE  ACTION  OF  HOMOEOPATHIC  REMEDIES.  847 


Fig.  2. 


Fig.  3. 


Examination  of  the  heart  showed  the  following  : 

There  was  visible  pulsation  in  the  carotids,  the  apex  beat  was  in 
the  fifth  interspace,  3J  inches  to  the  left  of  the  sternum,  and  the 
transverse  dulness  extended  from  J inch  on  the  right  of  the  sternum 
4 inches  to  the  left.  Vertical  dulness  began  at  the  lower  border  of 
the  third  rib.  No  bruits  were  audible,  but  there  was  at  the  apex  the 
peculiar  thumping  first  sound  which  indicates  mitral  stenosis,  this 
being  followed  by  a sharp  second.  Over  the  aortic  and  pulmonary 
areas  the  first  sound  was  inaudible,  the  second  being  sharply  accent- 
uated, the  accentuation  being  most  marked  in  the  aortic  area.  An 
exaggerated  second  means  increased  backward  pressure  on  the  heart, 
and  in  the  case  of  the  aortic  valve,  it  is  generally  the  prelude  to 
aortic  incompetence  and  regurgitation.  When  the  aorta  has  been 
affected,  either  by  acute  inflammation,  as  in  fevers,  or  by  chronic 
degeneration,  it  loses  a certain  amount  of  elasticity,  and  becomes 
permanently  dilated  under  the  force  of  the  heart’s  beats.  When 
this  has  taken  place  the  rebound  of  the  column  of  blood  after  the 
systole  is  more  sudden,  and  produces  the  accentuation  of  the  second 
sound  in  the  aortic  area,  such  as  was  present  in  this  case.  The  de- 
fect was  compensated  by  hypertrophy. 

The  rheumatic  symptoms  gradually  subsided  under  Bryonia  and 
Colchicum,  and,  finally,  Pulsatilla  3,  which  last  did  more  for  him 
than  any  other  remedy.  It  removed,  after  the  other  medicines  had 
failed,  swelling,  pain,  and  numbness  of  the  hands  across  the  meta- 


848 


world's  homoeopathic  congress. 


carpal  joints,  worse  in  the  morning  on  rising,  leaving  him  practi- 
cally well.  The  only  symptoms  he  had  during  the  course  of  the 
treatment  referable  to  the  heart  were  temporary  giddiness  and  buzz- 
ing in  the  ears.  In  this  case  I did  not  think  it  necessary  to 
alarm  the  patient  by  explaining  to  him  the  condition  of  his 
heart,  as  I believed  it  would  last  him  as  long  as  the  rest  of  his 
body. 

I will  now  give  the  particulars  of  a case  which  first  came  under 
*my  care  as  one  of  11  indigestion/’ 

Case  VIII. — Mr.  J.  W.,  a tradesman,  who  had  done  work 
about  my  house,  such  as  gas-fitting  and  the  like,  consulted  me  occa- 
sionally for  an  “ indigestion  ” he  was  troubled  with  from  time  to 
time.  The  first  time  was  in  February,  1888,  he  being  then  38 
years  old.  The  symptoms  of  his  indigestion  were  weight  at  the  epi- 
gastrium after  food,  tenderness  to  pressure,  and  drowsiness  after 
meals.  These  symptoms  were  quickly  removed  by  Bryonia.  He 
also  suffered  frequently  from  headache,  tightness  at  the  chest,  pain 
between  the  shoulders,  and  at  times  a cough.  His  pulse  was  some- 
what frequent,  but  there  was  nothing  sufficiently  remarkable  about 
it  to  make  me  suspect  anything  wrong  with  his  heart. 

On  April  13,  1889,  I was  summoned  to  see  him  in  the  greatest 
urgency.  After  a good  deal  of  worry  he  had  been  suddenly  seized 
with  violent  palpitation  and  faintness,  and  when  I saw  him  he  was 
in  a death-like  faint,  pallid,  with  purple  lips,  and  icy  cold;  in  fact, 
he  was  in  a very  grave  condition  of  cardiac  syncope;  the  pulse  was 
weak  and  slow.  On  examining  his  chest,  I found  the  heart  enlarged 
and  a mitral  systolic  bruit  present.  I put  on  his  tongue  a dose  of 
Ignatia  lm  (Boericke  & Tafel)  and  repeated  it  frequently,  and  he 
soon  revived  sufficiently  to  enable  me  to  take  him  home  in  a cab 
(for  he  was  at  his  place  of  business  at  the  time  of  the  seizure). 
On  examining  him  more  at  leisure,  I found  the  systolic  bruit 
(which  was  soft)  was  audible  over  the  apex  and  also  over  the  left 
auricle.  The  condition  was  one  of  mitral  incompetence  with  hyper- 
trophy. 

I now  learned  that  for  some  time  past  he  had  noticed  a short- 
ness of  breath  on  going  up  stairs,  and  three  months  before  he  had 
turned  faint  suddenly  and  been  compelled  to  sit  down.  I con- 
tinued the  Ignatia , and  I may  say  that  ever  since  it  has  been  a 
very  good  friend  to  my  patient.  He  never  goes  anywhere  without 


CURATIVE  ACTION  OF  HOMOEOPATHIC  REMEDIES.  849 


a bottle  of  pilules  of  the  medicine  in  the  same  strength,  and  when- 
ever he  has  any  sensation  of  weakness  about  the  heart,  whether  in- 
duced by  worry  or  by  over-exertion,  a few  doses  soon  put  him  right. 
He  has  never  had  a fully  developed  attack  again. 

He  is  fair,  and  of  a very  sensitive  temperament,  and  easily  af- 
fected by  worry,  but  active  and  muscularfy  strong.  To  return  now 
to  my  journal  : 

April  14th. — Had  a slight  attack  in  the  evening  after  talking. 
Dreamed  much  in  the  night;  short  breath  on  going  up  stairs;  head 
feels  rather  light ; feet  rather  colder.  Continue  Ignatia. 

April  16th. — Headache  in  occiput;  fluttering  sensation  in  left  chest ; 
faint  trembling  after  walking;  a little  fever;  much  flatus  down- 
wards; thirst;  lips  dry.  Arsenicum  lrn  every  two  hours.  Ignatia 
if  required. 

April  17th. — Went  for  a walk  yesterday,  but  could  not  go  far. 
Dreamed  much  all  night — muddled  dreams.  Tongue  white;  still 
thirsty.  Bowels  rather  confined.  Occipital  headache  on  waking. 
Tremor  at  heart.  Repeat. 

I need  not  follow  out  the  case  from  day  to  day.  There  was  an- 
other slight  attack  on  the  20th,  but  by  the  end  of  the  month  the 
patient  was  able  to  return  to  his  work.  He  had  occasionally  draw- 
ing or  digging  pain  in  his  left  side  and  at  times  a sharp  pain,  and 
headache  remained  troublesome.  At  one  time  he  described  it  as  a 
‘‘floating  weight”  at  the  vertex.  This  was  relieved  by  Act.  rac.  1. 
On  May  8th  he  complained  of  feeling  a weight  at  epigastrium  after 
food  ; sinking  sensation  comes  after  dinner  and  constipation.  He 
received  Sulph.  30,  one  pilule  three  times  a day.  After  this  he 
was  practically  well,  Sulphur  and  Ignatia  being  the  chief  remedies 
he  required. 

Early  in  the  following  year  he  had  influenza  very  badly,  with 
pneumonia  and  pleurisy  of  the  left  side.  The  heart  was  not  directly 
involved.  The  bruit  was  heard,  though  faintly.  Sulphur  was  his 
chief  remedy  on  this  occasion.  At  present  he  is  in  very  good  health. 
If  he  over-exerts  himself,  especially  when  at  work  on  great  heights, 
as  the  roofs  of  London  houses,  he  is  reminded  that  he  has  a heart. 
I examined  his  chest  quite  recently,  and  found  this  condition  ; 

Apex  beat  not  felt.  Area  of  cardiac  dulness  extends  2J  inches 
to  left  of  sternal  edge.  In  pulmonary  and  aortic  areas  the  first 
sound  is  soft ; at  the  mitral  area  no  bruit  is  heard,  but  the  first 

54 


850 


world’s  homceopathic  Congress. 


sound  is  impure.  This  shows  that  the  mitral  valve  has  been  re- 
stored to  competence,  though  not  to  its  normal  state.  The  sharp, 
clear  sound  of  the  closing  of  healthy  valves  is  wanting. 

This  patient  has  never  had  rheumatic  fever  or  any  illness  to  which 
the  state  of  his  heart  could  be  traced.  He  has  always  been  temper- 
ate. Eleven  years  ago  he  was  very  nearly  killed  by  a brick  falling 
on  his  head  from  a building  in  course  of  erection ; but  this  is  the 
only  illness  of  consequence  that  he  remembers.  I append  his  sphyg- 
mograph  taken  while  sitting,  March  21,  1893. 


Fig.  4. 


These  few  cases,  chosen  out  of  a large  number,  will,  I think,  suf- 
fice to  prove  to  the  Congress  that  valvular  disease  of  the  heart  is 
often  curable  under  Homoeopathic  treatment;  and  when  the  valves 
are  beyond  repair  and  the  balance  of  the  organ  lost,  much  may  still 
be  done  by  strict  Homoeopathy  to  give  power  to  the  heart  and  re- 
store its  equilibrium. 

The  sphygmograms  were  taken  with  Dr.  Dudgeon’s  pocket  sphyg- 
mograph. 


MOIST  HEAT  AS  A THERAPEUTIC  AGENT. 


851 


MOIST  HEAT  AS  A THERAPEUTIC  AGENT. 

By  W.  A.  Edmonds,  M.D.,  St.  Louis,  Mo. 


In  the  pathological  and  symptomatic  make-up  of  sick  humanity, 
fever  and  inflammation  cut  such  an  important  figure  as  to  be  practi- 
cally present  everywhere  in  all  the  forms  of  disorder  that  afflict 
the  race.  These  so  uniformly  go  hand  in  hand  that  we  rarely 
witness  one  without  the  other  in  any  given  case  of  disease.  No 
well-marked  case  of  established  fever  will  long  prevail  without  jsigns 
of  a local  inflammation.  In  exceptional  cases,  where  the  local  in- 
flammatory manifestation  is  very  circumscribed  and  involves  only  a 
limited  amount  of  anatomical  structure,  the  febrile  manifestation 
may  be  so  slight  as  to  form  apparent  exceptions  to  the  rule,  that 
fever  and  inflammation  are  practically  constant  in  symptomatic  and 
pathological  association. 

The  celebrated  French  physician  and  scientist,  Broussais,  spent 
much  time  and  literary  effort  to  establish  his  theory  that  every 
case  of  fever  is  attended  by  its  local  phlegmasia.  With  equal  pro- 
priety might  he  have  spent  time  and  effort  to  establish  the  proposi- 
tion that  every  local  phlegmasia  has  its  associate  febrile  condition. 
Of  the  two  conditions,  interest  is  concentrated  in  the  phlogistic  or 
inflammatory  state,  both  in  a pathological  and  therapeutic  point  of 
view.  In  a pneumonia  we  have  an  eye  to  the  lung  involvement 
as  a mode  of  relief  for  the  pulmonary  fever;  in  rheumatism,  to 
get  rid  of  the  fever  by  a relief  to  the  articular  surfaces ; and  so  on 
in  gastritis,  enteritis,  cerebritis,  carditis,  cystitis,  etc. 

Practically,  the  successful  management  of  inflammation  consti- 
tutes the  summum  bonum  of  professional  effort. 

From  the  times  of  Hippocrates  and  Galen  down  to  the  early 
years  of  the  present  century,  the  best  lights  in  the  profession  taxed 
ingenuity  and  thought  to  arrive  at  a correct  theory  as  to  the  nature 
and  cause  of  inflammation,  partly  as  matter  of  scientific  interest  and 
practically  to  institute  correct  modes  of  treatment.  These  various 


852 


world’s  homoeopathic  congress. 


theories,  with  the  names  of  the  authors  annexed,  have  been  stated, 
re-stated,  discussed,  and  re-discussed  so  often  and  so  amply  that  a 
rehash  here  would  seem  tedious  and  unnecessary.  The  leading  ones 
have  been  the  vitalists,  humoralists,  super-excitationalists,  mechani- 
cal and  chemical.  We  think  it  safe  to  affirm  that  in  every  well- 
marked  inflammation  there  are  qualities  and  conditions  involving 
the  main  element  in  each  of  these  theories.  It  is  a wise  provision 
of  nature,  in  the  direction  of  human  experience  and  activity,  that  as 
we  grow  gracefully  old  we  become  more  simple,  modest,  and  less 
pretentious;  so  that,  as  a profession  and  as  individuals,  we  have 
come  to  esteem  and  define  inflammation  as  an  association  of  appear- 
ances known  as  heat , pain,  swelling , tenderness , and  redness.  Of 
course,  this  association  of  conditions  becomes  in  the  future  of  mat- 
ters fruitful  in  such  superadded  conditions  as  suppuration,  ulcera- 
tion, gangrene,  atrophy,  hypertrophy,  and  the  various  dyscrasias. 

Having  disposed  of  the  various  theories  above  so  summarily  as  of 
little  value  scientifically  or  practically,  we  are  in  some  sort  estopped 
from  much  privilege  or  latitude  in  this  line  ourselves.  But  we 
think  it  entirely  safe  to  affirm,  as  a conclusion  drawn  from  observa- 
tion and  experience,  that  every  case  of  inflammation  consists  essen- 
tially and  primarily  in  a capillary  blood  stasis  of  the  part.  Physi- 
ologists teach  us  that  that  innumerable  mesh-work  known  as  the 
capillaries  stands  as  the  half-way  place  between  the  veins  and  arte- 
ries. Whether  the  motion  in  these  little  radicals  is  a vis  a tergo  from 
the  heart,  or  by  capillary  attraction,  or  by  a sort  of  secessive  ver- 
micular contraction,  is  still  matter  sub  judice.  We  know,  however, 
that  upon  the  successful  transition  of  the  blood  through  these  little 
tubules  depends  the  suitable  performance  of  that  covert,  mysterious 
performance  known  as  assimilation  and  disassimilation — the  repair 
after  waste  and  wear  and  the  removal  of  physiological  debris.  Now, 
any  hurt  or  adverse  agency,  whether  traumatic  or  toxic,  which  in- 
terferes with  the  capillary  motion  is  at  once  announced  by  inflam- 
matory manifestations — heat,  pain,  tenderness,  swelling,  and  red- 
ness. 

I believe  the  theory  or  idea  has  been  generally  conceded  that  the 
excess  of  blood  in  a part  under  inflammation  depends  upon  an  invi- 
tation of  the  circulation  to  take  direction  to  the  particular  locality 
of  the  part  under  affliction.  I confess  I have  never  been  able  to 
see  either  fact  or  sense  in  such  explanation.  Of  course,  there  is  an 


MOIST  HEAT  AS  A THERAPEUTIC  AGENT. 


853 


excess  of  blood  in  the  part.  How  does  it  occur?  I should  say  it 
depends  upon  a failure  of  the  capillaries  to  send  it  along.  They 
have  received  a hurt,  either  traumatic  or  toxic,  and  fail  of  this  part 
of  their  function.  At  first  it  may  be  slight;  stasis  adds  to  the  ob- 
struction ; until,  after  a short  while,  obstruction  and  capillary  failure 
become  so  complete  as  to  arrest  all  motion,  to  be  followed  by  extra- 
vasation, death  of  tissue,  suppuration,  ulceration,  gangrene. 

Common-sense  would  seem  to  say  or  indicate  that  whatever  helps 
the  disabled  capillaries  in  an  effort  to  send  the  blood  along  must  be 
palliative,  curative,  helpful.  Leeches,  blisters,  cupping,  blood-let- 
ting have  heretofore  been  supposed  to  be  the  means  to  this  desirable 
end. 

As  the  result  of  observation  and  experience,  I have  pleasure  in 
stating  that  moist  heat  has  a range  of  power  and  opportunity  for 
such  a purpose  unequalled  by  any  therapeutic  agent  in  the  whole 
resource  of  the  curative  art,  whether  we  consider  it  in  reference  to 
power  of  action  or  wide  range  of  applicability.  It  is  an  easy  matter 
for  the  busy,  enthusiastic  practitioner  to  get  himself  under  the  banners 
of  a fad  or  a hobby — things  which  I formerly  held  in  mjich  odium 
and  dislike.  Lately  I have  fallen  into  much  favor  with  such  modes 
of  thought  and  action.  A good  hobby  or  a good  fad,  if  pushed 
with  reasonable  discretion,  will  certainly  enable  us  to  get  all  the 
good  out  of  either  fad  or  hobby  that  may  inhere  in  the  premises. 
Any  excess  or  mistake  may  be  safely  left  to  the  corrective  help  of 
experience  and  conservative  observation.  In  a presentation  of  the 
claims  of  moist  heat  as  a therapeutic  agent  I can  hardly  expect  to 
present  anything  specially  new.  I simply  desire,  in  a systematic 
way  to  gather  together  the  various  details  and  modes  of  its  uses  and 
activities.  I opine  some  of  my  auditors  will  feel  surprise  at  the 
conclusion  of  my  contention,  at  the  great  range  of  activity  of  this 
simple,  everyday  agent.  Precisely  how  it  quickens  capillary  action 
and  sends  the  blood  along  the  normal  modes  and  channels,  I do  not 
pretend  to  -explain.  That  it  brings  relief  in  curable  eases  and  palli- 
ation in  others  not  curable,  is  beyond  contention  or  controversy. 

In  the  management  of  nervous  disorders,  insomnia,  rheumatism 
and  cutaneous  affections,  the  vapor  bath  is  of  the  very  first  import- 
ance. Submerging  the  entire  body  in  hot  water  is  in  the  same  line 
and  of  very  great  value.  In  the  early  part  of  the  present  century 
an  ignorant,  illiterate  New  Yorker  well  nigh  revolutionized  the  then 


854 


world’s  homoeopathic  congress. 


prevalent  modes  of  treating  disease  by  the  introduction  of  what  soon 
came  to  be  known  as  the  “ Thompsonian  Practice,”  Thompson  being 
the  author  of  the  plan.  He  came  upon  the  stage  of  professional 
action  at  a time  when  poor  sick  humanity  was  in  agony  and  despair 
from  the  heroical  uses  of  the  lancet,  the  scarificator,  the  blister,  plas- 
ter, salivation,  purging  and  vomiting.  Taking  advantage  of  the 
odium  attaching  to  these  modes,  Thompson  and  his  coadjutors  had 
for  a time  a wonderful  run  of  success.  His  treatment  consisted 
almost  exclusively  in  the  use  of  the  vapor  bath  coupled  with  the 
abundant  ingestion  of  hot  plizans ; so  that  the  patient  had  moist 
heat  galore  internally  and  externally.  He  made  abundant  cures, 
but  the  system  gradually  fell  into  disuse  from  certain  crudities  and 
excesses  attending  its  administration. 

The  great  success  of  the  celebrated  hot  springs  in  various  parts  of 
the  world,  of  which  “ Hot  Springs”  Arkansas  is  a reliable  example, 
is  simply  attributable  to  free  bathing  in  hot  water  and  the  free  drink- 
ing of  the  same  on  an  empty  stomach.  Precisely  the  same  results 
might  be  attained  in  the  private  family  home  if  method  and  per- 
sistency could  be  accomplished  in  the  use  of  the  hot  water  internally 
and  externally,  with  exemption  from  worry  and  business  cares.  The 
“ Turkish  Bath,”  now  so  popular  as  a luxury  as  well  as  in  the  cure 
of  disease,  has  its  chief  resource  in  the  moisture  and  heat,  together 
with  certain  manipulations  incident  to  the  administration. 

The  hot  “sitz-bath,”  so  useful  in  various  pelvic  disorders,  has  a 
marked  influence  upon  the  condition  of  the  patient  generally,  while 
acting  well  upon  parts  locally.  Much  the  same  may  be  said  of  a 
hot  “ foot  hath.”  I doubt  if  the  same  amount  of  hot  water  could 
be  applied  to  the  same  amount  of  external  bodily  space  elsewhere 
with  the  same  good  result.  In  violent  acute  brain  disorders  a pro- 
tracted hot  head  douche  will  sometimes  act  like  magic.  In  the  thirst, 
nausea  and  vomiting  attending  many  cases  of  strong  fever,  nothing  so 
quickly  allays  the  symptoms  as  constant  sips  of  hot  water  repeated  for 
ten  or  fifteen  minutes.  Hot  irrigations  of  the  intestines,  with  hot 
abdominal  fomentations,  bring  great  relief  in  acute  dysentery.  In 
cerebral  and  cerebro-spinal  meningitis  hot- water  bags  to  the  head  ard 
spine  will  be  found  far  better  practice  than  the  habit  of  freezing  the 
patient  to  death  with  ice-packs  and  ice-bags.  Chronic  dyspeptics 
who  suffer  from  eructations,  furred  tongue,  bad  breath,  bad  taste  in 
the  mouth,  constipation  of  the  bowels,  scanty  urine,  may  be  greatly 


MOIST  IIEAT  AS  A THERAPEUTIC  AGEKT. 


855 


benefited  by  drinking  a large  goblet  or  two  of  hot  water  on  an 
empty  stomach  at  early  rising  and  at  bedtime.  The  water  may  be 
acidulated  with  fresh  lemon  juice.  In  very  obstinate  cases  of  this 
kind  much  may  be  gained  by  systematic  hot  fomentations  over  the 
epigastrium  for  two  hours  at,  say,  from  7 to  9 p.m.,  the  applications 
being  renewed  every  twenty  minutes.  A good  hearty  sip  of  hot 
water  should  be  taken  with  each  renewal  of  the  compress.  This 
p’an  of  hot-water  drinking  on  an  empty  stomach  with  the  evening 
fomentations  should  be  continued  every  evening  from  two  to  four 
weeks,  according  to  the  needs  and  obstinacy  of  the  case.  I remem- 
ber very  distinctly  getting  this  plan  and  idea  some  thirty  years  or 
more  ago  from  a book  on  Water  Cure , by  an  English  author,  Dr. 
Gully,  who  enjoyed  much  celebrity  and  practice  at  the  time.  It  is 
very  remarkable  how  much  hot  water  may  be  taken  on  an  empty 
stomach,  with  little  or  no  inconvenience  to  the  individual. 

In  cool  or  cold  weather  it  pours  away  through  the  kidneys  and 
bladder;  in  hot  weather  it  finds  additional  outlet  through  the  skin 
in  the  form  of  perspiration,  bringing  a peculiar  sense  of  cleanness 
and  bodily  renovation,  with  improved  secretions  and  excretions 
everywhere.  I have  come  to  attach  importance  to  the  lemon  acid 
addition  to  the  water,  as  rendering  the  water  more  palatable,  and, 
besides,  exerting  a good  influence  on  the  stomach  and  other  organs 
which  it  may  reach.  I usually  prescribe  the  juice  from  half  a fresh 
lemon  to  a pint  of  water.  Should  so  much  juice  put  the  “ teeth  on 
edge,”  the  quantity  must  be  reduced  or  taken  less  frequently. 

The  whole  range  of  poultices  and  poulticing,  whether  in  domestic 
or  professional  practice,  would  seem  to  depend  for  efficacy  upon  the 
heat  and  moisture  contained.  Every  old  mother  or  nurse  knows 
full  well  that  the  poultice  ceases  to  do  good  when  it  gets  cold.  In 
mastitis,  peritonitis,  pneumonitis,  pleuritis,  and  the  whole  family  of 
furuncles,  the  good  to  be  derived  from  the  time-honored  “ mush 
poultice”  is  attributable  to  the  heat  and  moisture  in  the  application. 
A flannel  out  of  hot  water  might  do  just  as  well,  except  that  it  loses 
its  heat  and  moisture  too  soon,  necessitating  the  trouble  of  too  fre- 
quent reapplication.  I remember  very  distinctly  a case  of  infantile 
pneumonia  which  I had  visited  and  prescribed  for  daily  for  a period 
of  ten  days  or  more  without  success.  When  I came  to  make  my 
morning  call  I was  agreeably  surprised  to  find  the  child  bright  and 
almost  well,  from  being  quite  ill  at  my  last  visit.  The  mother  told 


856 


WORLD  S HOMOEOPATHIC  CONGRESS. 


me  in  a sort  of  beg-pardon,  apologetic  manner,  that  she  had  applied 
a poultice  to  the  patient’s  chest  the  night  before.  By  the  way,  the 
best  material  of  all  others,  for  a poultice,  is  flax-seed  meal . It  re- 
tains heat  and  moisture  well,  and  has  oil  enough  to  prevent  adhesion 
to  the  skin  surface. 

We  come  now  to  speak  of  a most  valuable  use  of  moist  heat  in 
the  management  of  the  various  uterine  disorders.  The  use  of  this 
agent  in  the  domain  of  gynaecology  does  not  seem  to  have  received 
any  special,  systematic  attention  until  within  the  last  ten  or  fifteen 
years.  Now,  it  is  the  fad  of  the  hour,  and,  like  many  other  good 
things  in  the  hands  of  indiscreet  zealots,  has  received  some  misuse 
in  the  house  of  its  friends.  Many  a poor  woman  is  to-day  being 
soused,  drenched  and  irrigated,  beyond  all  reason  and  propriety,  at 
the  hands  of  those  without  wisdom  or  discretion.  The  abuse  to 
which  a misdirected  zeal  has  brought  it,  is  only  an  argument  or  fact 
that  there  is  much  in  it  for  good  as  well  as  misuse.  To-day,  if  I 
should  be  offered  the  alternative  to  give  up  every  other  known  form 
of  local  application,  or  accept  hot  water,  as  my  only  resource  in  such 
cases,  I should  unhesitatingly  adopt  the  hot-water  treatment  as 
against  everything  else  in  the  local  line.  Not  that  I underrate  other 
agencies  and  modes,  but  this  much  by  way  of  indicating  the  impor- 
tance I attach  to  the  agent  I am  now  commending.  I have  now 
arrived  at  the  point  in  my  daily  professional  experience  where  I may 
say  that  I begin  the  treatment  of  every  case  of  sexual  disorder  in 
the  female  with  hot  water  irrigations.  These  are  prescribed  for 
morning  and  evening  observance,  from  one-half  gallon  to  one  gallon 
being  used  at  each  application,  from  a fountain  syringe.  In  very 
obstinate  cases  I add  the  use  of  the  hot  sitz-bath  for  teu  minutes 
every  twenty-four  hours.  If  there  be  constipation  of  the  bowels  the 
colon  should  be  filled  with  hot  water,  once  in  the  twenty-four  hours, 
to  be  retained  as  long  as  possible,  jointly  for  help  to  both  constipa- 
tion as  wrell  as  the  uterine  disorder.  The  colon  full  of  hot  water  for 
the  time  acts  muoh  as  a poultice  might  in  behalf  of  the  sick  uterus 
and  its  appendages.  In  the  adoption  of  this  mode  I do  not  stop  at 
nice  distinctions  as  to  whether  the  case  be  one  of  cervicitis,  endo- 
metritis, perimetritis,  ovaritis,  uterine  displacement,  or  sub-involu- 
tion. In  most  cases  of  long  standing,  several,  or  all  of  these  condi- 
tions, exist.  Each  and  all  are  benefited  by  the  treatment.  Usually 
this  mode  of  treatment  embraces  and  exhausts  its  opportunities  in 


MOIST  HEAT  AS  A THERAPEUTIC  AGENT. 


857 


from  two  to  four  weeks.  Protraction  beyond  this  probable  limit  will 
not  only  be  useless  but  may  prove  a source  of  defeat  or  even  draw- 
back. Any  powerful  agent  in  the  treatment  of  disease  has  its  limit 
as  to  usefulness,  beyond  which  an  adverse  result  may  be  expected. 
I beg  you  to  indulge  a slight  digression  while  I say  in  most  cases  I 
conjoin  the  glycerole  cotton  tampon  with  the  hot  water,  and  with 
great  seeming  advantage.  Indeed,  I sometimes  find  myself  almost 
at  the  conclusion  that  these  two  agencies  are  well  nigh  equal  to  the 
relief  of  any  and  every  form  of  sexual  disorder  peculiar  to  the  female. 
In  this  sweeping  declaration,  of  course  I provide  exception  for  the 
demands  of  surgery  in  case  of  lacerations,  abnormal  growths  and 
malignant  troubles. 

As  a haemostatic,  hot  water  has  come  to  be  a valuable  resource  in 
violent  haemorrhages,  especially  when  from  one  of  the  bodily  cavi- 
ties, as  the  stomach,  the  bladder,  the  uterus,  or  the  intestines.  In 
such  cases  it  should  be  used  just  as  hot  as  will  not  endanger  tissue 
integrity,  and  in  bold,  large  quantities,  thrown  in  forcefully  with  a 
syringe  in  a continuous  stream,  until  some  effect  shall  seem  to  have 
been  reached.  It  is  noteworthy  that  in  cases  where  the  hot  water 
may  seem  a failure,  the  other  extreme  of  cold  water  will  almost 
surely  succeed.  The  alternation  of  hot  and  cold  water  in  bad  uterine 
haemorrhages  is  sometimes  of  the  very  first  moment. 

As  a disinfectant  and  general  renovator  about  the  sick  room,  it 
would  be  hard  to  overestimate  the  value  of  steam  and  hot  water. 
They  have  absolutely  all  the  elements  of  success — cheapness,  effi- 
ciency, promptness,  harmlessness.  We  are  decidedly  of  the  opinion 
that  entirely  too  much  attention  has  been  given  to  loudly  vaunted 
proprietary  compounds,  as  disinfectants,  to  the  neglect  of  the  two 
valuable  agents  we  commend.  We  believe  all  parties  are  now  quite 
agreed  that  no  germ,  real  or  supposed,  and  no  toxic  effluvium  ema- 
nating from  the  sick  body,  can  maintain  identity  and  integrity  under 
the  action  of  water  at  212°  or  steam  at  a higher  degree.  All  toxic 
or  germ  activity  is  not  only  killed,  but  killed,  neutralized,  and 
washed  away.  There  is  no  way  so  effective  for  renovating  a sick 
chamber  and  all  its  belongings  or  contents  as  by  the  free  use  of 
steam  and  boiling  water.  An  advantage  under  the  steam  and  water 
regime  is,  that  tapestries,  clothing,  etc.,  are  not  the  worse,  but  rather 
the  better,  generally  for  future  use  if  desired. 


858 


world’s  homceopathic  congress. 


THE  STUDY  OF  HOMOEOPATHY  AS  A DISTINCT 
AND  COMMANDING  DEPARTMENT 
OF  MEDICINE. 

By  John  C.  Morgan,  M.D.,  Philadelphia,  Penna. 


My  friend,  Professor  Helmuth,  presents  to  this  Congress  a plea, 
just  and  able,  of  course,  as  well  as  eloquent,  in  behalf  of  surgery  as 
an  indispensable  force  in  the  Homceopathic  school.  The  title  of  my 
paper,  however,  'whilst  in  no  way  impugning  his  position,  assumes 
the  converse  view,  as  equally  just  and  even  more  essential. 

The  special  field  of  Homoeopathy,  viz.,  Chronic  Diseases,  owing 
to  insufficient  obedience  to  the  tenets  of  the  Founder,  having  been 
largely  relegated  to  surgery,  we  are  being  hurried  along  to  practical 
oneness  with  the  palliative  school ; and  our  testimony  to  curative 
medicine  grows,  I fear,  more  and  more  feeble. 

“ Distinct  and  commanding!”  Less  than  this,  I cannot  for  one 
moment  admit,  as  the  true  status  of  our  God-given  system  ; and 
must  demand  for  it,  and  for  its  study,  universal  recognition  as  such. 

The  Civil  War  played  an  important  part  in  American  medicine; 
firstly,  by  abstracting  from  ordinary  practice  and  teaching  the  bulk 
of  the  surgical  talent  of  the  country  ; secondly,  by  the  intensifica- 
tion of  surgical  enthusiasm  and  skill,  in  connection  with  a large 
military  experience;  and  thirdly,  by  the  initiation  of  a character- 
istic surgical  epoch,  with  imperious  fashions  and  some  fads  of  its 
own,  on  the  return  of  peace.  (This  epoch,  further  stimulated  by 
the  Franco-Prussian  war,  now  involves  the  whole  civilized  world.) 

The  effect  of  all  this  upon  Homoeopathy  has  been  almost  revolu- 
tionary. Our  surgeons,  in  the  army  and  navy,  were  numerous, 
despite  hostile  regulations.  These,  upon  returning  to  civil  life,  ob- 
served with  indignation  the  decadence  of  anatomy  and  surgery,  and 
of  the  scientific  branches  in  our  colleges,  and  bent  their  energies  to 
their  rehabilitation.  Disruption  of  the  faculties,  reorganization  and 
reform  were  the  immediate  and  general  results;  and  from  that  time 


THE  STUDY  OF  HOMOEOPATHY. 


859 


our  school  has  herein  maintained,  at  the  very  least,  a parity  w:th 
the  senior  branch  of  the  profession,  this,  also,  having  passed  through 
a similar  travail. 

This  happy  conclusion,  so  creditable  on  our  part,  and  so  impor- 
tant, has  not,  however,  proved  an  unmixed  good  to  us.  Nay,  so  far 
has  the  pendulum  swung  in  the  new  direction  that  those  of  us  who 
helped  to  set  it  in  motion,  with  unaffected  loyalty  to  Homoeopathy 
and  to  its  founder,  may  fairly  take  counsel  with  conscience,  and  ask 
ourselves  if  this  revolution  be  not  tinctured  with  elements  of  retri- 
bution. Of  old,  surgery  did  obeisance  to  the  genius  of  Homoeopathy, 
in  our  colleges  and  societies;  now,  it  would  almost  seem,  it  is  largely 
busy  in  trying  to  snuff  her  out! 

The  loyalty  of  her  true  adherents  of  the  American  Institute  is 
assertive,  but  to  many  this  whole  subject  is  but  matter  for  the 
merest  toleration,  as  one  tolerates  a demented  patriarch,  who  must 
soon  pass  away  and  cease  from  troubling  the  now  active  generation. 

The  loyal  spirit  has,  I believe,  succeeded  in  putting  the  profession 
on  record  as  demanding  that  the  u Institutes  of  Homoeopathy,”  in- 
cluding the  Organon  of  Hahnemann,  shall  be  taught  in  all  our  col- 
leges. Yet  how  is  this  demand  complied  with  ? How  ? By  thor- 
ough drill,  beginning  with  the  Freshman  year,  maintained  in  the 
Junior,  and  enforced  and  perfected  in  all  the  practical  departments 
throughout  the  senior  year,  and  in  the  post-graduate  curriculum,  to 
which  all  Allopathic  converts  must  needs  look?  Nay — not  a bit  of 
it ! Homoeopathic  Institutes,  being  confused  with  the  methods  of 
the  Old  School — as  if  these  were  equally  important  (sometimes,  in- 
deed, and  therefore  called  “ Methodology  ”) ; these  sacred  truths  of 
which  we  are  the  stewards,  are  cast,  as  an  inert  fragment  of  obsolete 
history,  into  the  arena  of  the  students’  novitiate,  alone  ; and  the 
post-graduate,  as  well  as  the  senior,  is,  above  all,  not  permitted  to 
waste  his  precious  time  with  them,  or  their  teachers,  at  all,  or  to 
abate  his  attendance  upon  surgical  and  special  sub-clinics,  a single 
hour,  for  their  sake. 

The  common  complaint  of  both,  in  the  East  and  in  the  West,  is, 
that  on  leaving  the  Homoeopathic  college,  they  feel  themselves 
“ utterly  incapable  of  the  systematic  and  thorough  study  of  a 
Homoeopathic  remedy.”  This,  I personally  know. 

A faithful  teacher  of  Homoeopathic  Institutes  may  have  suc- 
ceeded in  germinating  the  genuine  seed  in  the  minds  of  the  fresh- 


860 


world’s  homoeopathic  congress. 


men,  all  unprepared  and  unfit  as  he  has  found  them  (since  the 
highest  type  of  medical  intellect  is  needed  for  its  just  appreciation 
and  culture).  But  in  the  succeeding  years  this  seed  is  too  often 
found  to  have  been  sown  by  the  wayside,  where  the  fowls  of  the 
air  find  and  devour  it,  in  its  germinal  immaturity;  or,  among  the 
thorns  of  the  semi-allopathy  which  spring  up  and  choke  it,  as  if 
through  deliberate  purpose.  Indeed,  if  the  second  and  third  and 
post-graduate  years  had  been  planned  for  this  obliteration  of  Hah- 
nemannism,  the  result  could  scarcely  be  more  complete.  Our  grand 
old  man,  Dr.  C.  Hering,  if  yet  alive,  would  not  hesitate,  methinks, 
to  apply  the  moral  of  the  parable,  and  say,  u This  is  the  work  of 
the  devil !” 

Indictment  of  the  present,  however  just,  can,  however,  do  no 
good,  unless  the  way  out  of  its  errors  can  be  shown.  A long  inti- 
macy with  Hering  and  others  of  our  “ old  guard,”  seems  to  empha- 
size my  duty  here.  Permit  me,  therefore,  to  attempt  this  task.  My 
first  remedy  has  already  been  hinted  at,  viz.,  the  study  of  Homoeo- 
pathic Institutes  continuously , throughout  the  three  or  four  under- 
graduate, and  also  the  post-graduate  years!  All  the  chairs  in  our 
colleges  should  be  committed  to  faithful  support  of  this  programme, 
whilst  neglecting  nothing  belonging  specifically  to  themselves.  With 
the  adoption  of  the  four  years’  curriculum,  no  plea  of  “ lack  of  time  ” 
can  be  admitted,  in  the  future,  at  least.  Unfaithfulness  to  Homoeo- 
pathy alone  can  account  for  its  neglect  hereafter. 

Secondly,  the  science  and  art  of  Homoeopathy  must  receive  a 
logical  classification  in  order  for  purposes  of  'parallel  and  progressive 
study  and  teaching,  in  regular  form.  The  intrinsic  difficulties  of 
this  work  heretofore  have,  indeed,  been  the  sufficient  excuse  for 
much  of  the  neglect  here  indicated,  the  reasons  for  which  are  evident, 
and  need  no  discussion  here.  I offer  the  following  suggestions  in 
the  hope  of  giving  help,  such  as  the  hard  experience  and  study  of 
the  past  thirty-eight  years,  my  Homooepathic  period,  based  upon  an 
original  Allopathic  education  and  practice  of  some  years,  have 
brought  to  myself. 

Such  a “ classification  in  order”  may  be  thus  stated  : 

Part  I. — Hahnemann’s  Organon , divided  into  chapters,  accord- 
ing to  general  subjects.  This  reduces  the  mass  of  profound  discus- 
sion to  a simple  and  orderly  arrangement,  easy  to  study,  and  agree- 
able to  read ; Wesselhoeft’s  edition,  modified,  being  the  preferred 


THE  STUDY  OF  HOMOEOPATHY. 


861 


text.  This  should  be  studied  in  every  year,  in  a continuity  of 
evolution,  by  the  parallel  use  of  the  following  parts  ; that  is,  the 
several  parts  should  be  so  taught,  as  to  enforce,  from  their  several 
standpoints,  the  principles  laid  down  in  the  Organon  itself;  and  in 
like  manner,  the  other  branches  of  medicine  should  be  taught  in 
the  same  spirit,  and  with  the  same  tenacious  purpose,  from  year  to 
year. 

Part  II. — JEtiology. 

Part  III. — Symptomatology ; Physiological;  Pathological;  Diag- 
nostic; Pathognomonic;  Pharmacodynamic;  Prognostic;  Thera- 
peutic. Also,  Dietetic;  Curative;  Toxical;  Pathogenetic;  Sur- 
gical. 

Part  IY. — General  Pharmacodynamics  ; i.e .,  the  philosophy  of 
drug-action,  with  reference  to  primary,  secondary,  and  the  more 
remote  evolution  of  drug-effects;  and  in  assimilation  with  the 
known  development  of  “ natural  diseases,”  in  the  order  of  febrile 
action , and  typified  in  every  paroxysm  of  an  intermittent  fever. 
Provings,  rearranged  thus,  become  a “speaking  picture  !” 

Part  V. — Special  Pharmacodynamics;  the  study  of  the  indi- 
vidual provings,  that  is,  of  the  Materia  Medica  proper,  in  accordance 
with  Part  IV.  and  with  the  aid  of  such  classifications  and  general-' 
izations  as  have  proved  helpful  in  the  work  of  selection  and  indi- 
vidualization. 

Part  VI. — Clinical  Therapeutics ; the  verification  of  provings 
at  the  bedside;  thus,  the  discovery  of  “ characteristics  ” of  the  drugs, 
aided  by  the  observation  of  repeated  cures  of  symptoms  not  yet 
recorded  in  any  proving.  Besides,  the  illumination  of  pathology 
itself,  and  of  its  relation  to  various  drugs,  and  hence  the  interpreta- 
tion of  symptoms — both  of  natural  and  of  drug  diseases.  This  part, 
in  other  words,  has  to  do  with  the  Homoeopathy  of  experience. 

Let  these  six  parts  be  now  successively  presented  in  detail. 

The  Organon. 

Part  I. — Chapter  I. — The  “ Introduction.”  Pages  17  to  46, 
called  by  Hahnemann,  “ A Review  of  Physic,”  with  old-time  his- 
torical intimations  of  Homoeopathy,  Criticisms,  with  Notes. 
Pages  47  to  63. 

Chapter  II. — The  Functions  of  the  Physician.  Pages  65  and  66, 

§ 1 to  6. 


862 


world’s  homoeopathic  congress. 


Chapter  111.—  The  Autocratic  Vital  Force,  the  real  seat  of  life 
and  of  disease,  and  the  only  proper  Object  of  Treatment  ; its  Suffer- 
ings, i.e so-called  “ Symptoms,”  Cure.  Pages  67  to  70,  § 7 to  18. 

Chapter  IV. — How  Drugs  Cure.  Pages  70  to  76,  § 19  to  34. 

Chapter  V. — Disease  versus  Disease ; Unlikes  and  Likes.  Pages 
77  to  91,  § 35  to  52. 

Chapter  VI. — The  Methods  of  Medication , viz..:  Allopathic , Anti- 
pathic or  Enantiopathic,  Homoeopathic.  (Etymology.)  Exposition. 
Pages  SI  to  104,  § 53  to  71. 

Chapter  VII. — The  Study  of  Diseases,  Acute  and  Chronic , and 
their  Management.  Pages  105  to  111,  § 72  to  82. 

Chapter  VIII. — Examination  of  a Patient  with  Acute,  Chronic , or 
Epidemic  Disease.  The  “ Genius  Epidemicus.”  The  “ Genius 
Chronieus.”  Pages  111  to  119,  § 83  to  101. 

Chapter  IX. — Agents  of  Cure;  the  Study  of  Drug - Effects ; “ Pri- 
mary” and  “ Secondary  ” Effects ; Provings  and  Cures ; Idiosyn- 
crasies ; Individualization ; Conduct  of  Provings ; a True  Materia 
Medica..  Pages  119  to  135,  § 105  to  145. 

Chapter  X. — Practical  Directions  and  Suggestions  ; Selection  of  the 
Homoeopathic  Remedy ; Similitude  of  Symptoms  in  “ Totality in 
“ Characteristics  ;”  Drug- Action  during  Treatment;  Dosage;  Drug- 
Aggravation  ; Question  of  External  Treatment ; Management  of  Drug- 
Remedies  ; “ Local  Diseases ;”  Antecedents;  The  Three  Miasms  of 
True  “ Chronic  Diseases;”  Previous  Allopathic  Treatment;  other 
circumstances.  Pages  135  to  157,  § 146  to  209. 

Chapter  XI. — Special  Mental  Symptoms  ; Insanity  ; Paroxysmal 
Diseases  (Intermitting,  Recurrent,  Alternating);  Intermittent  Fever, 
etc.,  Cure.  Pages  157  to  170,  § 210  to  244. 

Chapter  XII. — Additional  Practical  Directions ; Management  of 
Cases  and  Remedies ; Dosage ; Repetition ; “ Favorite  Remedies.” 
Pages  170  to  177,  § 245  to  263. 

* Chapter  XIII. — Pharmacy  ; Selection  and  Preparation  of  Medi- 
cines. Pages  177  to  179,  § 264  to  271. 

Chapter  XIV. — The  Single  Remedy;  The  Minimum  Dose  ; Pro- 
portional Effect  of  Various  Doses  ; Dynamic  Nature  of  Drug-Effects  ; 
Forms  of  Administration ; Susceptibility  of  Living  and  Diseased 
Parts  to  Drug  - Action ; Transmission  of  Effects , by  Sympathy,  to 
Other  Parts ; The  Use  of  the  Skin  as  a Channel  of  Medication , etc. 
Pages  179  to  186,  § 272  to  292. 


THE  STUDY  OF  HOMOEOPATHY. 


863 


Chapter  XV. — ( Restored  to  place);  Mesmerism  or  “Hypnotism,” 
(“  Suggestive  Therapeutics  ”) ; with  Notes.  Pages  227  to  230. 

Chapter  XVI. — Notes  upon  the  General  Text . Pages  187  to  225. 

Index.  Pages  231  to  244. 

Etiology. 

Part  II. — After  the  special  part  just  discussed  the  next  is  JEtiology. 
No  one  doubts  the  importance  of  this,  and  it  might  seem  sufficient 
here  to  name  it  as  essential  in  a complete  course  on  Clinical  Medicine 
in  any  college  of  any  school. 

In  Homoeopathy,  however,  it  acquires  extraordinary  importance, 
inasmuch  as  a successful  prescription  so  often  pivots  upon  the  clear 
perception  of  causes,  often  remote  in  time  and  recondite  in  nature. 
Ever  alert,  ever  suspicious  of  this,  we  should  be ! 

I recall  a most  important  case  of  metrorrhagia.  Large  sums  of 
money,  spent  in  both  medical  and  surgical  endeavors,  and  years  of 
time,  had  brought  the  patient  to  feel  that  the  pursuit  was  well  nigh 
in  vain,  when  a Homoeopathic  physician  in  Heidelberg,  Germany, 
inquiring  into  the  antecedents  of  the  attack  in  the  beginning,  elicited 
the  fact  that  it  began  after  bathing  in  icv  cold  water,  six  years  be- 
fore, on  the  coast  of  Maine.  Cure  was  then  promptly  initiated  by 
giving  Rhus  tox.,  lx,  twice  a day,  on  this  exact  indication. 

Previous  abuse  of  drugs  is  a common  aetiology.  Cathartics,  mer- 
curials, and  quinine  are  every-day  drugs,  and  the  recognition  of  their 
part  in  complicating,  and  even  in  originating,  disease  symptoms,  is 
our  daily  duty.  Besides,  the  latent  remains  of  the  original  maladies, 
suppressed  by  these  drugs,  are  of  immeasurable  force  and  constantly 
require  treatment.  Dr.  Raue  insists  upon  an  initial  dose  of  Nux 
vomica,  after  prior  Allopathic  treatment,  in  every  case. 

A strain  years  ago,  or  a wound  of  nervous  tissue,  or  an  old  bruise 
may,  when  recalled,  be  of  prime  significance,  demanding  a corre- 
sponding remedy,  as  Rhus  tox,  Hypericum,  or  Arnica. 

Constitutional  hindrances  often  require  the  interpolation  of  Sulph., 
Calc.,  etc. 

To  ignore  causes  is,  in  our  school  of  practice,  to  tie  our  hands 
behind  us  and  to  insure  many  failures. 

In  this  connection,  “ Baffling  Causes”  deserve  special  notice,  for, 
by  these  our  best  work  may  be,  and  sometimes  is,  spoiled.  Thus, 
bad  nursing,  disobedience  to  orders,  and  many  things  of  detail  may 


864 


world’s  homceopathic  congress. 


ruin  an  otherwise  good  cure.  As  a glaring  example,  a young  man, 
the  subject  of  gonorrhoea  and  under  Homoeopathic  treatment,  but, 
preparing  for  a pharmacy  examination,  was  required  to  taste  some 
thirty  different  drugs  within  a few  days;  got  worse,  naturally,  but 
did  not  think  to  mention  it  until  many  days  afterwards.  Many  such 
cases  occur. 

Symptomatology. 

Part  III. — Physiological,  pathological,  diagnostic,  pathogno- 
monic, pharmacodynamic,  prognostic,  therapeutic.  Also,  dietetic, 
curative,  toxical,  pathogenetic,  and  surgical. 

This  is  the  most  essential  of  all  studies  in  the  practice  of  medi- 
cine, and  as  above  outlined,  most  comprehensive.  It  belongs  exclu- 
sively to  no  one  school,  and  deserves  universal  prominence  in  the 
college  curricula  and  in  medical  writing.  The  writers  recognize 
this,  but  no  college  does  it  even  scant  justice.  In  Homoeopathy, 
above  all,  it  is  the  sine  qua  non,  and  at  least  as  much  time  should  be 
given  to  it  as  is  assigned,  for  instance,  to  the  study  of  Obstetrics. 

The  above  order  is  planned  for  a graded  course.  The  pathological, 
the  pharmacodynamic,  and  the  prognostic  divisions  require  subdivi- 
sion, thus  : The  first  two  into  “ general  ” and  “ special ;”  the  last, 
the  prognostic,  into  prognosis : of  natural  diseases,  of  the  action  of 
remedies,  and  of  the  interaction  of  both. 

Considering  these  divisions  seriatim,  we  note : 

1.  Physiological  Symptomatology — This  is  simply  a narrative  of 
abundant  life,  with  its  conditions,  causes,  susceptibilities,  and  powers. 
Its  “ totality  ” is  the  rule  of  comparison  for  all  the  rest,  and  should 
be  ever  before  the  mind  of  the  thorough  physician,  as  mens  sana  in 
corpore  sano.  Deviations  from  this  standard  are  Diseases.  A few 
lectures  under  this  head,  following  the  “schema”  of  Hahnemann, 
viz.:  the  anatomical  and  physiological  order,  would  be  fruitful  of 
intelligent  interest  in  the  subsequent  study  of  abnormal  \ symptoma- 
tology, whether  natural  or  of  drugs,  artificially  applied.  It  is  in 
the  physiological  field  that  symptom-interpretation  should  begin,  and 
it  should  thenceforth  never  be  neglected. 

2.  Pathological  Symptomatology  is  as  yet  taught  only  incidentally 
in  the  lectures  on  “Practice  of  Medicine,”  and  in  connection  with 
the  special  diseases  discussed.  Even  if  there  be  a separate  chair  of 
pathology  this  is  now  held  to  mean  tissue-change,  plus  bacteriology, 
almost  solely;  hence,  symptomatology  comes  to  be  regarded  by  the 


THE  STUDY  OF  HOMCEOPATHY. 


865 


student  as  inferior,  and.  later  on  he  will  be  heard  denouncing  the  fine 
art  of  “ symptom-hunting  ” — for  “ fine  art”  it  is. 

One  pathological  specialty  is  characteristic  of  Homoeopathy,  viz., 
“ chronic  miasms,,”  according  to  Hahnemann.-  Chronic  diseases, 
when  transmitted  to  offspring  undergo  “ potentization  ” in  succes- 
sive generations;  resulting  in  latent,  but  all-powerful  poisoning; 
whereby  family  life  is  more  and  more  vitiated.  Family  similarity 
is  often  available  in  choosing  remedies  for  one  after  another  of  its 
members.  For  the  symptoms,  see  Hahnemann’s  Chronic  Diseases , 
vol.  i.,  also  the  Organon. 

As  the  medical  mind  is  now  constituted,  even  among  the  Hahne- 
mannians,  there  are  many  important  symptoms  in  any  “totality” 
which  are  overlooked  in  the  selection  of  the  remedy,  or  at  least 
belittled,  until  their  significance  is  demonstrated  by  physical  ex- 
ploration. Thus,  a physician  prescribing  for  a neuralgic  rheuma- 
tism of  the  left  thigh  found  no  suggestion  in  a co-existing  trivial 
complication,  viz.,  a semi-occasional  slight  hack  or  cough,  until ^ 
being  requested  to  “sound  the  lungs,”  he  discovered  (only)  a blow- 
ing sound  in  the  mitral  region  of  the  heart,  due  to  an  unsuspected 
and  incipient  endocarditis.  Thereupon  the  whole  malady  acquired 
a new  character  and  the  curative  remedy  was  speedily  found,  by  the 
totality  of  symptoms,  before  unseen , viz.,  Aconite . 

In  a similar  but  older  case  the  cough  remained  uncured  and  very 
troublesome  until  the  totality  was  added  to  by  a cholera  morbus, 
requiring  Arsenicum.  After  this  drug  the  cough  also  got  well,  but 
the  pathological  suggestion,  when  offered,  was  resented,, as  tending, 
to  “ wreck  true  Homoeopathy.”  Yet  this  is  truly  symptom-hunting, 
of  the  best  type. 

In  pathological  symptomatology,  also,  the  Hah.nemannian  schema 
is  our  best  guide,  and  a good  repertory  is  the  ever-ready  handbook 
for  its  orderly  and  interpretative  study.  The  best  for  this  purpose 
is  that  found  in  Jahr  and  PossarPs  Manual , and  which  should  be 
separately  bound.  Its  introductory  comparisons  of  drugs,  antidotes,, 
etc.,  come  into  play  at  a later  stage  of  the  same  studies. 

The  detail  of  symptoms  as  here  given  is  both  comprehensive  and 
suggestive,  and  may  be  extended  at  will.  Both  “general”  and 
“special”  pathology  are  here  represented.  However,  this  book 
needs  to  be  supplemented  by  the  works  of  Tanner,  Findlaysonv 
etc.,  on  “Clinical  Medicine;”  for  this  is  what  it  is,  and  this- 


866 


world’s  homoeopathic  congress. 


phrase  will  be  a proper  title  of  the  full  professorship  of  this  whole 
subject.  As  all  professors  should  hold  clinics , the  title  roust  no 
longer  imply  a faculty  scapegoat 

The  interpretation  of  symptoms  here  finds  a special  function,  of 
course;  but  a warning  is  required — not  to  spin  cobweb  theories 
therefrom  unto  vague  pathological  prescribing. 

Interpretation  of  symptoms  relates  to  the  following  subjects,  viz.: 

1.  The  nature  of  the  morbid  process ; as,  hypersemia,  active  or 
passive;  cardiac  tone,  or  atony;  connective-tissue  growth;  paren- 
chymatous inflammation  ; suppuration;  reflex  nervous  states,  etc. 

2.  Lesions  of  function. 

3.  Tissue-lesions,  e.g.}  of  epithelium;  of  nerve  substance,  etc. 

4.  Gross  lesions  of  organs,  e.g.,  heart,  kidney,  etc. 

Each  of  these  classes  is,  to  the  experienced  therapeutist,  at  once 
suggestive  of  a group  of  remedies  bearing  pathogenetic  and  thera- 
peutic relations  thereto,  as  judged  by  provings  and  by  clinical  ob- 
servations. Yet  the  physician  must  never  be  dominated  by  past 
experience,  but  ever  push  forward  in  fresh  research. 

Hahnemann1  s Chronic  Miasms  and  Modern  Pathology. — A perti- 
nent question  here  is,  how  does  Hahnemann’s  doctrine  of  Chronic 
Diseases  appear  in  the  light  of  modern  pathology?  Are  hfs  “three 
chronic  miasms  ” thereby  consigned  to  oblivion  as  the  “ disorderly 
fancies  of  the  master’s  senility?”  Or  do  they  appear  therein,  in  a 
new  dress,  irradiating  the  field  of  current  literature,  and  giving  in- 
spiration to  current  practice?  First,  is  “ repelled  psora”  a whim,  or 
a grave  pathological  fact?  Second,  is  constitutional  syphilis  a mere 
illusion,  or  a terrible  reality?  Third,  is  “sycosis,”  or  systemic 
gonorrhoea,  the  conceit  of  a narrow  doctrinaire,  or  is  it  a sad  fact  in 
the  history  and  in  the  pathology  of  modern  diseases? 

One  modern  word  will  embrace  the  whole  of  these,  namely, 
“septicaemia”;  duration,  or  chronicity,  is,  then,  the  only  thing  left 
to  question.  Its  prevention  demands  one  prime  condition,  whatever 
its  form,  viz.,  drainage.  Its  production  has  also  one  prime  cause, 
viz.,  absorption;  and,  again,  this  is  the  sure  consequence  of  non- 
drainage.  Add  to  this  the  local  use  of  absorbent  lotions,  ointments, 
with  frictions,  plasters  and  all  the  invasive  measures  of  “ local  ther- 
apeutics,” and  without  doubt  all  conditions  of  systemic  poisoning  are 
met.  “ Repelled  eczema  ” (the  “ itch,”  or  “ psora”  of  Hahnemann’s 
day)  has,  in  my  own  experience,  been  immediately  followed  by 


THE  STUDY  OF  HOMOEOPATHY. 


867 


hydrocephalus;  everybody  knows  the  syphilitic  taint;  and  Ash- 
hurst’s  Surgery  is  good  authority  for  the  reality  of  gonorrhoeal  sep- 
ticaemia, or  pyaemia.  All  authors  of  our  day  confirm  the  Hahne- 
mannian  doctrine  of  repelled  or  absorbed  organic  poison.  Advanced 
anatomy  elucidates  it.  The  “ superficial  cutaneous  lymphatics  ” lie 
just  beneath  the  epidermic  cells,  open  between  them,  and  communi- 
cate by  perforating  the  cutis  with  the  deep  lymphatics,  thus  furnish- 
ing a direct  route  to  the  circulating  blood,  and  to  every  living  cell 
in  the  body. 

Microbes  are  the  elements  of  mischief  according  to  modern  views; 
but  the  facts,  as  clinically  seen  by  Hahnemann,  were  just  as  real  as 
now,  and  were  the  sound  basis  of  his  theory,  and  the  perfect  justi- 
fication of  his  practice  and  of  his  advice.  Even  his  nomenclature, 
antique  though  it  may  be,  when  technically  understood,  is  no  worse 
than  the  modern  ; e.g .,  “ amyloid,”  etc. 

The  chronicity  of  psora,  or  septicaemia,  using  the  modern  phrase, 
and  its  protean  expressions,  to  many  unfortunate  surgeons  in  our 
day,  who  have  been  victims  of  “ blood-poisoning,”  are  indubitable 
facts.  Certainly,  such  may  well  be  Hahnemanians.  General  loss 
of  vitality  and  suse  ptibility  to  morbid  influences  and  processes, 
so  graplfically  described  by  Hahnemann  in  volume  one  of  the 
Chronic  Diseases — these  have  since  been  their  constant  experience. 
See  also  a quotation  from  Reynolds  by  Prof.  L.  L.  Danforth, 
Transactions  of  the  American  Institute  of  Homoeopathy,  vol., 
1892,  page  267,  in  “Antisepsis  in  Obstetrics.” 

Some  years  since  the  writer  contributed  to  the  Transactions  of 
our  Pennsylvania  State  Society  a paper,  in  which  the  unity  of 
origin  of  all  constitutional  taints  was  considered  at  length  from  the 
standpoint  of  evolution. 

Action  and  Reaction. — No  range  of  doses  monopolizes  either  the 
“primary”  or  the  “secondary”  effects  of  a drug;  nor  are  the 
“double  and  opposite  effects”  ascribed  to  all  drugs  to  be  wholly 
found  in  the  action  of  opposite  grades  of  dosage,  large  and  small. 
Nevertheless,  it  is  true  that  large  doses  display  the  primary  in  a far 
greater  measure  than  do  the  small,  whilst  in  regard  to  the  second- 
ary effects  the  predominant  display  is  just  the  reverse.  Primary 
action  is  the  attack  of  an  enemy.  Secondary  action  is  the  repulse 
of  that  enemy.  In  both  are  signs  of  battle — i.e.,  symptoms. 

The  primary  effect,  in  the  language  of  Allopathy,  is  called  “the 


868 


world’s  homoeopath rc  congress. 


physiological  action.”  This  being  transient,  is  regarded  as  of  little 
or  no  specific  individuality  or  significance  for  any  given  drug;  yet 
in  such  quarters  it  is  held  to  be  the  only  possible  medicinal  action  of 
any  drug,  to  be  maintained  by  ever-increasing  doses,  according  to 
the  surgical  idea.  From  this  point  of  view,  the  doses,  as  well  as 
the  specific  individuality  of  Homoeopathic  remedies,  are  absurd  be- 
yond description. 

In  taking  such  a position,  however,  they  themselves  necessarily 
commit  the  glaring  absurdity  of  ignoring  that  great  law  of  physics, 
viz.,  “ action  and  reaction  are  equal.”  Further,  they  ignore  the 
added  vital  resistance  against  all  things  inimical;  and  still  further, 
the  fact  that  all  drugs  are,  per  se,  thus  inimical  in  their  primary  in- 
fluence. The  materialistic  and  the  vital istic  philosophies  alike,  and 
throughout,  support  our  view  in  this  matter.  The  secondary  is  the 
permanent  and  final — the  curative  effect. 

Natural  law,  however,  as  generally  recognized,  is  rarely  uncondi- 
tional, and  this  “ law  of  reaction”  is  conditioned  by  an  important 
proviso,  viz.,  that  the  preceding  a action  ” be  neither  destructive 
nor  disabling. 

The  Homoeopathic  law  submits  to  this  self-same  proviso,  and 
hence  it  implies  “ the  minimum  dose,”  with  conservative  repetition, 
according  to  the  medical  idea.  So  far  as  we  know,  it  submits  to 
but  one  other,  viz.,  the  curability  of  the  given  case.  With  these 
provisos,  surely  “ likes  are  cured  by  likes.” 

3.  Diagnostic  and  pathognomonic  symptomatology  are  too  well 
valued  and  understood  to  need  more  than  mention  here,  but  a 
thorough  course  of  instruction  must  specifically  include  them; 
only,  the  physician  should  be  able  always  to  distinguish  drug- 
symptoms  from  those  proper  to  the  “ natural  history  ” of  the  dis- 
ease per  se. 

4.  Pharmacodynamic  symptomatology  is  the  capital  city  to  which, 
in  Homoeopathic  practice,  all  roads  lead  ; and  the  “totality”  is  the 
measure  of  the  study.  The  physiological  and  pathological  signifi- 
cances, previously  studied,  here  find  their  higher  illustration  in  the 
proving-records  of  the  materia  medica.  Indeed,  a prover  is  doubly 
equipped  for  his  important  work  if  he  has  had  this  previous  study; 
but  he  must  avoid  the  error  of  writing  down  his  subjective  patho- 
logical opinions  in  place  of  giving  a faithful  statement  of  the  ob- 
served phenomena.  Still,  symptoms  understood  are  symptoms 


THE  STUDY  OF  HOMOEOPATHY. 


869 


remembered,  and  both  prover  and  student  should  understand  all 
that  is  possible.  Even  single  symptoms,  understood,  illuminate 
the  totality,  as  above  shown. 

The  diagnostic  powers  of  the  mind  will  here  find  a most  difficult 
yet  most  remunerative  employment. 

Here,  again,  the  Repertory  of  Jahr  and  Possart  affords  a prac- 
tical analytic  handbook.  Each  chapter,  indeed,  is  full  of  points  for 
parallel  or  for  consecutive  study  of  all  the  subdivisions  of  symp- 
tomatology. 

The  strictly  Halinemannian  and  the  final  use  of  a repertory  is  as 
an  index  to  the  materia  medica,  where,  only,  the  salient  symptoms 
are  found  in  their  fulness,  and  thence  the  totality;  consulting  the 
provings  proper  under  some  one,  and  then  others,  of  the  several 
remedies  therein  suggested — examining  the  various  drugs,  one  after 
the  other,  in  the  order  of  their  apparent  similarity,  until  the  most 
similar  is  found. 

These  provings  are  the  sanctum  sanctorum  of  symptomatology. 

5.  Prognostic  Symptomatology. — ‘‘Dealing  in  futures”  is  a business 
phrase  which  applies  well  to  the  physician’s  work.  It  requires 
close  study.  In  the  evolution  of  disease  the  outcome  is  of  absorbing 
interest,  and  this  is  judged  by:  1.  The  natural  tendency  of  the 
malady.  2.  The  intensity  of  the  particular  attack  of  the  same. 
3.  The  importance  of  the  specially  affected  organs  and  the  amount 
of  their  involvement.  4.  The  amount  of  physiological  error.  5. 
Heredity,  age,  sex.  6.  Vital  force,  and  the  means  at  hand  of  sus- 
taining it,  by  food  and  other  hygienic  conditions.  (And  here,  be 
k observed,  that  to  the  followers  of  Hahnemann,  the  constitutional 
status  is  ever  paramount , and  its  symptoms  of  the  highest  rank).  7. 
The  environment,  as  a whole,  is  to  each  patient  an  individual 
factor,  intensely  bearing  upon  prognosis.  This,  too,  has  its  symp- 
toms, mainly  in  the  sphere  of  “ conditions  ” of  aggravation  and 
amelioration,  and  nowhere  is  there  a wider  field  for  interpretative 
study.  8.  Lastly,  prognosis  rests,  in  large  measure,  upon  the  char- 
acter of  the  treatment,  a fact  to  which  our  school  is  fully  alive. 

However,  the  mere  outcome  of  the  disease  itself  is  not  the  whole 
of  the  subject.  The  action  of  every  prescription  is  a proper  subject 
of  scrutiny  and  forethought.  The  probabilities  of  aggravation  and 
amelioration;  the  reasons  for  the  same;  the  periods  of  probable 
occurrence;  the  interpretation  of  paroxysmal  and  other  changes; 


870 


WORLD  S HOMCEOPATHIC  CONGRESS. 


the  incidental  drug-provings  which  may  crop  out,  intended  or  not; 
their  recognition,  anticipation,  and  guidance,  sometimes  their  open 
prediction — these  are  a part  of  our  daily  duty,  and  should  be  made 
the  subject  of  definite  study  and  teaching. 

In  all,  the  symptoms  of  the  given  case  must  play  a great  part  and 
require  close  study.  The  chair  of  clinical  medicine  has  this  field 
for  its  own. 

6.  Therapeutic  Symptomatology. — This  is  the  climax  of  our  work, 
and  it  includes  all  the  rest.  Whatever  their  help,  however,  neces- 
sity binds  us,  for  the  present  and  after  all,  to  the  mechanism  of 
Hahnemann’s  method  as  laid  down  in  the  Organon.  In  pursuing 
it  we  may  yet  invoke  the  aid  of  Boenninghausen,  with  his  fourfold 
classification  of  symptoms — “ location,  sensation,  condition,  and  as- 
sociation ” (or  concomitants);  also  of  Hering,  with  his  essay  on 
Hahnemann’s  'Three  Rules.  All  of  this  relates  closely  with  the 
Selection  of  the  Remedy. 

“Taking  the  case,”  by  the  rules  of  Hahnemann,  is  the  first  and 
most  important  step  in  therapeutic  symptomatology  ; the  use  of 
the  Repertory  and  of  the  Materia  Medica  duly  follows.  To  be 
able  to  do  these  rapidly  and  successfully  is  a necessary  attainment, 
and  no  Homoeopathic  physician  is  prepared  for  his  work  who  has 
not  become  fairly  expert  therein  ; hence,  no  college  has  fulfilled  its 
contract  with  its  students  which  fails  to  thus  qualify  them  by  special 
and  careful  instruction. 

In  this  connection  I recall  a remark  of  Dr.  J.  T.  Temple,  of  St. 
Louis,  thirty-five  years  ago,  and  which  has  proved  invaluable  to 
me,  viz.  : “I  find  my  best  selections  of  remedies  are  made  under 
the  rubric,  “Generalities.” 

I agree  largely  with  him,  but  would  extend  this  term  so  as  to 
include  all  that  follows  it  in  an  arranged  proving,  viz.,  skin,  sleep, 
fever,  conditions;  also,  and  above  all,  mental  states,  together  with 
related  attitudes  and  actions.  All  these,  grouped  under  the  one 
heading,  express  strikingly  the  whole  constitutional  status. 

Minute  Localizations. — Paradoxical  as  it  may  seem,  we  may  some- 
times, on  the  other  hand,  get  our  best  indications  in  the  minutest 
localizations ; but  that  these  readily  harmonize  with  the  other,  is 
plain  enough. 

Dr.  Jacob  Jeanes,  of  Philadelphia,  was  an  expert  in  this  line  of 
study,  e.g .,  in  his  discovery  of  the  specific  relation  of  Stramonium 
to  the  hip-joint,  especially  of  the  left  side. 


THE  STUDY  OF  HOMOEOPATHY. 


871 


Dr.  A.  Fellger  also  contributed  to  it;  as  in  his  indications  for 
Aurum,  Mercury , and  Kali  bichromicum  in  syphilis,  relating  them, 
respectively,  to  the  palate,  the  fauces,  and  the  pharynx  ; and  many 
others  might  be  named.  The  best  guide  in  this  particular  study 
is  Allen’s  edition  of  Boenninghausen' s Therapeutic  Pocket-Boolc 
or  repertory,  in  which  “ locality”  is  pretty  thoroughly  wrought 
out,  and  the  “ sides”  of  the  body,  etc.,  presented  under  each  head- 
ing. Further  minuteness , however,  can  be  secured  by  subsequent 
reference  to  the  Materia  Medica,  and  by  clinical  observation. 

Again,  Dr.  Lippe  recognized  a point  of  the  greatest  practical  sig- 
nificance in  reference  to  relief  from  medicinal  palliatives  as  well  as 
from  palliatives  of  other  kinds;  for  instance,  from  coffee,  from  alco- 
hol, from  vinegar.  Dr.  Hering,  in  his  Materia  Medica , under 
many  remedies,  observes  the  same  principle,  in  the  rubric  “ Other 
Drugs,”  as  to  both  amelioration  and  aggravation,  etc.,  of  these  upon 
the  proving-symptoms  and  the  therapeutic  effects.  Hering  and 
Lippe  alike  would  regard  such  indications  merely  as  additional 
reasons  for  the  choice  of  or  objection  to  the  remedy  under  study, 
i.e.,  when  the  patient  is  worse  or  better,  as  the  case  may  be,  from 
such  palliatives  or  from  such  “ other  drugs”  when  taken  surrepti- 
tiously by  the  patient  or  of  his  own  self-treatment. 

On  the  other  hand,  some  of  our  school  have  taken  an  opposite 
view  of  this  subject,  especially  if  such  palliatives  form  a part  of  the 
“ folk-lore”  of  the  common  people.  Dr.  Hering  himself  venerated 
this  sort  of  folk-lore.  Hahnemann  has  rescued  many  a medical 
tradition  as  to  the  powers  of  drugs.  Teste,  in  his  Materia  Medica , 
has  scrupulously  done  the  same,  believing  that  there  is  more  than 
palliation  therein,  even  cure,  provided  potentization  and  individu- 
alization be  invoked.  Following  this  lead,  Macfarlan,  of  Phila- 
delphia, in  view  of  the  traditional  and  empirical  use  of  common  tar 
(Fix  liquida ) for  the  cure  of  skin  diseases,  potentized  it  for  internal 
use;  and  now  Fix  liquida  proves  itself  almost  specific  in  eczema 
and  alopoecia. 

‘‘Symptoms  which  are  strange,  characteristic,  and  peculiar” — 
paraphrased  by  Prof.  C.  G.  Raue  as  “queer  symptoms” — are  of  the 
highest  therapeutic  rank,  both  in  natural  diseases  and  in  the  Materia 
Medica  according  to  Hahnemann,  and  require  special  study.  They 
may  be  wholly  irrelevant  in  pathology  as  now  understood,  being 
* often  merely  personal , but  they  are  in  subtle  relation  with  the  con- 
stitutional substratum  ; thus  essential. 


872 


world’s  homoeopath rc  congress. 

If  none  of  these  indices  (“  characteristics,”  “keynotes”  etc.)  be  con- 
spicuous in  a given  case,  the  drudgery  of  studying  the  whole  totality 
of  symptoms  in  detail  can  yet  lead  to  the  true  similimum.  In  the 
very  early  days,  when  our  Materia  Medica  embraced  but  few  drugs, 
and  all  the  provings  were  short,  it  was  no  great  task  to  study  the 
whole,  at  any  time,  or  even  to  keep  it  mostly  in  memory ; but  this 
can  no  longer  be  said. 

The  writer  once  sought  a remedy  for  a case  of  intermittent  fever ; 
chill  beginning  on  the  right  side.  Taking  Jahr’s  Symptomen- Codex, 
he  examined  the'  “ Fever”  rubric  of  every  drug,  and  found  under 
Rhus  tox .,  “ the  left  side  of  the  body  felt  hot,  and  the  right  side 
cold,”  etc.  Examining  for  the  other  symptoms — pains,  etc.,  this 
drug  was  found  to  have  all  of  them;  and  Rhus  tox.  was  then  known 
to  be  the  remedy. 

In  this  work  the  ubiquitous  four  categories  of  Boenninghausen 
constitute  the  classes  into  which  the  symptoms  naturally  fall.  In 
“ taking  the  case”  it  is  desirable  to  express  in  writing,  for  every 
marked  feature  of  the  same,  all,  or  rather  the  first  three  of  these 
categories.  This  will  greatly  facilitate  their  use  in  the  subsequent 
choice  of  the  similar  remedy. 

These  categories,  familiarly  called  “ Boenninghausen’s  Four 
Points,”  cannot  be  too  frequently  stated.  In  taking  the  case  and 
in  selecting  the  remedy,  they  are  a never-failing  guarantee  of  exact 
thought  and  practice. 

Category  1st. — Locality. 

“ 2d. — Sensation  (kind  of  symptom). 

“ 3d. — Condition  (of  worse  and  better). 

“ 4th. — Concomitants  (or  associations). 

Allen’s  Boenninghausen' s Therapeutic  Pocket-Book  is  the  hand- 
book for  the  easy  pursuit  of  this  method.  In  every  perfect  study, 
however,  the  final  step  must  be  a consultation  of  the  Materia 
Medica  (or  “provings”)  under  each  seemingly  similar  remedy, 
comparing  each  with  the  others  through  Hahnemann’s  schema,  and 
thus  determining  the  identity  of  the  most  similar , which  is  the 
object  in  view. 

This  method  of  comparison  of  similar  drugs  is  the  clinical ; it  is 
distinct  from  the  non-clinical  methods;  and  is  illustrated  in  the 
process  of  selection  of  the  similimum  in  any  subtle,  difficult  case 
of  chronic  disease.  (See  Hahnemann’s  Three  Rules , by  C.  Hering.) 


THE  STUDY  OF  HOMOEOPATHY. 


873 


This  consists  in  taking  two  or  more  drugs,  as  found  by  means  of 
the  index  or  repertory  to  be  closely  related  to  the  symptoms  of  the 
case  (as  well  as  to  each  other,  of  course),  for  trial.  Opening  the 
Materia  Medica  at  each  of  these,  read,  rubric  by  rubric,  noting  the 
agreement  of  each  with  the  case  as  previously  written  down. 

Discarding  the  least  similar,  the  chief  simile  is  again  compared 
with  the  others,  and  the  best  chosen. 

The  “ numerical  method  ’ 7 of  finding  the  similimum  is  a variety 
of  the  foregoing.  Its  most  salient  expression  is  found  in  Dr.  W.  J. 
Guernsey’s  Boenning hausen.  In  this  the  rubrics  of  the  Therapeu- 
tic Pocket-Book  are  printed  upon  separate  long  slips  of  stiff  paper, 
with  the  rank  of  each  drug  thereunder,  1,  2,  3,  4,  in  numerals.  Se- 
lecting the  slips  containing  the  various  symptoms,  they  are  placed, 
side  by  side,  upon  a table ; then  each  drug,  beginning  with  those  of 
highest  rank,  is  counted  by  adding  all  its  printed  numerals  together. 
The  one  having  the  highest  number  is  held  to  be  the  similimum, 
irrespective  of  the  claims  of  keynotes,  etc. 

Individualization  in  practice,  so  insisted  upon  by  Hahnemann 
and  his  true  disciples,  can  surely  be  realized  through  the  con- 
vergence of  all  these  studies,  based  upon  a faithful  preliminary 
college  drill ; and  thus  the  future  of  Homoeopathic  therapy  may 
prove  an  advance  upon  even  the  wonderful  success  of  the  pioneers ! 

The  plan  of  Boeuninghausen  separates  the  symptoms  from  each 
other,  as  actually  observed,  and  the  localities  and  kinds  of  symp- 
toms, pains,  etc.,  from  their  conditions  of  aggravation  and  amelior- 
ation, etc.  Now  at  first  sight  this  seems  to  abolish  all  prospect  of 
just  combination.  In  practice,  however,  the  drug-genius  is  found 
to  corroborate  and  fully  justify  his  method  by  satisfying  therapeu- 
tic effects. 

Several  specialties  in  symptomatology  demand  a further  continua- 
tion of  this  discussion,  all  related  to  general  clinical  practice,  and 
catalogued  at  the  beginning  of  this  second  part. 

The  first,  the  Dietetic,  is  recognized  in  these  days  at  its  true 
value  by  many  physicians;  yet  by  too  many,  in  no  scientific  spirit. 
The  perusal  of  Pavy  on  Food , and  similar  works,  will  be  the  proper 
means  of  studying  this  branch  of  our  present  inquiry. 

Every  one  should  be  prepared,  on  short  notice,  to  furnish  informa- 
tion to  patients,  which  is  often  indispensable,  and  occasionally  all- 
sufficient,  to  cure,  from  the  dietetic  standpoint. 


874 


world’s  homoeopathic  congress. 


Pathological  symptomatology  having  furnished  the  facts  and  in- 
dications, of  diabetes,  for  instance,  it  is  more  important  and  effective 
to  regulate  the  diet,  excluding  starches  and  sugars,  than  it  is  to  give 
medicine,  however  well  chosen. 

In  diarrhoea,  and  the  like,  it  is  frequently  essential  to  stop  the  use 
of  all  coarse-grained  cereals,  as  granular  oatmeal,  all  sorts  of  vege- 
tables or  fruits;  or  at  least,  to  strain  out  of  a desirable  vegetable 
soup,  all  unreduced  lumps,  which  are  indigestible  and  aggravating. 

On  the  contrary,  in  constipation,  these  substances  are  most  salu- 
tary, and  are  to  be  prescribed.  Also,  the  profuse  use  of  water, 
especially  at  night  and  morning.  Bulky  meals,  not  too  rich  or 
heavy,  and  often  late  at  night  may  be  serviceable.  Eating  fruit  at 
bedtime,  and  just  before  breakfast,  with  the  assistance  of  water 
drinking,  is  aperient  in  effect. 

Anti-fat  diet,  and  building-up  diet,  etc.,  all  are  the  outcome  of 
discriminating  study  of  this  kind  of  symptomatology;  and  all 
should  be  carefully  taught  in  the  medical  colleges,  and  at  length. 
This  is  now  much  better  done  than  of  old  ; but  there  is  room  for 
improvement. 

7.  Curative  symptomatology  is  that  which  expresses  the  amendment 
of  function  and  of  tissue-formation  during  the  treatment  of  disease. 
Applying  to  drug-treatment  the  light  afforded  by  the  foregoing  dis- 
cussion, what  signs  have  we,  as  Homoeopaths,  to  guide  our  judgment 
of  its  good  effects  ? 

The  first,  of  course,  is  diminished  tissue  and  organ-lesion,  as  to 
extent  and  intensity.  Secondly,  improved  psychical  state.  Thirdly, 
increased  physical  strength.  Fourthly,  correction  of  functional 
errors.  These,  we  have,  in  common  with  all  physicians.  The  oppo- 
sites are,  a priori,  unfavorable. 

Again,  in  paroxysmal  diseases,  as  neuralgia,  intermittent  fever, 
etc.,  we  have  an  improved  state  of  secretions,  shown  by  the  tongue, 
the  skin,  the  bowels,  which  is  a sine  qua  non,  in  cure,  here.  Further, 
the  amelioration  of  the  attacks,  the  shortening  of  the  same,  the  post- 
ponement of  recurrences,  the  lengthening  of  the  intermissions,  the 
removal  or  improvement  of  complicating  ailments,  the  improvement 
of  the  intermissions,  as  to  special  symptoms  and  general  well-being. 

On  the  other  hand,  aggravation  of  the  paroxysm  may  indicate 
only  the  Homoeopathic  action  of  the  drug,  and  require  the  entire 


THE  STUDY  OF  HOMCEOPATHY. 


875 


cessation  of  all  medicine  except  a placebo  and  a watchful  waiting 
for  the  ensuing  vital  reaction  to  cure. 

In  constitutional  ailments,  a gain  in  flesh,  diminished  complaints 
and  other  familiar  signs  are  at  hand  to  show  curative  conditions. 
Normal  temperature  may  be  added,  in  all  sorts  of  cases. 

These  are,  besides,  in  Homoeopathic  practice,  certain  subtle  indica- 
tions which  experience  has  proved  to  be  reliable.  Thus,  susceptibil- 
ity to  environment  and  to  other  circumstances,  often  annoying,  dis- 
appears. Dr.  Lippe  used  to  say  of  the  Natrium  carb.  patient,  “ He 
must  carry  an  umbrella  when  the  sun  shines  hot;  you  give  him 
this  medicine,  and  he  no  longer  carries  or  needs  his  umbrella.” 

Again,  in  any  disease,  especially  the  acute,  if  the  patient  falls 
asleep  soon  after  taking  a dose  of  Homoeopathic  medicine,  it  is  pretty 
good  evidence  of  its  curative  fitness,  and  a promise  of  good  to 
follow. 

Once  more:  if,  in  all  local  symptoms,  the  person  is  no  better, 
or  even  worse,  yet  in  the  general  sphere  feels  “ more  like  himself,” 
or,  as  Dr.  H.  N.  Guernsey  phrased  it,  “not  locally  better,  but  1 all- 
over  better;’”  he  is  better,  and  patient  waiting  under  a placebo,  will 
later  realize  universal  improvement.  Even  in  diphtheria,  with  as- 
surance of  proper  selection  of  remedy,  and  a single  dose  given,  high, 
in  consultation;  finding,  on  a second  visit,  some  hours  later,  that  all 
was  in  statu  quo , this  great  prescriber  remarked : “ The  patient  is 
certainly  no  worse ; therefore,  the  bad  tendencies  are  arrested,  at 
least,  and  that  means,  he  is  better;  continue  the  placebo;”  and  the 
third  visit  justified  this  decision. 

The  same  authority  told  a scared  doctor,  who  had,  in  a case  of 
broncho-pneumonia  in  a child,  repeated  Bryonia , 200,  until  brain 
symptoms  supervened,  “Well,  doctor,  you’ve  nothing  more  to  do; 
give  Sac.  lac.,  and  wait,  and  you’ll  ©ure  the  case;  but  don’t  spoil  it 
by  giving  any  more  active  medicine.”  A few  hours  demonstrated 
that  he  was  right.  It  is  easy  to  “ spoil  a case let  us  beware, 
therefore,  of  undue  officiousness  in  critical  cases. 

Thus,  pathogenetic  symptoms,  “ read  betwen  the  lines,”  may  be 
most  pleasing  to  the  expert;  always  provided  the  drug  be  indeed 
the  similimum. 

Further:  when  the  “ inmost  ” of  the  person,  the  nobler  organs, 
and  the  psychic  nature,  grow  better,  and  when  the  symptoms  of 
the  malady  seem  to  move  from  within  outward,  or  from  above 


876 


world’s  homceopathic  congress. 


downward,  the  patient  is  better.  And  yet  again,  if  the  latest  symp- 
toms (especially  in  chronic  diseases)  improve  first,  followed  by  the 
others,  in  the  inverse  order  of  their  appearance,  a true  and  perma- 
nent cure  has  commenced,  and  must  be  let  alone. 

8.  Toxical  symptomatology  is  fairly  well  taught  now  in  all  medical 
colleges,  and  we  need  only  to  refer,  besides,  to  the  standard  works 
on  poisons,  under  this  head. 

9.  Pathogenetic  Symptomatology  has  already  been  hinted  at,  above. 
But  it  requires  distinct  elaboration.  Diagnostic  and  prognostic,  in 
part,  it  may  be  best  studied,  in  these  relations.  In  drug  provings, 
and  in  therapeutic  medication,  it  is  likely  to  exercise  the  medical 
mind  to  its  full  capacity,  But  that  capacity  is  too  often  but  puerile, 
even  full  capacity  is  too  often  but  puerile,  even  among  well-educated 
physicians ; and  hence,  the  better  the  teaching  and  drill,  in  the 
college  should  be. 

Lack  of  faith  in  drug  power,  especially  in  attenuated  doses,  emas- 
culates the  student’s  mind  at  this  critical  juncture — for  such  it  is. 
Such  a one  should  first  clear  his  horizon  of  these  skeptical  vapors. 
The  records  of  provings  of  insoluble  substances,  as  Silica,  Lycopo- 
dium, and  many  more,  and  of  that  familiar  condiment  of  our  tables, 
common  salt,  or  Natrum  muriaticum,  and  the  Austrian  re-proving 
of  the  latter,  sweep  away  all  of  the  reasonable  doubts  of  candid 
Homoeopaths;  as  witness  Dr.  Watzke,  the  superintendent  of  the 
last  named.  He  says,  “I  am,  alas!  (I  say,  alas!  for  I would  much 
rather  have  upheld  the  larger  doses,  which  accord  with  current 
views) — I am  compelled  to  declare  myself  for  the  higher  dilutions. 
The  physiological  experiments  made  with  Natrum  muriaticum,  as 
well  as  the  great  majority  of  the  clinical  results  obtained  therewith, 
speak  decisively  and  distinctly  for  these  preparations.”* 

Pathogenesis  goes  hand  in  hand  with  curative  drug-action. 
Hahnemann’s  original  reason  for  attenuation  was  the  diminution  of 
the  former,  and  was  impressed  that  this  did  not,  by  any  means, 
abolish,  but  only  refined  it. 

Yet,  more;  he  claimed  that  no  dose  yet  known  is  so  small,  that 
it  is  inferior  in  strength  to  the  natural  disease  to  be  cured.  Still 
further,  he  held  that  the  cure  depends  upon  that  fact,  and  that  it 
produces,  always,  a disease  of  like  nature,  and  superior  strength, 


* See  Hughes’  Pharmacodynamics , 1876,  page  562. 


THE  STUDY  OF  HOMOEOPATHY. 


877 


which  supplants  the  original  disease,  and  thereby,  alone,  can  the 
Homoeopathic  cure,  so  far  as  we  know,  be  effected.  ( Organon , § 24 
to  34;  279  to  283).  In  § 29,  he  says,  “an  artificial  morbid  affec- 
tion is  substituted , as  it  were,  for  the  weaker  similar  natural  disease.” 
He  also  indicates  that  a drug-disease,  being  brief  and  self-limited, 
provided  the  doses  be  not  toxic,  it  is  soon  afterwards  terminated  by 
the  vital  force,  and  its  own  self-limitation. 

One  of  our  daily  difficulties  in  Homoeopathic  practice  is  to  re- 
duce the  morbific  drug-action  to  comfortable  limits.  Any  ad- 
ditional method  of  limiting  and  controlling  this  would  be  welcomed. 
One,  that  promises  something,  is  to  give  the  doses,  so  far  as  may  be, 
immediately  after  meals;  but  this  is  limited  in  its  applicability. 
Other  timing  of  doses  may  help. 

Now,  in  general,  what  signs  can  be  considered  as  evidence  of 
drug-pathogenesis,  either  in  a proving,  or  during  its  therapeutic 
administration.  Our  standard  of  comparison  has  been  already  set 
up,  viz;  Physiological  symptomatology  ; and  to  that  we  must  refer. 
Mens  sana  in  corpore  sano — the  consent  of  all  healthy  organs  and 
functions — produces  a synesthesia — a total  sense  of  well-being  ; and 
any  deviation  therefrom  means:  “I  am  sick;”  and  whenever  a 
drug,  or  other  morbid  influence  has  preceded  such  deviation,  it 
surely  has  some  part,  small  or  great,  in  its  causation. 

No  one  agent,  however,  can  claim  the  whole  of  such  causation. 
No  physiological  error  would  be  possible,  of  course,  without  a per- 
sonal, individual  susceptibility,  and  this  individual  response. 
Again,  no  such  effect  was  ever  independent  of  the  existing  environ- 
ment. In  a drug-proving,  then,  “ pure  drug-symptoms  ” are  an 
absolute  impossibility;  and  every  symptom  is  the  outcome  of  the 
three-fold  activity,  viz  ; of  the  individuality  ; of  the  environment ; 
and  of  the  drug  (which  is  but  a special  form  of  environment,  after 
all,  however).  Now,  the  symptoms  appearing  at  the  apex  of  these 
three  forces  form  the  so-called  drug-pathogenesis  ; and  the  three  must 
always  be  reckoned  with. 

The  first  named  is,  of  course,  modified,  in  disease,  by  a previous — 
a fourth  agency,  viz  : the  originating  cause  thereof ; but  the  indi- 
viduality is  there;  and  if  the  drug  be  a true  simile,  the  two  forces 
will  neutralize  each  other,  up  to  the  point  of  the  “just  sufficient” 
dosage;  and  cure  results.  If  either  predominate,  the  “symptoms” 
declare  it. 


878 


world’s  homceopathic  congress. 


Now,  how  shall  we  distinguish  symptoms  which  are  present  be- 
cause of  the  interaction  of  the  drug-force  with  the  others,  and  are 
hence  its  fruits  (with  their  aid). 

Firstly.  If  the  natural  history  of  the  individuality,  in  the  state 
of  health,  cannot  duplicate  a symptom,  with  the  same  environment, 
the  third  factor,  the  drug-force,  must  be  the  efficient  cause. 

Secondly.  If  previous  provings  show  that  in  other  individuals, 
the  same  drug  has  displayed  the  same,  or  very  similar  symptoms, 
they  are  reasonably  sure  to  be  drug-symptoms,  so-called. 

Thirdly.  During  the  treatment  of  disease,  consider  the  natural 
history  thereof;  and  if  the  new  symptom  or  symptoms  be  alien  to 
its  natural  history,  the  environment  being  the  same,  the  remaining 
factor,  the  drug  must  be  held  responsible  for  them. 

Fourthly.  Changes  of  environment,  however,  will  initiate  a corre- 
sponding change  of  symptoms  and  u conditions”  (or  “ modalities”); 
but  withal,  even  these  will  be  also  stamped,  characteristically , by  the 
modifying  force  of  the  drug-factor. 

Fifthly.  New  psychic  and  mental  errors,  pains,  altered  functions, 
obscure  chills,  spasms,  fevers,  etc.  (in  “ Fever  Order”),  are  the 
common  forms  of  symptoms  produced  during  treatment  of  disease 
in  the  line  of  drug-pathogenesis  or  so-called  “ Homceopathic  drug- 
aggravation.”  The  latter  phrase,  however,  belongs  more  correctly 
to  the  increase  of  pre-existing  disease-symptoms  after  the  administra- 
tion of  the  drug.  This  following  u low  potencies”  the  drug  may 
be  pushed  through  such  an  episode;  the  reaction  following,  with 
more  or  less  effort  of  the  etnunctory  or  secreting  organs,  in  the  way 
of  elimination  of  the  drug-excess.  But,  in  using  “ high  potencies,” 
experience  shows  that  a placebo  is  the  best  answer  to  the  same.  (It 
may  be  here  mentioned  that  a convulsion  is  the  fair  analogue  of  a 
chill,  in  practice.) 

Supposed  Sources  of  Fallacy  in  Provings. 

The  domination  of  subjective  or  of  environment  influences  is  not 
a sufficient  ground  for  condemning  a proving.  The  former  simply 
announce  the  kind  of  individuality  most  susceptible  to  the  other  two 
factors  when  acting  together ; and  the  proper  grouping  of  observed 
symptoms  will  depend  upon  making  use  of  the  subjective  or  personal 
symptoms  in  conjunction  with  those  alterations  which  are  excited  by 
the  other  factors,  viz.,  the  drug  plus  the  environment. 


THE  STUDY  OF  HOMOEOPATHY, 


879 


Again,  the  sy  mptoms  directly  traceable  to  environment  only,  one  may 
suppose,  do  not  fall  short  of  the  scientific  requirement,  as  experience 
shows,  and,  a priori , it  must  be,  that  a compound  susceptibility  exists ; 
the  other  two  factors,  the  individuality  plus  the  drug,  prepare  the 
total  physiology  for  certain  responses  to  each  hind  of  possible  environ- 
ment. (No  proving  is  absolutely  complete  short  of  the  test  of  all  of 
these,  as  well  as  of  all  kinds  of  individuality.) 

My  own  proving  of  Gelsemium  in  April,  1861,  illustrates  all  this. 
Reading  the  telegrams  from  Charleston,  S.  C.,  concerning  the  battle 
at  Fort  Sumter,  my  system,  in  its  original  individuality,  had  been 
so  modified  by  two  weeks’  use  of  the  drug  that  “ threaten ings  of 
diarrhoea”  always  followed,  and  I stopped  the  proving  in  the  belief 
that  the  further  record  of  such  symptoms  would  be  misleading  and 
fallacious.  But  Dr.  Hering  knew  better,  and  he  announced  that 
“ there  is  the  keynote  of  Gelsemium!”  This  was  also  the  “ latest 
symptom  ” • 

What  shall  we  do  with  the  many  striking  pathogenetic  symptoms 
often  arising  after  the  taking  of  a drug  by  the  sick?  These  have 
often  proved  intensely  characteristic  of  the  remedy ; but  their  use  is 
hazardous,  and  cannot  be  approved  until  further  cautious  experiment 
has  eliminated  all  chances  of  error.  In  cases  where  several  remedies 
have  been  taken  this  rule  is  urgent  indeed. 

Surgical  symptomatology  is  now  so  well  studied  that  it  will  here 
suffice,  in  the  main,  to  refer  to  the  current  authorities.  Several 
points,  however,  closely  concerning  the  general  practitioner  must  be 
here  specified. 

First.  Septic  fever.  Some  rise  of  temperature,  after  the  shock  of 
an  injury  or  an  operation,  is  only  reparative  and  salutary;  let  us  call 
it  u primary  fever.”  But  if  this  do  not  fall  in  a day  or  so,  or, 
having  fallen,  shall  again  rise,  as  shown  by  the  thermometer,  used 
at  least  twice  daily,  it  is  “ secondary  ” or  “ septic  fever,”  and  the 
only  thought  then  must  be  to  open,  irrigate,  and  disinfect  the  wound- 
territory  thoroughly.  The  Homoeopathic  dilutions  will  perform 
their  accustomed  work  all  the  same  afterwards,  especially  the  lower, 
but  not  exclusively. 

Second.  In  peritonitis  frequency  of  pulse  is  more  significant  than 
rise  of  temperature.  Thus,  the  greatest  of  signs  in  universal  sur- 
gical symptomatology  are  to  be  found  in  the  temperature  and  the 
pulse. 


880 


world’s  HOMOEOPATHIC  CONGEE'S. 


Third,  and  lastly,  in  haemorrhage,  as  in  chills,  the  temperature  is 
the  test,  i.e.j  a fall  to  97°  F.  or  below. 

General  Pharmacodynamics. 

Paet  IV. — Based  upon  the  Organon , and  rearrangement  of  prov- 
ings in  accordance  with  the  type  of  Intermittent  Fever , etc. 

It  has  been  said,  by  some  (Dr.  Dickson  of  London,  and  others), 
that  “all  disease  is  Intermittent  Fever.”  Certainly,  this  dictum 
will  but  confirm  the  experience  of  many  physicians  practicing  in 
malarial  districts;  for,  every  day,  it  seems  to  be  restated  by  Nature. 
Fven  in  non-malarial  countries,  so-called,  close  observation  supplies 
a plenty  of  illustrations  in  the  course  of  varied  diseases. 

Drug  Diseases  are  no  exception.  Plainly,  this  must  appear  to  every 
Hahnemannian ; for,  “every  drug  may  cure  Intermittent  Fever” 
if  duly  individualized;  the  natural  and  the  artificial  disease  alike 
presenting  abundant  variations — in  proportion  of  stages,  in  sequence 
of  the  same,  in  concomitants  of  each,  in  conditions  of  aggravation 
and  amelioration,  etc.  etc.  Generalities  of  all  kinds  are  easily  assign- 
able to  “stages,”  and  are  extremely  significant. 

Comparing  these  in  detail,  stage  by  stage,  we  observe  : 

a.  Certain  general  and  local  symptoms  of  every  drug  proving, 
regardless,  pro  tem , of  the  mere  date  or  observed  order  of  occurrence, 
assimilate  with  acute  physiological  depression  ; in  other  words,  with 
the  cold  stage  or  “chill.”  Such  symptoms,  whatever  their  date,  are 
essentially  “ primary,”  and  represent  truly  the  initial  shock  of  the 
drug  disease. 

b.  Another  set  of  sym ptoms  corresponds,  accurately  and  thoroughly, 
with  acute  physiological  exaltation , yet  a minus  of  secretion,  also 
irrespective  of  date;  in  other  words,  with  the  hot  stage.  This  is 
still  a “primary”  form  under  Hahnemann’s  nomenclature,  being 
simply  a fuller  development  of  the  morbid  impression  and  of  the 
vital  disturbance  thereby ; but  incipient  secondary  vital  reaction  has 
now  begun  to  mingle  with  the  primary  effect. 

c.  A third  set  of  symptoms,  usually  following  the  hot  stage, 
appears  in  intermittent  fever  with  a plus  of  secretion,  the  sweating 
stage  or  remission.  In  remittent  fever  it  does  not  ripen  into  a full 
?Wermission ; in  intermittent  fever  this  does  happen;  but  in  both 
cases  this  stage  is  evidence  of  acute  physiological  exhaustion;  the 
primary  effect  is  not  quite  abolished,  yet  it  is  subsiding  with  gradual 


THE  STUDY  OF  HOMCEOPATHY. 


881 


approach  of  vital  or  curative  “ reaction,”  which  is  synonymous  with 
“ secondary  effect.”  This  is  imperfect  and  uncertain  in  remission, 
however,  which  implies  important  congestion  or  other  lesion , prevent- 
ing complete  intermission  and  having  an  evil  prognosis.  Neverthe- 
less, we  may  say,  in  general,  that  in  both  the  hot  and  the  sweating 
stages  vital  reaction  approaches  nearer  and  nearer,  nay,  has  already 
commenced.  Corresponding  symptoms  of  such  a state  in  a drug 
proving  are  to  be  diagnosed  and  to  be  placed  under  this  head. 

d.  A fourth  state,  with  definite  symptoms,  is  seen  in  a completed 
intermission — the  “ apyrexia.”  The  same  class  of  symptoms,  gen- 
eral and  local,  are  to  be  sought  and  noted  in  every  proving,  and  these 
being  ameliorative,  compared  with  the  first  three,  they  may  be 
regarded  as  mainly  “ secondary.”  They  have,  however,  some  resid- 
ual organic  lesions  for  their  basis,  and  mean  incomplete  reaction  only. 

e.  A fifth,  more  advanced  state,  is  the  stage  of  Sequelae,  that  is, 
the  organic  and  functional  lesions  remaining  after  the  paroxysmal 
stages  have  passed,  perhaps  entirely  ceased.  In  heroic  provings  this 
may  also  be  distinguished  and  should  be  classified  as  a subdivision 
of  the  secondary  reaction,  still  blended  with  relics  of  the  “ primary 
effect.” 

/.  Recovery  is,  sixth }y,  perfected  secondary  effect.”  Its  symp- 
toms are  subtle  often,  but  negative.  Practically,  health  is  reached. 

g.  A seventh  stage  of  intermittent  fever  must  sometimes  be  noted, 
viz.,  that  of  periodic  recurrence.  The  symptoms  of  the  original 
“ primary  effect”  reappear  and  are  to  be  classed  as  such,  not  as  any 
part  of  the  “reaction  of  the  vital  principle”  or  r secondary  effect.” 
Indeed,  it  is  a clear  testimony  to  organic  sequelae,  apparent  or 
occult. 

h.  In  every  proving  a careful  study  of  the  symptoms  will  enable 
one  to  distinguish  their  relation  to  the  several  stages  of  intermittent 
fever,  and  the  resulting  groups  may  then  be  arranged  in  the  fore- 
going succession — the  true  perspective  of  the  drug-disease  picture, 
which  thereby  becomes  luminous,. continuous,  natural,  regardless  of 
varying  temperaments  of  provers,  varying  dosage,  and  dates  of 
symptoms,  and  of  their  written  or  printed  sequences,  resulting  from 
such  empirical  reasons. 

i.  Instead  of  copying  the  sj^mptoms  in  this  “ fever  order,”  it  may 
suffice  to  so  mark  them  that  they  may  be  read  at  a glance  in  that' 
order.  Pencils  of  divers  colors  being  provided,  blue  dots-  before 

56. 


882 


world’s  homceopathic  congress. 


certain  symptoms  would  place  them  under  “ chill  stage;”  red, 
under  “ hot  stage;”  yellow,  “ sweating  stage;”  green,  for  apyrexia; 
black,  for  sequelae,  etc. 

j.  Natural  diseases,  as  well  as  drug-provings,  develop  in  the 
fever  order.  Even  chronic  diseases  show  it;  and  no  perfect  simile 
between  disease  and  drug  can  exist  without  regard  being  had  to 
this  same  fever  order  and  to  the  febrile  stages , one  or  all  (nature 
sometimes  seems  to  skip  one  or  more),  which  truly  assimilate  the 
symptom-groups  of  the  case  and  its  remedy.  Hahnemann’s  remarks 
on  intermittent  fever  ( Organon , § 239,  235,  236,  etc.)  apply  thor- 
oughly to  all  forms  of  disease  and  to  nearly  all  remedy-selection  and 
administration. 

k.  One  can  now  appreciate  how  insufficient  is  mere  date  as  a cri- 
terion of  “ primary  ” and  “ secondary  ” symptoms.  In  fact,  abso- 
lute contrasts  of  all  sorts  are  abhorrent  to  nature;  and  as  in  the 
fevers,  all  seeming  contradictions  blend  somewhere,  even  in  date. 

This  old  notion  recently  cropped  out  when  a Homoeopathic  physi- 
cian declared  that  “as  the  primary  symptoms  of  drugs  alone  can 
guide  to  the  similimum,  the  secondary  (or  late)  symptoms  have  no 
right  to  any  place  in  the  materia  medica.” 

The  date  of  a symptom  in  a proving  depends  on  varying  circum- 
stances, as  temperament,  dose,  time  of  taking,  repetition,  and  envi- 
ronment, and  hence  is  fallacious  as  a test. 

Furthermore,  under  this  head,  Dr.  C.  Hering,  after  long  expe- 
rience, decided  that  the  very  latest  symptoms  of  any  proving  are 
probably  the  most  characteristic. 

To  all  this  a climax  is  needed  for  each  drug — a keystone , as  it 
were — completing  and  perfecting  the  symptomatic  arch  and  uniting 
the  primary  and  secondary  abutments  with  a single  phrase  for  each, 
related  but  antagonistic,  and  expressing  its  genius.  Diagnosis  from 
the  “totality  of  symptoms”  is  the  means  by  which  this  end  is 
reached.  The  search  in  itself  is  a fascinating  and  valuable  exer- 
cise. 

All  symptoms,  primary  and  secondary,  naturally  group  them- 
selves around  these  two  in  the  completed  picture,  but  in  their  proper 
“ fever  order.” 

Illustrations. — Thus,  in  Aconite  we  find  in  the  “primary”  range 
anxious  restlessness  ; in  the  “ secondary  ” range,  reptile-like 

TORPOR. 


THE  STUDY  OF  HOMOEOPATHY. 


883 


In  Rhus  tox,  primary,  rheumatic  restlessness;  secondary, 

TYPHOID  UNCONSCIOUSNESS. 

In  Hyoscyamus,  turbulent  restlessness  versus  profound 
stupor  for  primary  and  secondary  states,  respectively. 

In  Arsenicum , prostrated  restlessness  versus  death-like 

COLLAPSE. 

In  Chamomilla,  walking  about  like  a caged  animal  versus 

DOGGED,  QUIET  INCIVILITY. 

Ferrum , walking  about  to  relieve  severe  dull  pain 
versus  anemic  inertia. 

Belladonna,  hasty  activity  versus  dreamy  stupor. 

Bryonia , dryness  of  secretions  versus  a colliquative  state. 

Calcarea  carb.,  obesity  versus  emaciation. 

Sulphur , excessively  busy  manner  versus  LAZINESS. 

These  processes  of  study  are  perfectly  in  touch  with  all  others, 
affording  assistance  to  all,  hindrance  to  none. 

The  subject  may  yet  be  viewed  from  a variety  of  other  stand- 
points, helpfully;  but  in  this  place  emphasis  may  again  be  laid 
upon  the  only  one  of  these  which  can  never  be  spared — that  of  von 
Boenninghausen.  His  analysis  of  “ the  totality  of  symptoms  ” may 
appear  to  some  very  mechanical,  but  it  is  the  basis  of  arrangement 
of  his  indispensable  repertory.  To  recapitulate,  its  numerous  divi- 
sions constitute  four  essential  parts,  viz. : 

1 . “ Location  ” (of  symptom). 

2.  “ Sensation  ” (or  “ kind  of  pain/’  or  "of  symptom  ”). 

3.  “ Condition  ” (of  aggravations  and  of  ameliorations). 

4.  “Combination”  (or  “concomitants”). 

Added  to  these  is  the  final  one  of  “relationships”  (or  “compari- 
sons ”). 

Great  refinements  and  minutiae  are  possible  and  valuable  under 
every  one  of  these  heads,  and  thus  the  all-important  individualities 
of  both  the  person  and  the  drug  are  to  be  discovered  and  to  be 
matched,  the  one  with  the  other;  aided  by  carefully  writing  down 
all  the  phenomena,  whether  of  a drug  or  of  a patient,  under  these 
four  heads,  and  in  this  order.  A brief  but  attentive  reading  of  the 
Materia  Medica  will  give  a strong  impression  of  such  refinements 
and  minutiae ; and  by  parallel,  simultaneous,  comparative  reading 
of  similar  drugs  their  differences  will  grow  more  and  more  con- 
spicuous also. 


884 


world’s  homoeopathic  congress. 


The  practical  application  of  von  Boenninghausen’s  method  has  pro- 
duced a vast  harvest  in  the  hands  of  our  pioneers;  as,  von  B.  him- 
self; his  pupils,  Carroll  Dunham,  Ad.  Lippe,  and  others,  as  well  as 
Hering,  Guernsey,  and  many  more. 

The  free  use  of  this  or  of  some  similar  repertory  will  greatly 
facilitate  the  selection  of  the  remedy  and  will  gradually  give  large 
and  rapid  mastery  of  cases  and  of  the  Materia  Medica.  However, 
a word  of  caution  is  here  needed,  to  wit : a repertory,  after  all,  is 
but  a disjointed  catalogue  (classified,  it  is  true)  of  symptoms.  It 
scarcely  shows  the  'perspective  of  anything ; this  can  be  found  only 
in  the  Materia  Medica  proper.  But  we  find  the  greatest  usefulness 
in  both  when  we  employ  the  repertory  as  a simple  index  to  the 
Materia  Medica,  and  so  economize  precious  time  and  energy  in  our 
work  of  selection  or  of  a priori  study. 

For  bedside  use,  a “ repertory  of  modalities”  (of  “ conditions  ” of 
aggravations  and  ameliorations) — after  von  B.,  a very  little  book — 
often  gives  great  help  to  one  who  already  has  a good  general  knowl- 
edge of  the  remedies  of  our  school.  It  can  be  carried  in  the  medi- 
cine case  or  pocket,  and  attracts  little  if  any  attention  or  criticism. 

Drug- A ffinity  for  Organs  and  Tissues. 

It  is  most  interesting  to  note  the  apparent  proneness  of  divers 
drugs  to  display  their  effects — each,  in  its  own  peculiar  way — in 
certain  organs,  in  the  first  place  ; as,  Mercury , Chelidonium  and  Nux 
vom.  in  the  liver;  Phosphorus  and  Tartar  emetic , in  the  lungs;  Bel- 
ladonna and  Gelsemium , in  the  brain  • etc.  Attempts  have 
been  made  to  select  remedies  by  this  crude  relationship,  for  the  cure 
of  diseases,  under  the  name,.  “ Organopathy.”  But  this  is  alto- 
gether too  general  a method  to  answer  the  precise  demands  of  the 
sick  organism,  and  is  now  little  more  than  a tradition  among  us. 

Tissue-affinity  of  drugs  is,  however,  usually  recognized  ; as  Calc . 
phos.  for  bony  tissues;  Bryonia  for  fascia,  etc.  One  argument, 
indeed,  against  Organopathy,  is  that  no  one  drug  can  meet  the 
needs  of  any  one  organ,  since  it  contains  a variety  of  diverse  tissues, 
each  requiring  a distinct  remedy  or  remedies,  when  inflamed,  for 
instance;  and  besides,  as  the  organ  has  its  nervous  supply  from  a 
plurality  of  sources,  a plurality  of  nerve-remedies  at  the  same  time 
contend  for  the  choice. 


THE  STUDY  OF  HOxYlCEOPATHY. 


885 


Hausmann  and  Schussler  have  elaborated  this  subject.  (See,  in 
particular,  Schiissler’s  Twelve  Tissue  Remedies.) 

Constitutional  affinities  are  another  branch  of  the  same.  Grau- 
vogl’s  work  on  Homoeopathy  is  largely  occupied  with  its  develop- 
ment. He  recognizes  therein,  the  composition  of  organic  bodies, 
from  carbon,  nitrogen,  hydrogen,  and  oxygen — the  human  body,  in 
particular.  The  excess  of  some  element  or  elements,  or  deficiency 
of  some  other  (which  results  the  same  way),  is  largely  the  basis  of 
disease,  or  at  least,  is  commonly  coexistent  with  it,  and  modifies 
both  it  and  its  treatment.  In  short,  pathology  is  sustained,  and 
therapeuties  is  applied  to  cure,  alike  through  the  channel  of  such 
constitutional  conditions. 

According  to  Grauvogl,  these  are  to  be  placed  in  three  classes, 
according  to  the  predominance  of  elements,  viz  : 

1.  The  earbo-nitrogenoid  constitution;  (the  noil-eliminative ; 
u lithxmia  ” ) Sulphur  is  its  drug-type. 

2.  The  hydrogenoid  constitution  ; (the  flabby,  watery ; “ hy- 

drsemia.”)  Natrum  sulph.  represents  this. 

3.  The  oxygenoid  constitution;  (the  inflammatory,  combustible, 
febrile;  the  emaciating,  wasting,  consumptive).  Ferrum  is  its  type. 

Other  classifications  there  are,  but  this  must  here  suffice.  Grau- 
vogl’s  work  is  accessible,  and  should  be  studied,  in  this  connection. 

The  Sides  of  the  Body  and  their  Drug -Affinities. 

Nothing  in  Homoeopathy  appears  more  fanciful,  to  the  ordinary 
Allopathic  mind,  than  our  claim  that  drugs  show  a preferential 
relation  to  one  side  of  the  body  and  its  parts,  or  to  the  other.  On 
the  other  hand,  nothing  is  better  established  in  fact. 

Theoretically,  and  a priori , a clear  diversity  of  sides  should  ex- 
ist ; since  the  superior  nutrition  of  the  right  side  should  assure  us 
of  its  positive  electric  polarity,  with  the  left  side  negative.  And 
so  on  ; for  the  same  is  true  of  the  front  as  compared  with  the  back 
parts  ; also,  of  the  inner  parts,  as  compared  with  the  outer  ; all  nor- 
mal flow  of  force  being  from  within,  outward.  The  same  is  true 
of  the  head  as  related  to  the  extremities.  The  chemical  nature  of 
the  secretions  at  positive  and  negative  poles  is  characteristically  dif- 
ferent— alkaline  and  acid,  etc. 

Again,  the  sides  of  the  body  are  vastly  influenced,  in  sensation 
and  function,  by  the  asymmetrical  location  of  the  internal  viscera. 


886 


world’s  homoeopathic  congress. 


Thus,  the  liver  is  located  mainly  on  the  right  side ; and  the  right 
shoulder , as  is  well  known,  is  the  special  seat  of  its  sympathetic 
pains. 

Now,  everybody  knows  that  certain  drugs  “act  on  the  liver,” 
specifically  ; and  necessarily,  such  drugs  have  a marked  pathologi- 
cal symptomatic  affinity  for  the  right  side.  A marked  instance  is 
found  in  Chelidonium. 

Once  more — the  heart  is  located  mainly  in  the  left  side  of  the 
chest.  Strongly  related  to  this  organ  and  its  surroundings  and 
sympathies,  is  Lachesis — a serpent  poison.  Necessarily,  therefore, 
Lachesis  is,  so  far  forth,  a “ left-sided  remedy,”  in  the  upper  part 
of  the  trunk,  at  least. 

All  of  these  affinities  are  given  clearly,  in  Allen’s  Boenninghau- 
sen’s  Pocket-Book. 

At  this  last  point,  however,  a new  element  appears.  Lachesis 
also  affects  the  liver,  on  the  right  side,  and  below  the  heart-mass, 
and  other  left-sided  upper  organs  with  which  it  clearly  affiliates, 
as  the  tonsil.  Dr.  Hering,  in  view  of  the  spiral  type  of  all  living 
forms,  saw  in  this,  only  a natural  continuity  of  structural  relation- 
ship, and  expressed  it  by  the  formula — “ upper  left,  lower  right.” 
Rhus , on  the  contrary,  is  “ upper  right,  lower  left.” 

Again,  Belladonna  shows,  in  nearly  all  organs,  a preference  for 
the  right  side.  China , in  like  manner,  for  the  left  side. 

All  “ antipsorics,”  the  cardinal  remedies  for  “ psora,”  the  prin- 
cipal “ chronic  miasm  ” of  Hahnemann,  appear  to  develop  their 
symptoms  from  within,  outward.  Indeed  all  the  chronic  drugs,  used 
against  the  three  poisons — “chronic  miasms” — of  syphilis,  and 
sycosis,  or  gonorrhoea,  as  well  as  psora,  are  by  Hahnemann  required 
to  have  this  same  peculiarity.  Sulphur  is  the  type  of  the  anti- 
psorics; Mercui'ius,  of  the  anti-syphilitics;  Thuja , of  the  anti- 
sycotics. 

On  the  other  hand,  Psorinum,  the  virus  of  psora,  works  from 
without,  inward;  and  hence,  seems  scarcely  suitable  as  a genuine 
anti-psoric. 

Lastly,  some  drugs  exhibit  a tendency  to  act,  mainly,  but  with 
exceptions,  from  above  downward  ; as,  Belladonna.  Others,  from 
below,  upward  ; as,  Aconite. 

Symptoms  moving  either  upward  or  inward,  are  held  to  be  of 
similar,  and  grave  import;  those  moving  downward  or  outward,  as 


THE  STUDY  OF  HOMOEOPATHY. 


887 


of  similar  and  salutary  tendency.  Allied  to  the  former,  is  the 
approach  to  a noble  organs,”  or  to  the  mind  ; comparable  with  the 
latter,  those  symptoms  which  recede  therefrom. 

Dr.  Hering  was,  after  Hahnemann,  the  greatest  exponent  of  this 
profound  subject,  in  our  ranks. 

The  course  and  direction  of  pains  and  other  sensations,  and  of 
advancing  anatomical  lesions,  is  very  characteristic  in  many  cases. 
Thus  stitches  running  downwards  in  the  sacrum  and  thighs,  of 
Kali  carbonicum  ; tonsillitis,  extending  from  right  to  left,  Lycopo- 
dium; from  left  to  right,  Lachesis.  * From  his  intimacy  with  the 
provings  of  the  latter,  Dr.  Hering  inclined  to  the  opinion  that 
sometimes,  at  least,  this,  the  therapeutic  indication  is  opposite  to  the 
facts  in  the  proving;  and  that  similar  symptoms,  in  the  same 
locality,  or  region,  but  opposite  in  direction,  are  the  truest  types  of 
Homoeopathy.  Similar  undulations  of  force,  in  diseased  tissues  and 
drugs,  travelling  in  opposite  directions,  being  the  true  similars,  versus 
identities. 

On  the  other  hand,  Dr.  R.  R.  Gregg,  in  his  valuable  Illustrated 
Repertory,  figures,  for  therapeutic  use,  the  courses  and  directions  of 
stitching  pains  in  the  trunk,  just  as  stated  in  the  provings  ; and 
gives  many  instances  of  successful  application  thereof.  This  ques- 
tion is  still  sub  judice. 

Special  Pharmacodynamics,  or  Materia  Medica. 

Part  V. — (Jahr,  Allen,  Cowperthwaite,  etc.). 

The  work  of  this  part,  during  a limited  term  of  teaching,  differs 
from  the  course  of  study  required  by  the  studious  practitioner, 
mainly  in  extent;  the  method  is  the  same  in  both  cases.  With  the 
latter,  also,  the  considerable  number  of  classifications,  generaliza- 
tions, etc.,  published  and  unpublished,  and  which  some  of  our 
thinking  men  have  proposed,  are  entitled  to  a fair  consideration  ; 
as  Hausmann’s,  Grauvogl’s,  Schiissler’s,  Morgan’s,  etc. 

As  to  the  students’  course,  it  is  important  to  bear  in  mind  that 
Part  IV.  is  fundamental  and  preliminary  to  this.  Later,  it  consists 
mainly  in  the  selection  of  a limited  number  of  leading  and  familiar 
drugs,  such  as  those  already  quoted  under  Part  IV.,  and  others, 
known  as  “ polychrests  ” (or  drugs  of  many  uses),  and  applying  all 
that  has  been  said  to  each,  in  this  way  securing  the  most  striking 
picture  of  each. 


888 


world’s  homoeopathic  congress. 


This  being  done  for  any  two  very  similar  drugs  of  the  list,  there 
remains  one  more  essential  proceeding,  viz.,  comparison . This  is 
performed  in  two  ways.  First,  copy,  or  otherwise  select,  those 
symptoms  of  either  which  are  most  emphatic  in  the  proving;  also, 
those  which  are  the  most  monopolized,  or  most  characteristic  of,  the 
drug.  A symptom,  characteristic  of  one  drug,  and  not  found  in  any 
other,  is  termed  a unicum.  Then,  with  the  Repertory,  and  with 
other  provings,  search,  among  these,  for  the  remedies  having  either 
strikingly  similar  or  strikingly  antagonistic  symptoms,  or  both ; 
mark  upon  the  margin  opposite  the  words:  “ Compare  with”  and 
“ Opposite  ” (adding  the  abbreviated  names).  Lippe’s  Pharmacody- 
namics represents  this  plan.  Dr.  H.  C.  Allen  is  the  author  of  a 
recent  reproduction  of  this. 

The  second  method  of  comparison  consists  in  writing  the  symp- 
toms, especially  the  emphatic  or  characteristic  ones,  of  the  two 
chosen  drugs,  in  parallel  columns,  upon  foolscap  paper,  under  the 
usual  rubrics,  and  in  such  a way  that  those  opposite  to  each  other 
shall  relate  to  the  same  subject,  and  shall  thus  display  their  simil- 
arity or  antagonism  in  a striking  and  practical  way.  In  this  arrange- 
ment, the  usual  anatomical  order  of  the  Materia  Medica  as  prescribed 
by  Hahnemann,  is  the  most  convenient.  Gross’s  Comparative  Mate- 
ria Medica  is  the  type  of  this  method.  Lippe,  Hering,  Morgan, 
Farrington  and  others  have  extended  the  work,  and  in  journals,  etc., 
have  further  illustrated  the  method. 

The  Materia  Medica  of  A.  Teste,  M.D.,  of  Paris,  translated  by 
Hempel,  but  now  out  of  print,  is  a good  example  of  the  comparative 
method  of  study,  upon  Hahnemannian  principles.  Recent  studies 
of  Epiphegus  and  of  Latrodectus , by  Dr.  S.  A.  Jones,  are  also 
models  in  their  way;  having  a pathological  bent  ( American  Homoeo- 
pathic Observer , etc.). 

The  “ clinical  method”  of  comparison,  herein  discussed  (see 
Therapeutic  Symptomatology ),  and  also  Boenninghausen’s  last  divi- 
sion, “ Relationships,”  may  here  be  added. 

The  literature  of  our  Materia  Medica  is  now  ample.  The  works 
of  Drs.  C.  Hering  and  T.  F.  Allen  stand  first,  without  doubt.  Next, 
that  of  Dr.  A.  C.  Cowperth waite.  Many  of  the  older  physicians 
still  rely  upon  Jahr’s  Symptomen  Codex , and  Lippe’s  work  ; Hering’s 
Condensed  Materia  Medica  is  satisfying  to  many  of  the  juniors. 

The  Pharmacodynamics  of  Dr.  Richard  Hughes,  like  his  Thera- 


THE  STUDY  OF  HOMOEOPATHY. 


889 


peutics,  is  well  suited  to  those  who,  having  a knowledge  of  Old- 
School  medicine,  but  believing  in  Homoeopathy,  seek  to  enter  upon 
its  study  and  practice,  as  novices. 

Clinical  Therapeutics. 

Part  VI. — “ Clinical  Therapeutics  ” or  the  “ Homoeopathy  of 
Experience.” 

Here,  as  always,  Hahnemann  and  his  Organon  are  first.  His 
Aphorisms  of  the  Treatment  of  Chronic  Diseases , collected  by  Dr.  S. 
Lilienthal,  and  published  not  long  before  his  death,  in  The  Cali- 
fornia Homoeopath  (1889),  under  the  title,  Catechism , is  of  great  im- 
portance, and  should  be  printed  in  book  form.  So  also  is  the  first 
volume  of  his  Chronic  Diseases.  All  invite  and  deserve  careful 
research  and  study. 

Again,  an  essay  upon  his  teachings,  by  Dr.  C.  Hering,  entitled, 
Hahnemann  s Three  Rules , is  of  immense  practical  value.  It  was 
published  in  volume  one,  number  one,  of  the  Hahnemannian 
Monthly. 

Verification  of  Provings  is  a leading  part  of  our  clinical  study. 
A certain  amount  of  skepticism  of  the  reliability  of  the  pathogenetic 
records  prevails,  and  is  natural  enough  ; whilst,  in  a convert  from 
ancient  medicine,  it  is  ofttimes  both  debilitating  and  painful.  All 
evidence  of  the  truth  of  these  is  therefore  of  the  greatest  value. 
Every  symptom  and  symptom-group  confirmed  at  the  bedside  by 
successful  practice  thus  becomes  a permanent  addition  to  our  thera- 
peutic wealth. 

In  connection  with  the  question  of  reliability  of  symptoms,  in  our 
Materia  Medica  and  Repertories,  most  physicians  doubt  the  “pure 
provings,”  as  to  which  symptoms  are  due  to  the  drug  under  trial, 
and  which  to  the  environment,  or,  above  all,  to  the  subjectivity  of 
the  prover.  This  is  quickly  answered ; every  symptom  in  a prov- 
ing is  a composite  of  all  three  of  these  factors,  in  varying  propor- 
tions. But  so,  also,  are  the  clinical  symptoms,  in  every  case  of 
disease  we  are  called  to  treat;  and  the  “similarity  ” of  the  curative 
drug  must  be  found  in  all  of  these  three  lines,  if  we  arrive  at  the 
similimum.  Lack,  in  either  line,  impairs  the  validity  of  the  selec- 
tion. Even  the  very  personal  traits,  the  texture  and  color  of  skin, 
hair  and  eyes,  are  significant ; much  more,  the  passing  sensations, 
even  if  trivial. 


890 


world’s  homoeopathic  congress. 


Secondly,  other  skeptics  are  concerned  as  to  the  inclusion  of 
symptoms  in  the  Materia  Medica  and  repertories,  which,  being  ob- 
served in  the  sick,  have  disappeared  after  the  remedy  under  consid- 
eration has  been  taken.  This  question  is  to  be  settled  only  by  critical 
observation.  Our  best  and  most  experienced  prescribers  testify  that 
so  far  from  being  deceptive  or  unreliable,  these  symptoms  are  often 
of  the  most  characteristic  nature.  That  they  have  not  yd  appeared 
in  a proving  does  not  invalidate  this,  and  this  appearance,  some  day, 
must  be  expected. 

Dr.  Hering  humorously  said:  ‘‘Such  symptoms  are  like  chil- 
dren, well  born,  but  coming  into  the  world  by  a breech-presenta- 
tion;” 

Thirdly,  other  skeptics  insist  that  either  class  of  symptoms,  if 
separated  from  their  natural  and  observed  grouping,  and  succession, 
are  meaningless  and  useless.  The  answer  is,  that  in  pathological 
studies  this  is  partly  true;  but  that  pathological  studies  are  inade- 
quate in  prescribing,  and  that  we  are  largely  dependent  upon  pure 
symptomatology,  in  its  most  primitive  form,  at  the  bedside. 

At  the  last,  the  testimony  of  experienced  prescribers  must  decide 
this  question  also.  Hering,  Boenninghausen,  Jahr,  Lippe,  Dunham, 
Guernsey  and  a host  of  others  have  found  that  this  theoretical  and 
sesthetical  objection  is  unpractical  and  misleading  at  the  bedside, 
and  that  such  symptoms  are  valid,  and  do  not  disappoint  the  user 
of  them. 

“Cured  symptoms’’  are  recognized  by  most  physicians  as  bearing 
the  very  best  credentials,  but  only  an  abundant  experience  can  en- 
able one  to  say  that  in  new  and  strange  combinations,  or  even  stand- 
ing isolated,  they  remain  true  to  nature,  are  true  and  essential  seg- 
ments of  a natural  whole,  and  are  reliable  in  drug  selection.  Ex- 
perience, however,  is  too  unanimously  in  favor  of  this  conclusion  to 
permit  of  further  doubt,  with  all  deference  to  those  highly  esteemed 
colleagues  who  hold  the  contrary  view.  Not  yet  found  in  a proving 
in  a healthy  body,  Nature’s  law  predicts  and  requires  that  some  day 
they  shall  so  appear;  and  if  already  in  a pure  proving,  also,  the  evi- 
dence becomes  final. 

Rank  of  Symptoms. — One  of  the  practical  difficulties  encountered 
in  the  practice  of  Homoeopathy  is  the  maze  of  symptoms,  seemingly 
of  equal  value,  of  which  every  “ totality  ” is  composed,  both  in  the 
chronically  sick  and  in  the  provings — the  materia  medica.  There 


THE  STUDY  OF  HOMOEOPATHY. 


891 


are  three  methods,  or  systems,  in  vogue  for  the  practical  solution  of 
this  difficulty.  Individual  physicians  combine  these,  at  will  : 

1.  The  pathological  method,  in  which  the  provings  are  subjected 
to  diagnostic  grouping  in  advance,  and  the  symptoms  of  the  patient 
after  similar  diagnostic  and  pathological  collation  are  compared,  as 
a whole,  with  the  pathological  symptom-groups  in  waiting  in  the 
materia  medica. 

2.  The  key-note  or  “ characteristic  ” system.  The  latter  term  is 
Hahnemann’s  own.  The  former  phrase  is,  to  the  disease  caused  by 
any  drug,  somewhat  as  is  the  word  u pathognomonic  ” to  an  idio- 
pathic disease ; it  names  the  drug ; subject,  however,  to  exceptions. 
In  other  words,  it  is  super -characteristic : it  stands  at  the  head  of 
the  characteristics  of  that  drug,  with  which  the  whole  drug-tune  har- 
monizes, and  is  almost  always  found  in  the  cases  cured  by  that  drug. 
And  it  is  often  irrelevant  to  any  noble  organ  ; is,  indeed,  often  triv- 
ial, apart  from  its  drug  identification.  We  owe  the  term  and  its  ap- 
plication mainly  to  Dr.  H.  N.  Guernsey. 

3.  The  system  of  graded  rank  of  symptoms.  Thus,  of  all  clini- 
cal indications,  the  highest  rank  is  conceded,  in  a general  way,  in 
acute  cases,  to  the  latest  symptom.  In  chronic  diseases,  however, — 
not  their  acute  outcroppings,  which  resemble  other  acute  cases,  and 
include  recent  drug-effects — in  pure  and  simple  chronic  errors — the 
highest  rank  belongs  to  the  long-suppressed  skin  affections,  believed 
to  be  the  root  of  the  whole.  After  these,  the  symptoms  of  the  no- 
blest organs  take  rank  and  precedence  in  the  picture  — the  “ totality.” 

Lastly,  the  psychic  symptoms — intellectual,  moral,  and  emotional, 
with  the  will,  plus  and  minus,  outrank,  ceteris  paribus , all  others  in 
both  acute  and  chronic  diseases. 

Heredity  becomes,  often,  the  ranking  indication  for  drug-selection 
and  for  hygienic  measures.  And  it  is  here  needful  to  say  that,  in 
the  view  of  modern  pathology,  the  scrofulous  taint,  a form  of 
“ psora,”  is  little  else,  to  use  the  phrase  of  Dr.  F.  F.  Maury,  than 
“ quarternary  syphilis.”  The  skin-clinic  of  Professor  Duhring,  in 
the  University  of  Pennsylvania,  has  confirmed  this  view,  to  which 
he  assents.  A child,  born  with  syphilitic  pemphigus,  for  instance, 
and  “ cured  ” by  routine  treatment,  reappears  at  two  and  a half  years 
of  age  with  scrofulous  sore  eyes,  etc.,  no  other  known  aetiology  ex- 
isting. 

Pregnancy — the  ante-natal  period — is  the  right  time  to  begin  the 


892 


world’s  homoeopathic  congress. 


cure  in  such  cases,  judging  of  remedies  by  the  symptoms  of  the 
mother,  and  of  the  other  children  if  any  there  be,  and  of  the  father 
also.  After  birth,  continuous  and  strict  Homoeopathic  auspices  are 
necessary  to  fit  the  young  person  to  produce  healthy  offspring,  and  to 
live  in  health  to  old  age. 

Ante-natal  treatment  of  a child  is  also  the  mother’s  opportunity  ; 
for  she,  herself,  is  the  prime  field  of  curative  activity,  in  which  her 
child,  as  part  of  herself,  simply  shares. 

In  girls  and  boys,  the  ages  of  teething  and  of  puberty,  and  the 
years,  more  or  less,  before  and  after  these  periods,  offer  special  oppor- 
tunities of  constitutional  and  radical  treatment  by  the  methods  of 
Hahnemann. 

All  of  these  are  in  the  line  of  physical  evolution.  The  age  of 
involution,  also — called,  in  women,  the  climacteric — is  truly  held  to 
be  “ the  critical  age,”  when  chronic  taints,  with  special  symptoms, 
often  seek  to  reassert  themselves.  Then,  we  should  be  prepared  to 
give  them  the  coup  de  grace. 

Nosodes  ; “ Isopathy.” — The  virus  of  any  disease  producing  such 
material,  according  to  Dr.  Hering  and  others,  is,  when  potentized,  a 
similar,  not  identical,  remedy  to  the  same.  Others  insist  on  the 
identity;  hence  reject  this  sort  of  therapy  as  isopathic  {isos,  equal; 
pathos , disease).  Hering,  however,  by  proving  these  on  healthy 
persons,  established  their  right  to  a place  in  the  Materia  Medica 
and  defined  their  particular  indications ; for  instance,  Lyssin , the 
attenuated  virus  of  hydrophobia,  which  has  a wide  therapeutic 
range  (see  Guiding  Symptoms).  Tuberculin , too,  is  our  ancient 
possession. 

Dr.  Samuel  Swan,  not  hesitating  to  push  this  idea,  extended  it, 
with  provings,  to  preparations  of  milk  (Zac),  human  and  other; 
to  beef  {Carnis  bovis) ; to  sugar  (Saccharum  officinals);  to  oatmeal 
(Avena),  and  many  others ; given  versus  cravings,  repugnances,  and 
ill  effects  alike  ; asserting  great  clinical  success. 

Typical  Drugs. — Whilst  individualization  is  the  invariable  duty 
of  the  physician  in  treatment,  it  is  restful  and  helpful  always  to 
initiate  this  mental  process  from  an  anchorage  in  the  consideration 
of  a few  pathological  drug-types;  thus  in  dysentery  one  must  in- 
stantly perceive  the  type  in  Nux  vomica  and  Alercurius  ; in  pneu- 
monia, j Bryonia,  Phosphorus , Tartar  emetic , etc.;  in  acute  fever, 
Aconite ; yet  none  of  these  may  be  finally  selected.  Nevertheless, 


THE  STUDY  OF  HOMCEOPATHY. 


893 


they  serve  as  fixed  points  whence  we  can  the  more  readily  proceed 
in  comparison  and  differentiation. 

A small  Domestic  Practice,  by  Samuel  Morgan,  M.D.,  may  be 
recommended  to  beginners  for  this  precise  purpose.  It  can  be  car- 
ried in  the  breast-pocket. 

Special  Drugs. — Two  common  drugs  (and  doubtless  many  more) 
are  of  special  interest,  owing  to  the  fact  that  they  cure,  on  the  one 
hand,  certain  perilous  states,  and,  on  the  other  hand,  they  sever- 
ally control  some  common  and  troublesome  but  merely  inconvenient 
conditions.  These  two  drugs  are  Aconite  and  Gelsemium.  Aconite 
is  the  remedy  for  profound,  acute  congestion,  even  with  loss  of  con- 
sciousness. It  also  cures  nervous  anxiety,  unwillingness  to  tell 
symptoms,  omodynia,  etc.  Gelsemium  cures  scarlatina,  with  stupor 
and  sudden  outcries  from  ear-pains;  also  mild  but  active  delirium 
in  typhoid  states.  Again,  it  helps  in  neuralgia  of  the  cervical 
plexus,  in  gastralgia,  and  in  alcoholic  and  other  forms  of  insomnia, 
viz.,  the  “ wide-awake ” kind. 

These  two  drugs  often  follow  each  other  very  well,  and  so  are 
especially  “complementary.”  They  outflank  and  overlap  the 
spheres  of  many  other  drugs,  performing  their  apparent  but  mis- 
taken duty.  Thus  after  failure,  in  children’s  diseases,  of  Chamo - 
milla , Bryonia , Podophyllum , etc.,  Aconite  has  repeatedly  cured. 
Years  ago,  Dr.  C.  J.  Hempel  so  taught;  but  he  wrongly  substi- 
tuted Aconite — mother-tincture  of  the  root — for  proper  attenua- 
tions of  true  curative  and  “similar”  drugs,  and  reaction  and  neg- 
lect followed.  Gelsemium  often  supersedes  Mercurius,  Pulsatilla , etc. 

Yet  another  drug  deserves  a special  place,  viz.,  Mercurius.  Most 
of  its  uses  are  well  known.  One,  little  if  at  all  recognized,  is  in 
that  mild  but  depressing  periostitis  which  remains  often  after  in- 
ternal diseases.  The  ribs,  the  bones  of  the  head  or  face,  the  coccyx, 
or  the  edges  of  joints,  are  tender  on  pressure  with  the  thumb-nail. 
Mercurius  cures. 

Hering’s  Analytical  Therapeutics — particularly  its  sections  on 
“Mind,”  and  on  “Typhoid  Fever,”  are  types  of  Homoeopathic 
clinical  study.  Hering’s  and  Horne’s  Materia  Medica  cards  or 
similar  ones,  home-made,  are  partly  “clinical”  in  origin  and  char- 
acter, and  are  very  helpful  for  self-quizzing ; having  characteristics 
printed  or  written  on  one  side,  and  the  name  of  the  drug  upon  the 
other. 


894 


world’s  homoeopathic  congress. 


Farrington’s  Clinical  Materia  Medica  is  substantially  Dr.  Her- 
ing’s  teachings  interpreted  and  extended  by  an  able,  young  and  en- 
thusiastic editor.  Happy  it  is  for  Homoeopathy  that  he  lived  and 
taught  and  wrote ! 

Dr.  Carroll  Dunham  performed  a similar  office  for  his  teacher, 
von  Boenninghausen,  besides  much  original  work.  His  Homoeopathy , 
the  Science  of  Therapeutics , is  one  of  our  “ sacred  books.” 

The  Pocket  Repertories , both  of  Jahr  and  of  Bryant,  quite  diverse 
in  plan,  and  now  nearly  or  quite  out  of  print,  were  exceedingly  use- 
ful. Jahr’s  Clinical  Guide , so-called,  is  founded  upon  the  former, 
edited  by  Dr.  S.  Lilienthal. 

Lilienthal’s  Clinical  Therapeutics  is  an  extension  of  the  Guide , so 
far  as  concerns  the  detail  of  known  drug  indications,  in  particular 
diseases  ; is  thus  well-suited  to  recent  converts,  and  to  beginners  gen- 
erally. A repertory  of  the  “ symptoms  ” is  greatly  needed. 

Hering’s  Guiding  Symptoms,  in  ten  volumes,  is  the  most  complete 
and  reliable  summary  of  Homoeopathic  experience  and  of  verified 
provings,  in  existence.  Among  our  English  colleagues,  the  method 
itself  is  disapproved  ; they  preferring  pathological  interpretation  and 
application  of  provings;  but  to  symptomatic  prescribers,  it  has 
proved  an  essential  aid.  The  author  was,  through  life,  wont  to 
record  the  symptoms  of  his  cases  and  when  these  disappeared  after  a 
well  selected  remedy , that  fact  was  noted  by  means  of  his  colored 
pencil.  In  constructing  his  book  the  varying  phraseology  of  many 
different  patients  in  describing  the  same  symptom,  has  been  largely 
preserved  ; enabling  the  reader  to  study  drug  characteristics  from 
so  many  sides,  as  to  give  assurance  of  exact  meaning  in  each  instance. 
For  example,  see  the  “ rattling  respiration  ” of  Tartarus  emeticus , 
in  this  work. 

Now  whilst  this  method  is,  as  already  shown,  not  above  theoretical 
and  scientific  criticism,  it  is,  to  some  mental  organizations,  indispen- 
sable. Therefore,  let  us  be  devoutly  thankful  for  its  existence. 

Dr.  T.  S.  Hoyne’s  Clinical  3Iateria  Medica,  after  the  plan  of 
Renckert’s  Therapeutics,  affords  a vast  mass  of  experience,  which 
might  now  be  much  extended.  Such  books  ever  need  an  Index 
and  Repertory  to  be  quite  available.  Allen’s  Index  is  often  essen- 
tial. 

Hale’s  New  Remedies  contains  much  valuable,  but  largely  empi- 
rical information. 


THE  STUDY  OF  HOMOEOPATHY. 


895 


Raue’s  Annual  Record  of  Homoeopathic  Practice  ; also  his  Path - 
ology  and  Therapeutic  Hints , afford  a rich  field  of  clinical  study. 

Guernsey’s  Keynotes  are  invaluable,  notwithstanding  all  objections. 

Johnson’s  Therapeutic  Key  is  really  a condensed  pocket  summary 
of  all  the  authorities,  and  its  many  editions  prove  its  necessity. 

Our  numerous  monographs  on  special  diseases,  of  which  the  type 
is  “Bell  on  Diarrhoea,”  etc.,  are  justly  held  in  high  esteem. 

Gentry’s  Concordance  Repertory  affords  a rapid  alphabetic  refer- 
ence to  clinical  and  proving  symptoms,  and  their  remedies. 

A number  of  systematic  text-books  on  Practice,  Surgery  and  Ob- 
stetrics, are  published  within  our  ranks,  and  are  worthy  of  attention. 

The  Repertories  and  the  Materia  Medica  are  here,  as  everywhere, 
in  place. 

Lastly,  our  numerous  journals,  and  society  Transactions,  are  full 
of  therapeutic  experiences  of  moment,  which  may  well  employ  the 
leisure  of  post-graduates,  in  turn  with  other  literature. 

True  Homoeopathy  has  nothing  to  fear,  and  everything  to  gain  by 
clinical  study. 

Besides  “ Bell  on  Diarrhoea,”  etc.,  we  have  others  in  the  field  of 
the  Specialties  ; on  the  Nervous  System,  the  Eye,  Ear,  Nose,  Throat ; 
Genito-Urinary  Organs ; Diseases  of  Women;  of  Children;  of  the 
Rectum,  Hemorrhoids,  etc. 

Diagnosis  has  too  much  hindered  our  progress  here,  by  apparently 
demonstrating  lesions  hopeless  of  medical  cure ; but  the  Homoeopaths 
of  forty  years  ago  must  have  cured  them  ; for  these  patients  had  a 
wonderful  fashion  of  getting  well.  Membranous  dysmenorrhoea, 
ovarian  tumors,  endometritis,  cancer,  etc.,  were  cured.  Just  before 
the  death  of  Dr.  H.  N.  Guernsey,  a great  cure  of  the  first-named 
malady  was  effected  by  me,  through  his  counsel ; and  I have  wit- 
nessed much  more  of  the  same  kind,  and  so  have  others. 

Original  Work . — Such  work  as  this  is  identical  with  that  of  the 
founder  and  the  pioneers.  Expressed  in  scientific  form,  it  belongs 
to  the  department  of  Original  Work  ! This  it  is  that  has  furnished 
to  indolent  and  mercenary  doctors,  the  clinical  material  of  our 
School,  the  so-called  “usual  symptoms,”  by  which  they  always  has- 
ten to  their  prescriptions,  and  earn  their  money  ; and  which  are 
literally  their  “ stock  in  trade;  ” they  being  personally  incapable  of 
the  said  “original  work  ;”  and  who  habitually  sneer  at  their  bene- 
factors. 


896 


world’s  homoeopathic  congress. 


The  Cyclopedia  of  Drug  Pathogenesy , a condensed,  synoptical 
work,  recently  published  by  the  joint  efforts  of  the  British  and 
American  national  societies,  supplies  a former  lack  in  this  line,  and 
with  its  Repertory  will  undoubtedly  advance  us  in  the  future  with- 
out superseding  older  books. 

Reading  Between  the  Lines. — This  is  a common  exercise  of  the 
human  intelligence,  since  not  all  things  are  as  they  seem.  In  the 
repertory  and  in  the  Materia  Medica,  interpretation  is  often  needed, 
in  order  to  get  the  just  meaning  of  a symptom  ; it  may  say  too  much, 
or  too  little.  Rash  interpretation  must  be  avoided,  but  the  mind 
should  be  on  the  alert  in  this  way.  For  instance,  Dr.  Lippe  com- 
plained to  Boenninghausen  that  u aggravation  by  wearing  the  hat” 
was  not  to  be  found  in  the  extant  edition  of  his  Pocket-Book. 
His  reply  was  : “ Yes,  it  is  necessarily  included  in  ‘ worse  by  cover- 
ing the  head.’”  Such  reading  between  the  lines  is  always  in  place. 

Again,  Gelsemium  produced  intestinal  symptoms  under  depressing 
excitement ; but  it  has  been  successfully  applied  when  no  intestinal 
symptoms  were  present. 

Dr.  Hering,  being  a Swedenborgian,  laid  stress  upon  a branch  of 
this  subject,  falling  under  “ the  doctrine  of  correspondences.”  A 
special  thought  of  his  was,  that  certain  persons  correspond  to,  and 
represent  certain  animals  of  known  physiology  and  habits  and  symp- 
toms. Thus,  a hog.  human  or  other,  will  grovel  in  the  dirt;  and 
Sulphur  presents  a physical,  and  hence,  a psychical  affinity  to  both, 
and  thus  a physiological  and  pathological  adaptation  to  both.  Again, 
long  before  Schiissler  wrote  he  has  said,  “ Wherever  an  inorganic 
substance  exercises  a physiological  function  in  the  nutrition  of  the 
tissues,  there  it  is  sure  to  be  an  important  remedy  in  sickness.” 
(Sulphur  in  all  albuminoid  tissues.)  He  compared  people  who  cannot 
vomit  with  the  horse,  which  also  cannot  vomit.  In  the  language  of 
Evolution,  this  kind  of  correspondence  would  be  called  “ physiolog- 
ical homology.”  Hausmann,  Schiissler,  Grauvogl,  Morgan  have 
pursued  this  subject  in  old  publications. 

Dr.  Samuel  Freedley  informed  me  of  his  curing  himself  of  an 
“ old  man’s  ulcer  ” of  the  leg  by  Tarantula  cubensis.  I reasoned 
that  an  animal  so  low  represents  degraded  human  tissue,  and  is  ho- 
mologous with  low  disease-changes.  Hence  I have  used  Cimex  with 
benefit,  in  ulcer  of  the  rectum,  and  Apis  in  gonorrhoea,  etc.  All  of 
which  is  “ reading  between  the  lines.” 


THE  STUDY  OF  HOMOEOPATHY. 


897 


The  germ-doctrine  as  related  to  Homoeopathy  has  agitated  many 
among  us.  The  first  impression  of  such  was  that  it  might  render 
infinitesimal  doses  in  germ  diseases  absurd,  indeed,  and  that  the 
rational  treatment  of  such  diseases  must  needs  be  germicidal. 
Diphtheria,  in  particular,  was  the  field  of  conflict ; for  the  Hahne- 
mannians  held  their  ground  by  faith  and  cured  their  cases,  as  be- 
fore, with  the  similimum. 

The  latest  light  of  bacteriological  science  fully  justifies  them.  It 
is  now  determined,  firstly,  that,  internally  at  least,  germicides  are 
improper;  secondly,  that  healthy  blood-serum  and  other  fluids  of 
the  body  destroy  the  life  of  the  disease-germs,  and  that  then  the 
wdiite  globules  devour  and  digest  them ; thus,  thirdly,  the  one 
thing  needful  above  all  else  versus  germ  diseases  is  to  maintain  or 
to  restore  the  vigor  of  the  organs  and  tissues  which  generate  these 
germicide  fluids  and  globules  continuously  during  life.  This  is  the 
special  office  of  Homoeopathic  medication,  supplemented  by  hygienic 
care.  Doubters  may  now  rest  in  peace. 

The  “ orificial  philosophy  ” in  medicine.  The  surgical  successes 
of  this  new  element  in  the  healing  art  have  done  much  to  divert 
Homoeopathic  physicians  from  their  own  specialty  and  to  aid  in  the 
dominance  of  “the  surgical  epoch.”  This  is  scarcely  necessary. 
Many  orificial  lesions  are  still  amenable,  as  they  have  always  been, 
to  Homoeopathic  remedies  skillfully  chosen  and  administered. 

Our  present  concern  is  the  recognition  of  the  inlets  and  outlets  of 
the  body  as  special  disease  foci.  An  old  doctrine  is  here  brought 
prominently  into  view  but  in  a new  dress,  in  a new  light  and  with 
great  extension,  viz.,  vital  sympathy.  Not  alone  the  sympathetic 
nervous  system,  but  the  spinal  reflex  system  as  well  must  be  con- 
sidered in  this  philosophy ; and  both  not  only  as  to  the  motor  re- 
fl  xes,  but  also  as  to  reflex  sensation  and  functions,  and  trophic  or 
nutritive  reflexes  affecting  the  most  remote  and  diverse  tissues  and 
organs. 

In  looking  over  our  written  notes  of  former  cases  we  are  struck 
with  the  many  anomalies — not  always  paralleled  in  the  Materia 
Medica — in  all  these  particulars  which  have  distressed  the  patients 
and  distracted  the  doctor.  And  now  the  orificial  philosophy  has 
come  to  teach  the  profession  how  to  grasp  and  utilize  these  and 
give  them  a natural  grouping;  to  “read  between  the  lines”  in  this 
new  direction,  and  to  aid  the  Homoeopathic  physician  in  exposing 

57 


898 


world’s  homoeopathic  congress. 


the  occult  u totality  of  symptoms  99  to  objective  recognition  by  eye- 
tests,  by  the  rectal  speculum,  and  by  all  the  modern  methods  of 
examination . Methinks  Hahnemann  himself  would  delight  in 
these  were  he  with  us,  and  would  insist  that  our  drug-provings 
be  perfected  by  like  means,  that  our  selections  might  be  more  and 
more  precise.  No  one  more  than  he  has  valued  positive  objective 
demonstration  of  morbid  alterations,  but  in  his  day  this  was  sadly 
restricted  by  the  limitations  of  general  knowledge.  Let  our  future 
prescribing  intelligently  reflect  our  present  advantages! 

“ Treat  the  Patient  not  the  Disease  99  This  dictum  of  the  pioneers, 
now  classic,  is  distinctive  of  pure  Homoeopathy ; which,  however 
practical  exigencies  may  seem  to  cause  any  to  depart  from  it,  is  the 
only  possible  “point  of  departure,”  as  navigators  phrase  it,  and  it 
is  ever  in  view,  also,  as  “ the  returning  point,”  as  rhetoricians 
say. 

It  is  justified  in  two  ways:  Firstly,  by  the  fact  that  “ totality  of 
symptoms 99  means  the  whole  man — nothing  less.  Secondly,  that,  like 
a derelict  householder,  the  man  is  the  sustainer  of  a nuisance  called 
disease . A municipality  does  not  itself,  usually,  abate  a nuisance, 
but  calls  upon  the  householder  himself  to  do  so.  Homoeopathic 
solicitation  of  the  living  organism,  or  its  “ vital  principle,”  does  the 
same  thing  as  to  every  particular  disease.  The  attack  upon  disease, 
perse,  savors  of  surgical  coercion. 

This  may,  indeed,  be  needful  at  times,  but  should  never  be  con- 
founded with  medical  practice  proper.  It  is  wholly  exceptional.  The 
pure  medical  idea,  we  repeat,  is  purely  Homoeopathic. 

The  Medical  Idea , in  the  Treatment  of  Tumors ; of  Intestinal 
Worms  ; and  of  Parasitic  Skin  Diseases. 

This  is  largely  a matter  of  “ treating  the  patient,”  rather  than  the 
disease;  for,  although  local  sensations  and  objective  appearances  have 
much  influence  in  drug  selection,  nevertheless,  these  are  still  only 
emphasized  voices  in  which  we  hear  that  of  the  suffering  vital  prin- 
ciple, as  Hahnemann  would  say  ; the  witnesses  of  the  error  of  the 
whole  living  man.  These,  together  with  the  “ generalities  ” and 
mental  symptoms,  can  point  out  to  us  the  lines  on  which  “ Homoeo- 
pathic solicitation  of  the  imperial  vital  principle”  may  be  offered, 
and  by  which  nature’s  curative  reaction  may  be  received. 

In  a word,  our  business  is,  to  make  the  living  soil  so  healthy  and 
resistant  that  it  will  no  longer  afford  a nidus  for  the  tumor  or  the 


THE  STUDY  OF  HOMOEOPATHY. 


899 


parasite.  In  all  germ  diseases,  likewise,  this  is  the  aim,  and  this 
the  successful  practice,  of  the  genuine  Homoeopathic  physician. 

Our  surgeons , in  the  old  days,  realized  the  vast  superiority  of  our 
law  and  our  remedies  in  the  after-treatment  of  wounds,  accidental 
or  operative,  and  of  “ surgical  diseases,”  so-called  ; and  the  excellent 
work  of  Dr.  J.  G.  Gilchrist,  entitled  Surgical  Therapeutics , illus- 
trates their  practice.  To  day,  however,  it  must  be  confessed  with 
shame  that  surgical  therapeutics  is  the  same,  almost,  in  both  schools, 
and  that,  often,  our  surgeons  mildly  resent,  to  the  detriment  of  their 
patients  and  of  their  statistics,  all  suggestions  of  u Homoeopathic 
purity,”  and,  particularly,  of  Hahnemannian  individualization. 

The  sources  of  surgical  progress  in  the  old  world  are,  also, 
the  tyrants  of  surgical  therapeutics,  and  their  dicta  are,  by  both 
schools  more  or  less,  regarded  as  final.  The  remedy  for  this  lapse, 
on  our  part,  is  to  establish,  in  all  our  surgical  hospitals,  a rule  of 
therapeutic  consultations,  in  all  cases,  with  competent  exponents  of 
sound  Homoeopathy. 

Contra-indications  of  Remedies. 

Drugs  may  be  deleterious  to  the  organism,  even  in  homoeopathic 
doses.  It  follows  that  in  certain  cases,  where  the  chances  of  life 
are  already  very  slight,  that  use  of  an  unsuitable  drug  may  even 
prove  lethal.  It  is  important,  therefore,  to  study  this  matter  well. 

1.  Too  great  persistence  in  giving  the  right  remedy,  also  too  ma- 
terial doses,  impose  too  much  of  the  “ primary  effect”  thereof  upon 
the  living  body.  High  potencies  may  overdo,  in  the  general  sphere 
of  the  organism,  and  in  the  nervous  system. 

2.  Persistence  with  one  potency  beyond  the  show  of  vital  reac- 
tion may  retard  this ; whereas  a change  of  potency,  higher  or  lower, 
may  revive  it. 

3.  Giving  a drug  suitable  to  the  leading  local  symptoms,  but  un- 
suited to  the  temperament , often  does  harm.  Thus  in  a fever,  with 
drowsiness,  suffused  eyes,  slow  motions,  crimson  color  of  the  whole 
face  to  the  hair  and  the  ears,  Gelsemium  is  indicated,  not  Aconite , 
nor  Belladonna  ; and  both  of  these  are  contra-indicated. 

And  if  the  patient  is  anxious,  restless,  thirsty,  sure  of  speedy 
death,  etc.,  neither  Gelsemium , nor  Belladonna , but  Aconite  is  suit- 
able. 

Or  if  he  is  hasty,  audacious,  maniacal,  with  sudden  notions,  and 
dry,  throat,  all  but  Belladonna  are  contra-indicated. 


900 


world’s  homoeopathic  congress. 


4.  Some  drugs  are  contra-indicated  by  the  nature  of  the  existing 
morbid  process.  Thus  blood-poisoning,  typhoid  or  other,  has  little 
in  common  with  the  sthenic  Aconite , but  calls  for  Gels .,  Bapt., 
Rhus , Bryonia  or  Arsenic,  asthenic  drugs.  The  first  is,  hence,  usually 
contra-indicated  in  the  height  of  typhoid  fever.  Teste  points  out 
that  drugs  are  likely  to  suit  best  the  temperament  and  the  diseases 
of  mankind,  in  their  own  habitat.  Aconite  is  a mountain  drug  ; 
Gelsemium  growing  in  low,  damp,  warm,  and  malarial  districts. 

5.  Symptomatic  antipathy,  of  course,  is  always  a contraindica- 
tion. 

6.  Inimical  drugs  are  such  as  do  not  follow  each  other  well — as, 
Apis  and  Rhus ; Phosphorus  and  Causticum — and  exert,  thus,  bad 
effects,  and  so  are  contra-indicated.  (See  a pamphlet  on  this  subject 
by  Charles  Mohr,  M.D. ) 

Dosage. — As  an  addendum  to  this  part  it  is  needful  to  refer 
briefly  to  the  question  of  dosage. 

The  “ minimum  dose”  of  Hahnemann  is  a relative  measurement 
only,  and  means  ft the  smallest  dose  sufficient  to  cure;”  and  this 
measurement  must  be  determined  by  each  physician  for  himself 
and  for  each  individual  case  separately.  In  general,  we  may  accept 
the  empirical  formula,  viz.,  “ all  drugs  have  double  and  opposite 
properties  and  effects,  according  as  the  doses  are  large  or  small,” 
and  admit  that  the  former  show  dominant  primary  or  “ physio- 
logical ” effects,  the  latter  dominant  secondary  or  opposite  effects. 
From  this  vantage  ground  we  may  consider  the  neutral  point  be- 
tween these  and  both  extremes. 

Management  of  Remedies  and  Dosage. — A few  detailed  sugges- 
tions on  these  matters,  as  seen  in  daily  practice,  will,  doubtless,  be 
acceptable.  And  in  the  first  place,  it  should  be  said  that  in  acute 
diseases  both  high  and  low  attenuations  are  effectual;  but  that  the 
more  extensive  the  anatomical  lesion  the  more  solid  the  affected  or- 
gan, and  the  greater  the  degree  of  tissue  alteration  the  greater  the 
tolerance  of  the  low  and  even  of  the  lowest.  On  the  other  hand, 
the  less  extensive  the  lesion  the  less  solid  the  tissue  affected,  and  the 
less  the  tissue-change — in  short,  the  more  purely  functional  is  the 
malady  the  more  needful  are  the  highly  attenuated  preparations. 
Also,  the  personal  sensitiveness  is  a leading  reason  for  corresponding 
dosage.  A plus  of  this  demands  the  higher;  a minus , lower. 


THE  STUDY  OF  HOMCEOPATIIY. 


901 


Recent  intermittent  fever  does  well  on  low  attenuations,  as  of  Gel- 
semium.  Confirmed  cases  demand  the  higher,  e.g.,  the  thirtieth  cen- 
tesimal and  upward  of  Bry.,  Puls.,  Nux  v.,  Natr.  m.,  Ars.,  etc.  The 
lower  attenuations  (lx  to  6x)  are  usually  repeated  in  hyperacute 
disease  very  rapidly,  say,  five  to  twenty  minutes.  In  common  acute 
cases  hourly  or  oftener*  “ until  an  impression  is  made,”  i.e.,  until  dis- 
tinct and  positive  improvement  is  noted ; then,  less  and  less  fre- 
quently— “ tapering  off,”  as  it  has  been  called,  as  the  lesion  subsides 
with  the  symptoms.  But  if,  instead,  an  w impression  ” of  aggrava- 
tion sets  in,  due  to  the  drug,  a higher  potency  is  given,  provided  the 
symptoms  still  indicate  it;  but  if  these  have  changed,  and  the  lesion 
remain  unsubdued  in  great  part,  then  a re-examination  and  a new 
drug  are  in  order.  If  every  prescription  aggravates  the  symptoms 
and  the  lesion  be  in  abeyance,  and  if,  besides,  the  vitality  be  better, 
all  drugs  should  be  stopped  and  a placebo  or  else  nothing  be  given ; 
permitting,  now,  the  “ secondary  vital  reaction”  to  occur,  without 
the  least  interference,  so  long  as  improvement  continues.  “ Improve- 
ment” recognized,  even  when  it  is  as  yet  limited  to  the  psychic 
sphere,  the  physical  is  sure  to  follow,  duly. 

In  subacute  diseases  the  doses  are  given  about  three  times  a day 
for  a week ; although  some  physicians  repeat  much  oftener  if  the 
system  tolerate  it,  even  in  chronic  cases.  Change  of  symptoms  is 
met  by  change  of  the  drug. 

Low  attenuations  in  chronic  diseases  are  repeated  once,  twice,  three 
or  more  times  per  week.  Sometimes,  if  counterbalanced  by  obstinate 
lesions  in  similarity  with  the  drug  every  three  hours  has  been  borne, 
e.g.,  Rhus  tox.  6,  in  cutaneous  syphilis,  continued  some  months,  with 
Bryonia  as  an  intercurrent  remedy  for  “ muscular  pains.” 

High  potencies  (attenuations)  are  usually  given  more  sparingly. 
In  collapse,  after  exhausting  disease,  one  dose  only  can  be  endured. 
Per  contra , in  early  cholera,  etc.,  every  five  minutes  to  twenty  min- 
utes. In  acute  diseases,  sometimes,  a single  dose  will  carry  the  case 
to  the  curative  reaction.  But  better  work  is  likely  to  be  done  in 
such  cases  by  some  repetition;  e.g,,  three  doses,  one  hour  apart;  or 
four  doses,  two  hours  apart,  and  if,  after  an  improvement,  exacerba- 
tion occur,  repeat  and  give  six  hours  apart.  Six,  instead  of  four 
doses,  if  the  patient’s  organism  be  known  to  be  refractory  to  Homoe- 
pathic  remedies — also  every  two  hours.  This  is  often  satisfactory 
in  confirmed  intermittent  fever ; sometimes,  however,  twelve  doses 


902 


world’s  homoeopathic  congress. 


do  better.  The  placebo  is,  of  course,  much  used  with  the  higher 
attenuations,  or  rather,  commonly,  after  them,  viz.,  Saccharum  ladis. 
Much  lesion  justifies  hourly  doses  for  one  day,  or  every  three  hours 
if  less;  gradually  lengthening  the  intervals. 

In  subacute  diseases  two  doses  every  second  day,  six  in  all,  is  well  • 
but  every  night,  or  every  second  night,  may  be  preferred  if  very 
gradual  effects  are  sought. 

In  chronic  diseases  one  dose  may  cure.  Two  doses  are  more  em- 
phatic, two  to  twelve  hours  apart.  Or,  three  doses,  one-half  to  one 
hour  apart.  Or,  four  doses,  one  every  third  or  fourth  night.  Some- 
times, as  in  tumors,  a single  dose,  once  in  thirty  days,  as  of  Sepia  or 
Hepar  sulph .,  has  done  good  “ alterative”  work. 

High  Potency  Aggravation. — Sudden  increase  of  lesion  and  seri- 
ous aggravation  of  symptoms  in  acute  disease  demands  a placebo. 
If  the  drug  were  the  true  similimum  the  case  will  hold  its  own  there- 
under for  about  six  hours,  and  then  a rapid  improvement,  in  every 
respect,  may  be  surely  expected.  Such  a case,  however,  should  be 
faithfully  watched ! 

In  chronic  disease  a primary  aggravation  is  a good  sign,  and  usu- 
ally lasts  about  three  to  four  days;  sometimes,  however,  one  or 
more  weeks ; whilst  the  physician  must  stay  his  mind  upon  the 
assurance  of  his  skillful  selection.  No  repetition,  of  course,  nor 
change  of  remedy  is  proper  if  this  assurance  be  well  founded.  The 
secondary  vital  reaction  is  now  his  objective  point,  and  at  that  point 
the  cure  becomes  apparent  as  a coming  event.  (See  Hahnemann’s 
Three  Rules.) 

A word  as  to  “ schools  of  practice 

A symbolic  view  of  the  entire  healing  art,  with  all  of  its  theory 
and  practice,  may  be  had  by  taking  a rod  or  wand  and  inscribing 
upon  the  two  ends  and  the  middle  certain  words,  viz. : On  one  end, 
“ coercion — surgery;”  on  the  other  end,  “ solicitation — medicine;” 
and  on  the  middle  “ palliation  ” (including  all  kinds).  “ Practice  ” 
is  addressed  to  living  nature;  the  surgical  idea  is,  nature  intending 
to  go  wrong  ; our  aim,  therefore , is  here  wholly  to  coerce  her  to  the 
will  and  subject  her  to  the  dictation  and  manipulation  of  the  doctor. 
Sometimes — that  is,  in  proper  cases — she  kindly  consents;  in  all 
the  rest  she  resents  and  defeats  the  effort.  Not  only  the  knife,  but 
drugs  also  may  do  the  surgical  work,  as  emetics,  cathartics,  etc. ; 
and  the  result  is,  as  stated,  still  variable.  This  “surgical  idea” 


THE  STUDY  OF  HOMOEOPATHY. 


903 


and  its  practice  are,  in  one  word,  “Allopathy,”  as  now  before  the 
world  ; and  this  word  is  hence  to  be  written  also  upon  the  surgical 
end  of  the  wand,  with  no  offensive  but  with  a purely  philosophical 
meaning,  of  course,  as  originally  used  by  Hahnemann  himself. 

Again,  the  medical  idea  is,  nature  is  striving  to  go  right , but  is 
diverted  by  lack  of  proper  suggestion,  or  stimulus,  or  solicitation  ; 
the  least  sufficing.  The  aim  here  is  to  recognize  her  proneness  to 
cure;  her  sole  power  to  cure;  her  need  of  suggestion,  guidance, 
stimulus — in  one  word,  of  solicitation — at  the  exactly  right  point 
or  points  in  the  organism,  as  shown  by  the  symptoms  and  under 
the  law  of  similars.  To  this  solicitation,  in  all  curable  cases,  she 
responds  and  cures  the  whole  disorder — restores  the  whole  patient. 

This  “ medical  idea”  and  its  practice  are,  in  one  word,  “Homoeo- 
pathy,” as  now  known  to  the  world  ; and  this  word  is  therefore  to 
be  now  added  to  the  inscription  upon  the  medical  end  of  our  wand. 

Lastly,  the  middle  of  the  wand  includes  all  that  is  not  absolutely 
surgical  or  medical  in  the  healing  art,  viz.,  dietetics,  sleep,  clothing, 
and  the  whole  field  of  physical  and  psychical  hygiene.  “ Poison- 
ing ” and  its  treatment  belong  properly  to  the  surgical  end  ; after- 
effects of  dynamic  sort  to  the  medical  end.  But  what  further  palli- 
ation is  to  be  classified  ? Answer  : All  the  “adjuvants,”  so  called, 
of  medical  practice — non-medicinal  applications,  non-surgical  expe- 
dients, etc.;  and,  lastly,  the  “similar  remedy”  itself  may  be  con- 
sidered. Old-school  practice  is  so  largely  palliative  that  it  seems 
fitting  to  call  it  the  palliative  school.  But  mark  the  difference  ! 
The  palliatives  of  the  latter  are  most  characteristic  upon  the  surgical 
or  coercive  side  of  this  centre  ! Those  of  the  Homoeopathic  school 
are  neutral,  e.g .,  water,  hot  or  cold,  demulcents,  etc.  (as,  powdered  gum 
arabic,  in  moist  ulcer  of  the  nipple);  as  a rule  neither  medical  or  sur- 
gical, but  if  otherwise  they  are  found  upon  the  medical  side  of  this 
centre*!  Indeed,  Dr.  Henry  N.  Guernsey  used  to  assert  that  “the 
best  palliative  is  the  Homoeopathic  remedy  !” 

A connection  may  also  be  formed  between  the  two  lines  of  profes- 
sional thought  and  experience  by  assimilating  equivalent  phrases  in 
use  by  both.  Three  of  these  pairs  are  as  follows:  Our  “ primary 
effect”  the  other  side  call  “the  physiological  action,”  and  this  is 
their  main  reliance.  If  this  be  subject,  as  in  Digitalis , to  sudden 
toxic  excess  the  effect  is  ascribed  to  a yielding  of  resistance,  owing 
to  the  storing  up  of  the  drug  in  quantity  in  the  system ; its  victory 


904 


world’s  homoeopathic  congress. 


over  vitality  then  occurring.  Now,  we  see  our  minute  doses  do  like- 
wise, but  in  a milol  way.  According  to  our  respective  ideas,  they 
entitle  this  phenomenon  “ cumulation;”  we  say,  “ drug-aggravation.” 

Again,  in  chronic  cases,  they  give  minute  doses  of  Iodine , Mercury , 
Arsenic , etc.,  acting  in  a quiet,  subtle  way,  not  understood;  they  call 
them  “ alteratives.”  We  say,  “antipsoric,”  antisyphilitic,”  “anti- 
sycotic  ” remedies. 

It  is  not  to  be  inferred  that  either  school  of  practice  confines  itself 
logically  to  its  own  end — its  own  characteristic  field,  or  that  truth 
and  consistency  demand  that  it  shall  do  so.  The  correct  principle 
is  simply,  to  treat  medical  indications  purely  by  Homoeopathic  reme- 
dies, with  neutral  palliatives,  if  necessary ; on  the  other  hand,  to 
treat  surgical  indications  accordingly,  and  finally,  never  to  confound 
them.  Physiological  errors,  and  the  resulting  alterable  anatomical 
lesions,  always  belong  to  the  former  class.  The  best  treatment  of 
“ diseases  ” by  the  senior  branch  of  our  profession  is,  “ Homoeopathy, 
unawares,”  crude  and  mongrel-like,  indeed,  but  recognizable.  In 
our  own  school,  the  converse  is  too  often  visible ; hence,  this  paper ! 
All  the  malicious  insinuations  uttered  against  our  loyalty  will,  how- 
ever, fall  to  the  ground  whenever  we  ourselves  shall  sharply  distin- 
guish between  medicine  and  surgery,  as  above. 

In  many  painful  affections  people  clamor  for  a liniment.  I then 
prescribe,  with  good  and  innocent  effect,  the  following : Alcohol, 

two  ounces  ; Sweet  oil,  one  teaspoonful.  Mix  in  a new  vial,  with  a 
new  cork,  and  apply  as  needed. 

Narcotics  and  other  drug  palliatives,  germicides,  and  condiments, 
tobacco,  et  id  omne  genus , as  a rule,  do  not  prevent  the  specific  action 
of  well  selected  Homoeopathic  preparations;  but  they  nevertheless 
may  work  evil  in  the  system,  each  in  its  own  way,  independently  of 
our  drugs.  Only,  if  they  are  similars  to  the  latter  they  may  have 
some  antidotal  effect. 

A familiar  instance  of  a Homoeopathic  remedy  fulfilling  its  spe- 
cific work,  despite  medicinal  conditions  and  the  like,  and  even  in 
the  face  of  the  fact  of  “ similarity”  itself  is  seen  in  the  unerring 
action  of  Natrum  muriaticum  or  Sodium  chloride,  when  prepared  by 
attenuation  or  “ potentization,”  notwithstanding  the  crude  substance 
is  in  simultaneous  use  in  most  articles  of  food.  This  is  a stumbling 
block  to  some  superficial  thinkers,  but  is  easily  explained,  thus : the 
potentized  drug,  so  far  as  dynamic  activity  is  concerned,  apart  from 


THE  STUDY  OF  HOMCEOPATHY. 


905 


chemical  and  physical  forces  is  experimentally  found  to  be  the  supe- 
rior; hence,  the  term  potentization.  The  provdngs  of  Natrum  muri- 
aticum , already  mentioned,  have  revealed  this  astonishing  fact  and 
established  it  beyond  peradventure.  Silica,  Aurum , and  the  other 
insoluble  drugs  have  added  their  confirmation. 

A common  Homoeopathic  experience  is  the  mutual  antidotal,  or, 
at  least,  modifying  power  of  the  higher  and  the  lower  attenuations 
of  drugs.  Often,  when  a drug  has  acted  in  excess  of  equilibrium 
with  disease  forces  a change  of  potency,  in  either  the  upward  or  the 
downward  direction  renews  the  good  effect  or  abolishes  a bad  one, 
i.e.,  “ antidotes”  it. 

Dr.  H.  N.  Guernsey,  in  view  of  this,  was  in  the  habit  of  treating 
chronic  tobacco  poisoning  with  Tabacum  in  high  potency. 

Pain  and  Analgesics. — Many  “analgesic”  drugs  are  now  offered 
for  our  favor,  but  we  cannot,  with  impunity,  forget  that  only  the 
totality  of  symptoms  (pains  included)  can  justify  any  prescription. 
Pain  \s  the  second  point  in  Boenninghausen’s  system  of  selection,  and 
a rightly  selected  drug,  duly  regarding  location,  hind  of  pain,  and 
the  conditions  of  aggravation  and  amelioration  represents  a specific 
analgesic  power,  with  which  crude  non-specific  anodynes  have  no 
right  to  compete  or  to  interfere.  Thus  it  is  that  the  best  anodyne 
is  the  “ similar  remedy,”  and  also  the  most  prompt  and  permanent. 
Hot  or  cold  applications,  wet  or  dry,  may  be  of  temporary  service, 
likewise  satisfying  clamors  which,  sometimes,  cannot  be  put  off;  and 
they  are  not  hurtful  if  properly  managed,  but  they  must  be  non- 
medicinal,  as  a rule,  or,  if  medicated,  it  must  be  with  the  similimum, 
and  the  same  remedy  as  that  given  internally. 

Consider  Aconitum  for  wound  pain  and  any  severe  pain  with  dis- 
tress, worry,  feverishness,  restlessness,  and  looking  for  death.  Cham - 
omilla  when  one  must  walk  the  floor,  and  can  scarcely  or  not  at  all 
speak  civilly.  (Besides,  consider  the  whole  case.) 

Soporifics . — Sleeplessness  is  another  evil  little  tolerated  by  patients 
and  friends.  Indeed,  it  is  devitalizing,  per  se,  quite  as  much  as  is 
pain.  Two  principal  kinds  of  proximate  causes,  I think,  are  respon- 
sible for  it,  and  by  removing  these  it  may  be  controlled.  Firstly, 
physical  discomfort,  as  from  heat  or  cold,  general  or  local,  hunger, 
thirst,  uneasy  position,  or  pain.  Careful  and  minute  diagnosis  of 
such  causes  is  preliminary  to  removal,  of  course.  Unconscious  mus- 
cular effort , often  trivial,  is  a common  condition  of  insomnia.  Hold- 


906 


world’s  homoeopathic  congress. 


ing  up  the  chin  for  free  breathing  is  a common  form  of  this ; it 
should  always  be  suspected  and  eliminated.  Elevation  of  the  head 
from  the  pillow  for  hearing  or  other  purposes,  if  but  to  the  height 
of  a millimetre,  suffices  to  keep  one  awake.  Supporting  a knee  or 
even  a finger  will  do  the  same. 

The  remedy  is  to  agive  way  all,”  and  fall  asleep.  One  who  has 
tried  this  proceeding  testifies  that  its  effect  is  always  instantaneous. 
Pain,  as  above  discussed,  again  requires  consideration  here  in  the 
same  terms. 

Secondly.  Mental  preoccupation,  pleasant  as  well  as  unpleasant,  is 
equally  inimical  to  sleep.  Hence,  monotonous,  dry  reading,  or 
grave,  heavy,  muffled,  uncertain  sounds,  as  of  distant  machinery  or 
vehicles,  are  often  soporific,  whereas  high,  short  notes  tend  to  the 
opposite  effect.  That  form  which  attends  nervous  alertness  and  ten- 
sion and  morbid  attentiveness  is  here  particularly  referred  to.  Gel- 
semium  and  Coffea  cruda,  also  Kali  brom.,  in  potency,  if  no  physical 
or  other  symptoms  are  superior  in  the  case,  are  of  the  greatest  ser- 
vice. If  with  malignant  fevers,  Belladonna  or  Hyoscyamus  may 
supersede  these  at  times.  In  insanity,  Kali  brom.,  Capsicum,  or 
Arsenicum , or,  if  with  an  omnes  admirari,  or  else  a very  busy  mood, 
Sulphur.  In  infantile  colic,  Magnesia  phosph.  In  peritonitis,  Ar- 
sen., Rhus , etc. 

With  proper  precautions,  avoiding  conversation  and  other  noises 
in  or  near  the  room  (particularly  with  sensitive  infants,  little  chil- 
dren, and  nervous  people),  and  following  the  foregoing  suggestions, 
there  will  be  little  wish  to  tamper  with  objectionable  drugs.  In 
this  connection,  be  it  remembered  that  fatal  brain  disease  after  “sum- 
mer complaint”  in  infants  usually  happens  as  a sequel  to  using  some 
form  of  opiate. 

Bathing  or  sponging  the  feet,  hands,  face,  head,  etc.,  with  water, 
cold  or  hot,  as  most  agreeable ; brushing  the  hair ; gentle  patting  or 
stroking  of  the  surface;  any  of  these  may  help,  if  agreeable  and  de- 
sired, in  certain  cases.  Rhythmic  movement  of  one  foot  in  bed,  by 
a friend,  has  proved  very  soothing  in  “ brain  fever.” 

Constipation. — Full  meals,  full  water-drinking,  full  exercise,  and 
full  opportunity  for  obedience  to  nature’s  calls,  in  spite  of  those  of 
business  and  pleasure,  these  are  the  sufficient  conditions  of  a good 
state  of  the  bowels  unless  these  be  the  seat  of  disease.  In  the  latter 
case,  of  course,  the  similar  remedy  also. 


THE  STUDY  OF  HOMOEOPATHY. 


907 


Sick  regimen,  of  course,  generally  means  empty  bowels,  and  they 
should,  therefore,  until  convalescence,  with  resumption  of  eating,  be 
mostly  let  alone. 

In  health,  or  when  about  the  house,  there  must  be  no  sitting 
down  immediately  after  breakfast,  particularly  not  in  a rocking- 
chair.  A walk,  then,  of  five  minutes,  with  the  thoughts  concen- 
trated upon  the  intended  evacuation,  excluding  all  other  subjects  re- 
ligiously. Then,  ten  minutes  consecrated  to  the  act  itself,  regardless 
of  engagements  of  every  kind,  carefully  avoiding  reading,  smoking, 
and  all  other  diversions.  This  daily,  with  coarse-grained  diet  and 
the  Homoeopathic  remedy,  will  often  suffice.  But  sometimes  this 
programme  is  impracticable,  in  which  case  use  the  so-called  “gluten 
suppositories/’  which,  really,  are  made  of  only  cocoa-butter,  con- 
taining the  relics  of  the  pulverulent  cocoa  itself,  an  important  aid  in 
the  aperient  effect,  as  it  would  seem.  These  may  be  repeated  every 
night,  or  night  and  morning,  or  oftener,  until  success  is  attained.  In 
a few  cases  the  straining  which  follows  may  demand  relief  by  a hot 
water  enema,  one  and  a half  pints  retained  twenty  minutes;  repeated 
several  times  in  the  day,  if  needed,  until  regular  action  is  estab- 
lished. 

In  very  feeble  persons,  especially  if  stubborn  in  rejecting  these 
measures,  fatal  collapse  may  follow  prolonged  straining.  This  must 
on  no  account  be  permitted. 

In  surgical  cases,  laxative  drugs  are  not  out  of  place,  as  prior  to 
herniotomy,  etc. 

Debility. — Again,  our  patients,  in  convalescence  or  otherwise, 
often  clamor  for  a tonic.  Good  food,  well  digested,  is  the  real, 
permanent  tonic,  of  course.  Tender,  rare  beef,  whole  wheat-flour 
bread,  oatmeal,  plain  maltine,  good  milk,  cream,  buttermilk,  butter, 
fresh  eggs,  and  unfermented  wine — these  are  the  type. 

Sometimes  these  are  declined.  If  so,  the  best  tonic  and  appetizer 
again  is  the  similar  remedy ; for  instance,  China,  Ignatia,  Lycopo- 
dium, Natrum  muriaticum,  Nux  vomica,  Pulsatilla , Sulphur,  etc. 

When,  however,  the  debility  is  the  most  commanding  symptom, 
this  indication  becomes  a leader.  Here  several  drugs  compete,  viz., 
Arsenicum,  Ferrum  (the  acetate),  and  China,  in  the  first  rank. 

Arsenicum,  high,  if  the  debility  be  out  of  all  proportion  to  any 
attendant  ill-health  or  lesion,  with  fear  of  solitude,  desire  for  ex- 
ternal warmth,  < draft  of  air.  One  to  four  doses — all  within  six 


908 


world’s  homoeopathic  congress. 


to  eight  hours,  or  once  every  six  hours,  followed  by  Saccharum 
laetis — have  often  transformed  the  scene  speedily. 

Ferrum  aceticum  2x,  one-half  grain,  three  times  daily,  immedi- 
ately after  meals,  as  recommended  by  Dr.  Bayes,  of  London,  is  ex- 
ceedingly useful  when  anaemia  with  debility  seems  to  account  for  a 
stubborn  resistance  to  “ similar”  remedies.  Among  the  cases  in 
which  it  has  served  me  well  I will  specify  those  children  growing 
tall,  full  of  activity,  which  exhausts  them  and  keeps  them  thin, 
susceptible,  weak,  and  pale. 

China. — When  exhausting  disease  or  loss  of  blood  has  preceded 
the  debility,  and  perspiration  attends  the  least  exertion,  <on  breast 
and  back. 

The  enthusiastic,  practical,  and  successful  cultivation  of  “the 
medical  idea”  implies  a certain  unfaith  in  “the  surgical  idea,”  and 
at  the  same  time,  a habit  of  subjective  thought.  Equally,  on  the 
other  hand,  the  surgical  idea  displaces  the  medical,  and  its  habit 
and  its  faith  are  almost  wholly  objective.  The  two  are,  at  any  given 
moment,  psychic  incompatibles — exclusive,  dogmatic. 

Either,  however,  is  but  a mental  bias , not  to  be  mistaken  for  abso- 
lute and  universal  wisdom,  but  understood  to  be  a sharp  limitation 
against  it;  yet,  as  being  ever  complementary,  the  one  to  the  other, 
and  both  as  being  entitled  to  mutual  respect  and  mutual  sway.  As 
in  all  other  cases,  man’s  gravest  errors  herein  lie  more  in  lines  of 
denial  than  in  those  of  affirmation.  False  affirmations  soon  correct 
themselves;  but  denials  are  easily  maintained,  and,  however  errone- 
ous, are  ofttimes  incorrigible. 

The  general  subject  of  Antidotes  requires  mention  here. 

Toxicology  presents  us  with  a series  of  chemical  poisons,  often 
corrosive  or  at  least  irritant,  and  with  each  a series  of  substances 
having  the  power  to  chemically  neutralize  it,  or  otherwise  render  it 
inert,  insoluble,  etc.  Also,  other  substances,  acting  physiologically 
in  antagonism  to  its  after-effects.  All  are  called  “ antidotes.” 

In  Homoeopathy  we  discover  another  sort  which,  on  the  contrary, 
antidote  each  other  in  consequence  of  the  similarity  of  their  symp- 
toms in  pathogenesis  or  provings.  These  we  call  “ Homoeopathic 
antidotes.”  Our  older  authors,  as  Jahr  and  Teste,  made  great 
account  of  these,  and  in  the  introductory  portion  of  Jahr  and  Pos- 
sart’s  Repertory , under  each  remedy  are  given  its  known  Homoeo- 


THE  STUDY  OF  HOMOEOPATHY. 


909 


patliic  antidotes ; also,  those  drugs  which  follow  it  with  most 
frequent  known  advantage  in  therapeutics;  and,  lastly,  those  which 
it  follows  well ; each  being,  of  course,  given  singly.  Such  remedies, 
often  completing  a curative  action  already  begun,  are  said  to  be  (bor- 
rowing a term  from  mathematics)  “ complementary  ” to  each  other. 

Nowadays,  instead  of  direct  efforts  to  antidote  drug- aggravations, 
we  commonly  rely  on  the  happy  effects  of  these  sequences , which 
practically  accomplish  the  same  end;  always  determined,  as  they 
must  be,  by  the  totality  of  existing  symptoms. 

After  Allopathic  medication,  Prof.  C.  G.  Raue  advises  to  preface 
the  Homoeopathic  treatment  with  Nux  vomica,  one  or  more  antidotal 
doses,  as  already  mentioned. 

A strict  adherence  to  Hahnemann’s  methods  precludes  the  use  of 
antidotes  to  Homoeopathic  remedies  in  great  measure.  Given  the 
“ minimum  dose  ” without  undue  repetition,  and  the  true  similimum 
being  selected,  drug-aggravation  means  simply  that  the  similar  drug 
disease  is  supplanting,  and,  therefore,  curing  the  original  malady, 
and  under  a placebo  the  “ secondary  vital  reaction”  will,  ere  long, 
prove  it.  By  no  means,  then,  let  it  be  antidoted ! 

The  employment  of  antidotes,  whilst  proving  a drug , is  a great 
abuse,  and  goes  far  to  vitiate  the  result,  besides  depriving  the  world 
of  a full  pathogenetic  picture,  in  all  stages.  Young  student  provers, 
with  college  work  to  do,  often  thus  destroy  their  own  contributions 
to  medical  science.  Moderation  in  dosage,  with  patient  waiting, 
watching,  and  recording,  is  the  solution  of  this  difficulty. 

In  conclusion,  we  may  say,  that  less  than  the  following,  as  a col- 
lege programme,  is  not  in  keeping  with  good  faith  toward  Homoe- 
opathy, viz.,  in  both  the  junior  and  the  senior  years,  besides  the 
complete  didactic  course  a full  series  of  subclinics  should  be  included 
as  a “ specialty,”  in  which  a rigorous  drill  in  the  Hahnemann 
methods  should  be  given  by  competent  teachers  and  practitioners 
thereof;  directing  placards  being  also  hung  up,  within  view  of  all. 

u Taking  the  case,”  selecting  the  remedy,  choosing  the  dosage,  and 
the  succession  of  remedies,  etc.,  writing  records  and  marking  them 
for  subsequent  disappearance,  amelioration,  or  aggravation  of  symp- 
toms and  lesions,  from  visit  to  visit,  should  be  taught  to,  and  prac- 
ticed by,  each  and  every  student. 

Such  a course  of  instruction  would  create,  not  slavery  to  Hahne- 


910  world’s  homceopathic  congress. 

mann,  but  a reasoning  and  experimental  acquaintance  with  him, 
most  essential  to  the  true  advancement  of  our  cause,  but  which  is, 
at  present,  the  very  least  of  the  accomplishments  of  the  average 
Homoeopathic  graduate. 

A course  of  study,  such  as  that  above  marked  out,  cannot  do  more 
than  mere  justice  to  Homoeopathy  in  a full  graded  college  course. 
Less  than  this  is  injustice  to  a holy  cause — a sacrilege,  in  short. 

Thus,  we  may  realize  how  distinct  is  Homoeopathy  as  a grand 
department  among  all  others  in  a medical  course,  and,  moreover,  in 
view  of  its  fundamental  truth,  how  commanding  and  supreme  in  the 
presence  of  them  all ! 

The  institution  of  the  four  years’  course  for  under-graduates,  as 
well  as  of  post-graduate  curricula,  I feel,  calls  for  the  immediate 
and  effective  interposition  of  our  highest  authority  in  behalf  of  its 
future ! 

Psychic  Cure. — In  presenting  this  subject  I do  but  follow  the  ex- 
ample of  Hahnemann  in  the  conclusion  of  the  Organon. 

Great  is  the  power  of  mind  over  matter!  Great  the  power  of  the 
mind  over  the  body!  These  sayings  have  become  axiomatic;  even 
the  materialist  accepts  them,  with  his  own  glosses. 

For  ages  ‘‘regular”  medicine  embraced  and  practiced  upon  the 
dominance  of  the  soul  in  life.  The  materialism  of  the  moderns  has 
declared  against  it  and  such  practice  has  been  relegated  to  the  realm 
of  charlatanry.  Mesmerism,  of  which  Hahnemann*  was  an  expo- 
nent, was,  of  course,  long  ago  tabooed  as  simply  an  ism. 

But  time  has  already  avenged  the  soul  for  the  contempt  of  a gene- 
ration, and  psychic  cure , in  some  form,  is  in  everybody’s  mouth. 
Mesmerism  under  other  names  is  not  so  bitter ; and  great  men,  as 
Charcot  and  others,  are  not  ashamed  of  “ thought  transference,” 
“mind-reading,”  “hypnotism,”  and  “suggestive  therapeutics.”  A 
regular  text-book,  so  entitled,  is  published  by  the  house  of  Putnam, 
in  New  York.  In  Homoeopathy,  Dr.  H.  N.  Guernsey  declared  the 
soul  to  be  the  real  seat  of  disease,  and  the  highest  potencies  its 
“ nearest  of  kin.” 

It  would  be  quite  unscientific,  to-day,  either  to  ignore  or  to  fail 
of  tracing  psychic  cure  to  its  highest  development.  Throughout, 
the  nature  of  psychic  force  is  evidently  oue,  from  the  fascination  of 

* See,  also,  Reichenbach,  on  “The  Odic  Force.” 


THE  STUDY  OF  HOMOEOPATHY. 


911 


the  serpent  or  of  the  voodoo,  upward.  Its  evil  and  its  benevolent 
acts  are  alike  in  kind,  different  in  purpose,  plan,  and  effect;  its 
moral  quality  according  with  the  will  of  the  actor  and  of  the  sub- 
ject as  well ; for  co  operation  intensifies  and  multiplies,  whilst  an- 
tagonism nullifies  it,  at  least  in  part. 

The  psychic  cure  of  disease  illustrates  all  this.  The  patient  must 
be  just  and  benevolent  in  purpose  or  his  malevolence  will  antagonize 
the  benevolent  will  which  purposes  his  cure.  He  must  confide  in 
that  will  or  his  unfaith  must  surely  block  its  access  to  him. 

The  simplest  form  of  psychic  cure  is  self -cure.  One  illustration 
from  army  experience  will  suffice.  A young  medical  officer  about 
to  mount  his  horse  for  a march,  found  himself  with  a malarial  fever. 
On  being  offered  medicine  he  declined,  saying : u No;  I believe  1 can 
throw  it  off.”  He  rode  on  ; his  faith  in  himself  mastered  the  fever, 
and  directly  afterwards  he  was  well. 

And  now,  mark  ! it  was  by  no  violent  exertion  of  “ will-power.” 
but  by  self -faith,  inspiring  quiet,  calm,  and  resolute  self  control. 

Not  many  persons,  however,  are  equal  to  the  same.  To  such,  the 
sympathy  of  friends  may  supply  the  aggregate  of  curative  force 
needed;  or  the  assertion  or  “ suggestion  ” of  an  operator — call  him 
mesmerist,  or  hypnotizer,  or  doctor — will  accomplish  more  if  the 
patient  agree,  or  mayhap  in  spite  of  him. 

“ Christian  science”  or  “ spiritual  science,”  so  called,  originated 
with  Mrs.  Eddy,  of  Boston,  a few  years  ago.  It  proffers  to  teach 
each  person  to  rely  upon  u the  divinity  within,”  with  a threefold  or 
composite  faith — in  the  teacher,  in  indwelling  divinity,  and  in  self 
thus  empowered. 

A lady  practitioner,  being  asked  what  and  how  long  is  “ a treat- 
ment,” replied,  in  substance,  “ I sit  alone  with  my  patient,  in  quiet 
agreement,  and  assertion  of  this  (three-fold)  faith ; my  mind  ex- 
cluding and  denying  all  antagonisms;  all  subserviency  to  material 
forces ; to  all  social,  medical,  and  other  tradition  or  authority  ; to 
any  and  all  fetters  ; denying  all  faith  in  the  domination  of  evil  of 
any  kind  ; hence,  all  ill-will,  and  all  fear.  I deny  all  those,  for 
both  of  us. 

“ On  the  other  hand,  I continuously  maintain  and  affirm , for  both 
of  us,  our  perfect  good-will,  and  our  freedom,  and  purity  of  purpose 
toward  all  beings  : our  assurance  of  the  indwelling  divinity;  of  the 
universal  human  enduement,  including  ourselves ; of  the  unap- 


912  world’s  homoeopathic  congress. 

proachable  supremacy  of  spirit;  its  omnipotence,  in  the  presence  of 
so-called  matter,  and  the  physical  forces.  I further  affirm  and  main- 
tain, for  both  of  us,  that  good  is  the  very  essence  of  divinity  the 
only  absolute  ; the  original  substance  of  all  things. 

“And  how  long  do  I continue  in  this  close  mental  relation  with 
my  patient — now  my  pupil  and  my  friend — and  what  is  the  length 
of  the  ‘ treatment?’  Why,  whether  five  minutes,  or  one  hour,  until 
I see  the  Truth  ! 

“ If  I,  only,  reach  this  point,  the  treatment  is  efficacious.  The 
patient,  however,  after  a while,  resuming  her  relations  with  the  con- 
trary and  noxious — that  is  the  ignorant,  falsely  polarized  thought 
and  tradition  in  which  all  her  troubles  (mental,  and  hence  physical) 
were  originally  brewed,  resumes  also  the  downward  trend,  in  the  old 
order  and  the  treatment  must  be  (usually  it  is  so)  repeated,  from 
time  to  time. 

“ If,  however,  she,  too,  sees  the  truth  with  me,  and  maintains  it 
against  all  hindrance,  she  needs  me  no  more,  so  long  as  no  taint 
falls  into  her  being.  She  is  now  herself  a teacher  and  a healer.” 

And  this  lady  had  real  success  in  healing.  Hygienically,  at  least, 
such  high  optimism  must  be  credited  with  great  powers.  Once 
more,  and  higher  “ Divine  healing,”  as  expounded  by  its  excellent 
and  exemplary  teachers,  takes  the  standpoint  of  orthodox  theology, 
the  promises  of  Jesus,  and  the  practice  of  the  apostles;  and  particu- 
larly, the  command  of  St.  James  (Epistle,  chapter  fifth,  verses 
thirteenth  to  fifteenth);  anointing  with  (olive)  oil,  and  the  prayer 
of  faith.  And  many  have  thus  recovered. 

One  of  the  earliest  exponents  of  “Divine  healing”  in  America 
was  the  greatly  beloved  and  loving  Dr.  Charles  Cullis,  recently  de- 
ceased ; one  of  our  own  school ; one  of  the  Christian  philanthro- 
pists of  the  age,  and  a citizen  of  Boston,  Massachusetts. 

Hahnemann,  in  his  own  way,  received  also  a gift,  all  divine.  The 
world  will  ever  need  it.  Let  us  be  forever  thankful  for  this,  and 
for  all  other  divine  gifts;  and  let  our  faithful  cultivation  of  Homoeo- 
pathy prove  to  all  men  that  we  are  of  the  Truth,  and  that  the  Truth 
hath  made  us  free. 


HOMOEOPATHIC  TREATMENT  OF  TABES  AND  PSEUDO-TABES.  913 


THE  HOMOEOPATHIC  TREATMENT  OF  TABES  AND 
PSEUDO-TABES. 

By  Alexander  Villers,  M.D.,  Dresden,  Saxony-,  Germany. 


All  over  the  civilized  world  nervous  diseases  are  on  the  increase 
— a condition  at  once  explicable  by  and  sequential  upon  the  vast  de- 
mands upon  the  central,  the  vital  force.  In  the  changing  battle  for 
life,  in  the  hurry  and  irregularity  of  the  daily  routine,  in  the  grow- 
ing necessity  for  varying  types  of  distraction,  it  is  inevitable  that 
nervous  exhaustion  must  more  and  more  obtain.  Transmission  of 
disease  from  generation  to  generation,  the  mild  form  begetting  the 
severe,  tends  also  toward  the  emphasis  and  establishment  of  these 
conditions,  until  in  this  deteriorated  soil  the  rank  growth,  syphilis, 
strikes  firm  root,  and  upon  the  central  nerve  trunk  are  grafted  the 
various  forms  of  disease.  Such  an  effect  from  such  a cause  is  tabes,, 
and  if  Homoeopathy  will  render  an  account  to  itself  and  to  us  of  its 
accomplishment  in  this  trouble,  we  shall  find  a touchstone  of  com- 
parison between  our  own  work  in  this  behalf  and  that  of  our  col- 
leagues of  the  alien  persuasion.  In  a historical  resume  of  this  sub- 
ject, the  testimony  of  our  older  literature  is  only  valuable  theoreti- 
cally. 

It  is  not  available  as  statistic  and  comparative  material,  for  its 
erudition  and  deduction  have  waned  in  the  fuller  light  of  a later 
day,  a day  whose  classification  of  other  as  well  as  nervous  derange- 
ments is  more  promisingly  rational,  definitive,  pathological,  and 
anatomical.  It  may  be  here  opposed  that  classification  of  any  day 
or  description  can  have  no  Homoeopathic  weight  because  Homoeopa- 
thy challenges  treatment  which  bases  on  disease  names;  but  to  such 
opposition  I cite  Hahnemann’s  reply  to  Dr.  Jahr,  where  he  expressly 
asserts  that  independent  diseases  may  exist  “ by  which  the  robust 
may  be  attacked  without  internal  cause,  as  in  la  grippe,  whooping- 
cough,  scarlet  fever,  erysipelas,  inflammatory  pleurisy,  and  other  in- 

58 


914 


world’s  homoeopathic  congress. 


dividual  diseases  where  names  represent  disease  and  not  symptoms 
of  disease,  as  is  the  usual  case.” 

And  among  these  independent  types  one  may,  in  absolute  accu- 
racy, rate  tabes,  so  positive  and  individual  is  its  character.  I need 
not  here  enter  into  detailed  enumeration  of  tabes’  varying  forms  • 
suffice  it  that  I deal  with  the  more  intrinsic  features  of  the  pathology 
of  the  disease.  Our  modern  designation  of  tabes  is  not  complicated 
with  the  archaisms  of  earlier  medical  literature,  which  confuses  with 
its  multifold  distinction  and  explanation.  However,  from  the  early 
chaos  of  diseases  of  the  spinal  marrow,  Horn,  in  1827,  Romberg, 
in  1851,  and  Duchenne,  in  1858,  had  already  crystallized  a oneness 
of  existence  for  that  acute,  destructive  form  which  we  to-day  know 
as  tabes  dorsalis,  progressive  locomotor  ataxia.  Its  patho-anatomi- 
cal  character  is  indicated  in  the  atrophy  of  the  posterior  ligaments 
and  of  the  posterior  nerve  roots,  especially  noticeable  in  the  hip  seg- 
ment of  the  spinal  marrow.  The  uniformity  of  the  pathological 
showing  testifies  to  the  limitation  of  the  range  of  symptomatology. 
There  are,  to  be  sure,  other  affections  of  the  spinal  marrow  which 
manifest  certain  of  the  symptoms  of  tabes,  vide,  disseminating  scle- 
rosis, in  which  the  sclerotic  changes  are  apparent  in  the  posterior 
ligaments;  but  it  is  in  specific  tabes,  and  only  in  tabes,  that  all  the 
essential  symptoms,  and  only  the  essential  symptoms,  appear. 

Concerning  the  aetiology  of  tabes,  I stand  committed  free  and 
entire  on  the  side  of  those  who,  following  the  precedent  of  Four- 
nier and  Erb,  account  syphilis  the  most  important  aetiological  period. 
All  other  aetiological  periods  which  may  be  cited  are,  in  my  opinion, 
subordinate. 

Neither  mental  nor  sexual  excesses,  nor  the  oft-responsible  colds, 
can  ever  engender  tabes  in  themselves.  However,  it  is  interesting 
to  mark  the  influence  of  a cold  upon  the  incipience  and  course  of 
some  special  symptoms,  and  encouraging  to  be  able  to  fasten  at  once 
upon  one  effective  remedy  in  the  treatment.  I refer  to  j Rhus  tox — 
an  indispensable  factor  in  the  management  of  tabes.  In  the  atrophy 
of  the  posterior  ligaments  Seea/e  corn,  is  one  of  our  most  opportune 
remedies. 

Although  tabes  is  more  frequent  with  men  than  with  women,  its 
course  in  the  two  sexes  is  not  marked  by  any  difference,  and  in  either 
it  is  named  incurable.  Improvement  is  possible;  skillful  treatment 
may  control  and  abort  many  an  outward  manifestation,  but  the  de- 


HOMCEOPATHIC  TREATMENT  OF  TABES  AND  PSEUDO-TABES.  915 


veloped  disease  itself  is  only  manageable — ineradicable;  and  this 
for  the  reason  that  we  have  only  cure  agents — not  creative  agents — 
within  our  range  of  medicine.  We  cannot  make  new  tissue  out  of 
nothing.  We  cannot  recreate  tissue;  we  can  only  mitigate  the  pro- 
cesses which,  without  our  aid,  tend  to  utter  destruction.  We  are, 
of  necessity,  effective  against  disease  processes,  not  products.  These 
last  mark  the  ne  plus  ultra  of  our  abilities. 

When  the  symptoms  of  tabes  begin  to  marshal  in  double  rank  it 
behooves  us  to  distinguish  clearly  between  them,  because  the  one 
array  indicates  the  change  in  the  spinal  marrow  which  precedes  atro- 
phy, the  other  the  developed  atrophic  condition  of  the  marrow.*  The 
first  condition  is  manageable,  the  latter  is  hopeless.  To  the  first  class 
belong  the  skin  eruptions,  the  feeling  of  fatigue  and  of  muscular 
stiffness.  To  the  other  class  belong  the  various  forms  of  ataxia, 
muscular  lameness  of  eyes,  limbs,  intestines  and  bladder.  The  de- 
terioration of  sexual  power  belongs  to  the  first  class,  the  utter  loss 
thereof  to  the  second  class. 

To  deduce  now  for  practice:  we  can  cure  incipient  tabes,  we  can 
allay  the  irritative  symptoms  of  the  developed  forms,  we  cannot 
materially  modify  the  accomplished  results  of  the  developed  forms. 
Even  with  this  admission,  however,  we  are  in  better  plight  than  our 
confreres  of  the  Old  School,  for  they  cannot  check  the  progress  of 
the  incipient  symptoms. 

Symptoms  greatly  resembling  those  of  tabes  belong  to  many  forms 
of  hysteria.  Multiphased  as  this  latter  disease  is,  it  is  not  sur- 
prising that  it  should  also  cloak  itself  in  some  of  the  guises  of  tabes. 
The  genus  of  the  misleading  symptoms  becomes  apparent  under 
careful  consideration  of  the  duration  of  the  individual  play  of  the 
disease.  One  exquisite  case  of  hysteria  with  pseudo-tabic  symp- 
toms, which  had  deceived  several  experienced  specialists,  came  under 
my  observation  in  a person  43  years  of  age.  Basing  wholly  on  the 
symptomalogical  indications,  I chose  a remedy  which  bettered  one 
class  of  symptoms.  Then  I set  to  work  to  beguile  the  spiritless 
patient  into  a belief  that  her  trouble  was  hysteria,  and  not  tabes. 
In  a short  time  my  course  was  justified  by  the  passing  of  the  psychi- 
cal condition  of  despair  and  inertia,  leaving  me  firm  in  my  convic- 
tion of  the  mild  and  hysterical  incipiency  of  the  case. 

Since  in  the  treatment  of  disease  we  are  Homoeopathically  con- 
cerned with  our  knowledge  of  the  immutable  workings  of  drugs, 


916 


world’s  homgeopathic  congress. 


basing  not  at  all  upon  the  shifting  values  of  symptoms,  it  is  imma- 
terial, in  the  treatment  of  tabic  symptoms,  whether  these  are  intrin- 
sically of  the  disease,  or  whether,  suggesting  other  nerve  disorders, 
of  the  same  class  of  indication.  Such  being  the  case,  it  is  not  worth 
while  for  me  to  longer  discriminate  between  symptoms  tabic  and 
pseudo-tabic. 

Jendrassik  has  recently  asserted  that  tabes  is  not  an  affection  of 
the  spinal  marrow,  but  primarily  of  the  gray  matter  of  the  brain, 
from  which  source  the  destruction-processes  fasten  upon  the  poste- 
rior ligaments.  This  theory,  which  rests  exclusively  upon  the  fre- 
quent appearance  of  cerebral  symptoms  in  the  incipient  stage  and 
course  of  tabes,  has  little  of  probability  in  itself,  but  serves,  rather, 
to  show  what  a fruitless  labor  it  is  to  found  a treatment  of  this  dis- 
ease upon  the  accepted  knowledge  of  its  source,  and  to  indicate  the 
superiority  of  our  Homoeopathic  position,  since  we  act  upon  our 
frank  admission  that  we  can  only  recognize  certain  external  symp- 
toms in  the  aggregate  of  cases,  and  can  but  approximate  the  origin 
of  the  disease  so  long  as  the  origin  of  life  is  a sealed  chapter  to  us. 
It  is  a simple  truth,  and  one  universally  intelligible,  that  we  cannot 
place  and  classify  abnormalities — departures  from  the  rule — so  long 
as  we  are  limited  in  our  knowledge  of  the  normal,  so  long  as  we 
cannot  resolve  the  rule;  and  where  is  the  man  bold  enough  to  assert 
that  he  hath  read  aright  the  riddle  of  life? 

The  course  of  the  disease  divides  itself,  during  the  long  years  of 
its  duration,  into  three  periods;  the  first,  or  stage  of  invasion;  the 
second,  or  stage  of  development;  and  the  third,  or  stage  of  compli- 
cation. The  length  of  the  single  periods  varies,  while  the  entire 
time  consumed  in  the  course  of  the  disease  ranges  from  six  to  twenty 
years.  The  stage  of  innovation  is  always  the  longest  and  presents 
the  more  promising  possibilities  of  recovery.  It  is  that  tide  in  the 
affairs  of  men  which  can  be  taken  at  the  stem,  and  a great  percent- 
age of  cases  then  treated  will  permit  of  a check  in  the  disease’s 
course  and  of  a prolonging  of  the  life  at  stake,  and  of  a maximum 
decrease  of  suffering,  which,  for  all  practical  purposes,  may  count 
for  recovery.  In  the  second  stage,  that  of  completed  development, 
all  the  symptoms  which  figure  in  the  pathological  schema  of  tabes 
stand  out  pronouncedly  and  the  treatment  becomes  more  difficult. 
In  the  third  and  final  stage,  the  stage  of  complication,  the  devasta- 
tions of  the  spinal  marrow  begin  to  result  upon  the  various  organs? 


HOMOEOPATHIC  TREATMENT  OF  TABES  AND  PSEUDO-TABES.  917 


and  from  that  point  on  the  question  is  no  longer  of  recovery,  but  of 
mitigation  of  suffering.  The  devastating  changes  which  the  pic- 
ture of  the  disease  now  localizes  in  the  central  organs  are  radical 
and  unsusceptible  of  substantial  betterment.  The  destroyed  or  viti- 
ated nerve-cells  cannot  be  recreated ; in  such  case  we  have  run  again 
upon  the  bleak  wall  of  our  limitation.  Disease-processes,  let  me 
repeat,  are  curable;  disease-produets  are  only  modifiable  when  en- 
gaging nerves  of  reflex  capability. 

In  the  first  and  third  stages  of  tabes  the  treatment  must  in  all 
cases  be  purely  Homoeopathic,  that  is,  based  wholly  upon  the  corn- 
plexus  of  symptoms  which  the  individual  case  presents.  In  the 
second  stage,  the  symptoms  are  so  characteristic,  that  any  individu- 
ality of  case  coloring  recedes,  and  we,  like  our  Allopathic  colleagues, 
can  refer  directly,  and  in  all  cases,  to  the  name  of  the  remedy  path- 
ologically indicated. 

Neither  opportunity  nor  time  just  now  presents  for  a review  of  the 
whole  detail  of  tabes,  but  it  seems  fitting  that  I should  here  enter 
somewhat  into  the  treatment  of  the  premonitory  conditions,  because 
those  are  the  conditions,  and  then  the  time,  where  treatment  is  most 
effective. 

Year  in  and  year  out,  long  before  the  patient  experiences  any 
actual  hindrance  or  any  noticeable  pain,  he  complains  of  “that  tired 
feeling,”  often  the  only  urge  which  precipitates  him  upon  a timely 
treatment.  This  premonitory  feeling  of  fatigue  is  peculiar  to  all 
chronic  diseases  of  the  spinal  marrow,  and  is  as  essential  an  element 
in  the  constituency  of  that  at-present  reigning  disease,  neurasthenia. 
In  the  valuation  of  this  symptom  we  must  carefully  discriminate 
between  two  offering  possibilities  : the  one  a condition  of  neurasthenic 
weakness,  the  other  pointing  to  a more  onerous  complication  of  the 
nervous  system,  tabes.  From  the  one-view  point  will  be  whetted  a 
critical  judgment  of  ourselves  and  our  trade,  from  the  other  we  will 
be  led  to  clap  spurs  to  speedy  care.  In  the  many  remedies  indi- 
cated in  fatigue,  the  most  essential  in  import  are  Arnica , Antimony 
tart.,  Causticum , Cannabis , Nux  vomica,  Rhus  and  Tabacum,  while 
Pulsatilla,  which  counts  the  feeling  of  fatigue  among  its  indications, 
is  not  at  all  effective  in  the  forerunning  conditions,  for  the  reason 
that  they  lack  that  eminent  characteristic  of  Pulsatilla,  deterioration 
in  repose. 

Not  so  significant  as  the  fatigue,  but  of  equally  early  appearance 


918 


world’s  homceopathic  congress. 


and  steady  duration,  is  the  admitted  weakness  of  the  bladder  and  the 
sexual  organs.  Where  excess  is  directly  determined  upon,  and  where 
symptoms  of  neurasthenia,  or  of  some  special  affection  of  the  centre 
of  the  uro-genital  nerves  are  not  peculiarly  indicated,  the  apparent 
symptoms  must  immediately  direct  attention  to  the  possibility  of 
tabes  in  the  prodromal  stage.  In  the  premonitory  bladder  vitiation 
I have  got  best  service  from  Clematis  and  Sulphur , and  in  sexual 
im potency,  Caladium,  Causticum,  Graphites  and  Sulphur , are  my 
preferences. 

The  prevalent  impression  that  tabes  is  the  result  of  sexual  de- 
bauchery, and  the  moral  reproach  consequently  attaching  to  the  un- 
fortunate patient,  is  undeserved.  Wheu  in  the  setiological  forecast 
of  a case  of  tabes  the  responsibility  rests  with  sexual  excess,  compli-  * 
cations  early  ensue,  as  is  true  in  multiple  sclerosis,  which  may  pass 
in  its  incipiency  for  almost  every  other  form  of  spinal  affection,  and 
other  immediate  and  indubitable  symptoms  index  the  origin  of  the 
trouble. 

During  the  stage  of  invasion,  every  possible  remedial  agent  must 
be  cautiously  and  advisedly  employed.  Tonic  effects  upon  the  body 
are  to  be  secured  through  massage  and  waters,  the  unloading  of  the 
system  through  special  diet  and  the  sparing  of  the  nerve  system 
through  change  in  the  habits  of  life  are  to  be  prescribed,  and  the 
prescriber  must  vehemently  insist  upon  a rigid  adherence  to  his  side 
orders  as  upon  the  use  of  his  remedies.  Baths  in  thermal  springs 
are  helpful  in  the  first  stage.  We  of  Europe  may  have  recourse  to 
Gastein,  and,  further  up  the  line,  to  Wildbad,  Baden,  Weiler,  and 
the  thermal  springs  of  France.  But,  on  the  one  hand,  the  chosen 
springs  must  be  Homoeopathically  adapted  to  the  individual  case, 
and  the  required  provings  of  the  waters  are  with  difficulty  and  rarely 
obtained — one  of  our  best,  the  proving  of  the  Gastein  waters,  got  up 
by  Dr.  Proll,  I have  made  public  in  the  first  volume  of  my  Annals 
(International  Homoeopathic  Annals j Dr.  Villers,  vol.  i.,  p.  17,  Eng- 
lish Edition),  while,  on  the  other  hand,  the  right  bath  being  carefully 
selected,  the  waters  must  be  cautiously  employed,  lest  the  very  Hom- 
oeopathicity  of  the  application  lead  to  a deterioration  whose  course 
cannot  be  checked. 

In  the  stage  of  perfected  development  there  stands  at  the  apex  of 
all  bewailed  symptoms  the  lancinating  pains  through  the  trunk  and 
in  the  lower  limbs.  However  the  image  of  the  pain  may  vary  as 


HOMCEOPATHIC  TREATMENT  OF  TABES  AND  PSEUDO-TABES.  919 


to  its  burning  or  boring  or  sticking  character,  there  always  obtains 
an  impression  of  its  sudden,  interpenetrating  nature.  According  to 
provings,  the  remedies  most  widely  effective  for  this  state  of  affairs 
are  Belladonna , Lycopodium , Sulphur , Colchicum , Graphites , and 
Stannum.  These  especial  pains  frequently  manifest  a further  indi- 
viduality in  the  fact  that  severe  pressure  upon  the  seat  of  pain  gives 
substantial  relief,  while  light  pressure  violently  augments  the  trouble. 
This  limits  the  above-cited  number  of  remedies  to  those  whose  path- 
ogenesy  presents  this  idiom  ; these  are  Graphites , Sulphur , and  Stan- 
num. In  accord  with  this  consideration,  I have  obtained  the  best 
results  with  Graphites  in  most  cases,  using  Stannum  only  when  the 
appearance  of  pain  was  marked  by  a steady  increase,  a not  infrequent 
manifestation  in  tabes. 

Sooner  or  later  to  these  lancinating  pains  is  allied  parasthesia,  the 
most  frequent  symptom  being  the  feeling  of  formication  in  the  lower 
limbs;  then  the  feeling  of  being  laced  across  the  throat  and  in  the 
joints,  and  the  sensation  of  abnormal  temperature  in  particular  parts. 
The  formication,  in  its  slightly  varying  forms,  is  almost  always 
greatly  amenable  to  Secale.  In  a few  cases  only  Nux  vomica  serves 
a better  turn.  This  last  agent  is  indicated  in  the  early  appearance 
of  sluggishness  in  the  colon,  and  we  at  once  recall  the  application 
of  Nux  vomica  in  the  frequent  cases  of  titillation  of  the  soles  of  the 
feet  after  the  overloading  of  the  stomach,  or  especially  in  that  stow- 
ing in  the  abdomen  which  we  often  see  in  our  daily  practice. 

The  feeling  of  lacing  in  both  trunk  and  joints  belong  to  the  prov- 
ince of  Graphites , Nux  vomica,  and  Stannum ; and  three  other  reme- 
dies may  be  hereto  appended  as  worthy  of  note,  as  their  application 
is  not  to  be  overlooked  in  the  therapeutics  of  tabes.  I refer  to  Rhus 
and  Alumina , and,  in  the  acute  contraction  of  the  abdomen  in  the 
spasms  of  pain,  to  Plumbum. 

The  feeling  of  circumscribed  warmth  or  cold  when  appearing  sep- 
arately I have  never  yet  been  able  to  subdue  without  the  aid  of  out- 
side agents  like  rubbings,  massage,  fomentations,  etc.  Moreover, 
the  fact  that  these  symptoms,  as  well  as  those  of  other  parasthesiac 
showing,  appeared  in  the  section  of  the  under  arms,  has  given  me 
no  clue  capable  of  development,  although  I marked  improvement 
in  one  case  with  Ruta.  In  this  stage  the  reflex  muscles  are  either 
destroyed  or  materially  vitiated.  Although  this  indication,  which 
most  clearly  presents  in  the  so-called  Westphalian  phenomena  and 


920 


world’s  homoeopathic  congress. 


also  in  the  destruction  of  the  reflex  patella  muscles,  blurs  somewhat 
between  the  above  alternatives,  yet  the  appearance  of  the  symptoms 
is  indubitable  proof  of  the  existence  of  genuine  tabes,  and  appeals 
to  our  most  searching  attention  in  our  diagnosis.  A coexisting — 
and  in  many  patients  even  earlier  appearing — symptom  is  the  irri- 
tation in  the  region  of  the  sexual  centres.  Strauge  to  say,  women 
present  more  striking  indications  herein  than  men,  for  the  disease 
course  in  the  male  develops  no  characteristic  similar  to  the  clitoris 
crises  of  the  female,  of  which  Charcot,  Bouchard,  and  Pierret  make 
mention.  These  excitative  symptoms  in  the  sexual  organism,  with 
the  pains  of  the  clitoris  and  along  the  nerves  directly  dependent 
upon  the  uterine  plexus,  manifest  in  hysterical  patients  given  to 
masturbation,  and  more  particularly  in  women  whose  husbands  dis- 
continue the  marital  relationship  to  avoid  the  begetting  of  children. 
It  becomes,  therefore,  of  prime  importance  to  raise  this  question 
with  the  patient,  for  if  the  irritating  cause  of  trouble  is  unknown 
it  is  useless  to  think  of  improvement  or  of  healing.  But  whatever 
the  cause,  Nux  vomica,  Selenium,  Camphora,  Stannum,  and  Cantharis 
are  not  without  good  results. 

It  was  left  to  Duchenne’s  imperishable  service  to  prove  that,  des- 
pite the  ataxia  of  the  tabes  patient,  the  muscular  power  does  not 
suffer  detriment.  The  ataxia  is  indeed  but  the  result  of  the  decre- 
ment of  the  inner  muscle  matter.  The  question  has  been  mooted 
in  discussion  to  be  true,  but  Leyden’s  theoretical  and  Charcot’s  and 
Pierret’s  anatomical  researches  have  left  small  doubt  on  this  score 
in  my  opinion.  The  possibility  of  proceeding  further  in  our 
symptomatology  here  again  fails  us  because  our  provings  do  not 
cover  these  finer  differences.  It  is  an  urgent  duty  of  our  genera- 
tion to  perfect  the  provings  of  drugs  with  regard  to  the  chem- 
istry of  secretions,  and  to  the  modern  aids  to  research  in  the  nerve 
province. 

In  consideration  of  the  circumstance  that  any  infallible  knowl- 
edge of  the  right  remedy  is  lacking,  and  that  the  actuating  cause  of 
disturbance  is  the  completed  degeneration  of  the  central  nerve  sys- 
tem, we  are  precipitated  upon  the  practical  conclusion  that  in  this 
stage  of  tabes  we  can  here  and  there  obtain  fortuitous  results,  but 
not  as  yet  cures,  by  our  present  methods  and  knowledge.  In  this 
connection  it  is  well  to  glance  at  the  results  accruing  in  this  behalf 
to  our  colleagues  of  traditional  medicine.  They,  too,  find  their  po- 


HOMOEOPATHIC  TREATMENT  OF  TABES  AND  PSEUDO-TABES.  921 


sition  one  of  helpless  incompetency,  for  the  insensibility  of  narcotics, 
their  cul-de-sac  of  refuge,  is  never  to  be  accounted  recovery  nor  im- 
provement. Of  their  recommended  methods  of  treatment,  whose 
number  but  the  more  increases  as  their  efficacy  is  disproved,  only 
three  need  attract  our  attention  : suspension,  the  application  of  elec- 
tricity, and  baths. 

The  theory  of  suspension,  which  was  so  enthusiastically  preached 
by  Motschutkowsky,  and  given  a friendly  God-speed  by  Charcot, 
has  already  outlived  its  practice.  After  those  careful  showings  of 
Eulenberg  and  Mandel  no  one  will  quite  dare  to  again  recommend 
it.  The  application  of  electricity  still  flourishes,  although  its  most 
eager  supporters  adduce  no  convincing  results  in  its  vindication.  In 
former  days  I,  too,  rather  lent  myself  to  the  belief  that  the  applica- 
tion of  a constant  current  was  advantageous  in  treatment,  since  its 
beneficent  result  is  undeniable  in  certain  pain  sensations.  But  prac- 
tice, that  great  and  final  schoolmistress  of  us  all,  has  taught  me  that 
the  application  of  the  intermittent  current  during  and  after  Homoeo- 
pathic treatment  jeopardizes  and  even  annuls  our  results.  More- 
over, the  cautious  intermittent  current  is  an  agent  whose  positive 
effect  is  incompatible  with,  and  consequently  destructive  to,  the 
healing  of  our  potencies. 

There  are  yet  left  certain  symptoms  of  tabes  to  be  touched  upon 
of  not  so  inevitable  appearance  as  those  already  discussed.  I mean 
the  retardation  of  the  functions  of  the  bladder  and  intestines,  the 
gastric  crises  and  the  atrophic  changes. 

While  I am  justified  in  speaking  decisively  of  my  victories  in 
subduing  the  intestinal  trouble  by  lightening  the  work  of  the  rectum 
through  warm-water  injections  according  to  Hegar’s  method,  yet  I 
have  been  unable  to  universally  cope  with  the  equally  important 
disorders  manifesting  in  the  functions  of  the  bladder,  in  spite  of 
many  happy  results  in  the  use  of  Arsenicum.  In  order  to  avert  the 
dangers  imminent  upon  a retention  of  the  urine,  I empty  the  blad- 
der three  times  daily,  and  if  I cannot  myself  attend  to  the  same  with 
the  catheter,  I have  it  done  by  manual  compression. 

The  gastric  crises,  which  are  so  closely  allied  to  the  lancinating 
pains,  I have  never  been  able  to  overcome,  and  the  atrophic  changes, 
with  which,  however,  I have  seldom  met,  I consider  unamenable  to 
treatment. 

The  choice  of  remedy  must  be  unconditionally  Homoeopathic,  and 


922 


world’s  homoeopathic  congress. 


I furthermore  believe  that  in  the  treatment  of  tabes  the  best  results 
will  accrue  to  that  Homoeopathic  physician  who  adds  to  a scholarly 
knowledge  of  symptomatology  the  fundamental  features  of  the  anti- 
psoric  method  of  cure.  For  this  reason  I have  contended  from  the 
beginning  for  the  use  of  the  highest  possible  potency  of  the  chosen 
remedy,  and  I have  come  off  very  well  in  the  attempt.  These  higher 
potencies — the  200x  suffices  for  my  need — I give  at  long  intervals, 
and  in  order  to  quell  the  sufferer’s  impatience  between  doses,  I give 
him  mock  powders. 

In  a critical  review  of  the  results  obtained  one  should  not  forget 
that  remissions  often  endure  for  a month  and  deceptively  simulate 
improvement  or  recovery.  It  is,  for  this  reason,  advisable  to  im- 
press the  patient  from  the  beginning  with  the  need  of  long-continued 
treatment,  and  to  picture  to  him  emphatically  the  difficulty  with 
which  any  favorable  modifications  of  his  trouble  are  attained. 

From  practical  experience  I have  deduced  the  opinion  that  Hom- 
oeopathy may  undertake  the  treatment  of  tabes  with  the  certainty  of 
securing  recovery  to  the  patient  in  the  first  stage,  and  remissions  of 
long  duration  in  the  developed  process — the  which  is  more  aptly  and 
accurately  of  Homoeopathic  capability  than  of  that  of  any  other  sys- 
tem of  cure. 


REPORT 


OF  THE 

SECTION  IN  MENTAL  AND  NERVOUS 
DISEASES. 


Chicago,  Friday,  June  2,  1893. 

The  Section  in  Mental  and  Nervous  Diseases  of  the  World’s 
Congress  of  Homoeopathic  Physicians  and  Surgeons  met  in  “Hall 
29”  of  the  Art  Building  and  was  called  to  order  at  3 o’clock  p.m., 
by  Selden  H.  Talcott,  M.D.,  of  Middletown,  N.  Y.,  Chairman  of 
the  Section. 

Chairman  Talcott  opened  the  meeting  by  delivering  his  Sectional 
Address,  his  subject  being  “A  Review  of  Recent  Work  and  Pro- 
gress in  the  Field  of  Psychology.” 

“Clinical  Instruction  to  Medical  Students  in  State  Hospitals  for 
the  Insane,”  by  N.  Emmons  Paine,  M.D.,  of  West  Newton,  Mass., 
was  the  title  of  a paper  read  by  its  author.  The  paper  was  supple- 
mented by  certain  resolutions,  which  were  unanimously  adopted. 
(See  the  resolutions  at  the  close  of  the  paper). 

“ The  Octave  (Septenary)  in  Nature  and  in  Man  as  the  Key  to 
Pyschology,”  was  read  by  its  author,  J.  D.  Buck,  M.D.,  of  Cincin- 
nati, O. 

These  papers  were  discussed  by  Drs.  H.  B.  Fellows,  of  Chicago, 
111.,  Davis,  of  Michigan,  and  E.  R.  McIntyre,  of  Topeka,  Kan. 

“Puerperal  Insanity,”  a paper  by  A.  P.  Williamson,  M.D.,  of 
Minneapolis,  Minn.,  was  presented.  In  the  absence  of  the  author  it 
was  read  by  the  Chairman  of  the  Section,  Dr.  Talcott. 

The  next  paper  submitted  was  on  “ The  Causes  of  an  Increase  in 
Melancholia,”  by  William  Morris  Butler,  M.D.,  of  Brooklyn,  N.  Y. 
In  the  absence  of  Dr.  Butler  it  was  read  by  Chairman  Talcott. 

“ Some  Statistical  Facts  Concerning  Insanity,”  an  essay  by  George 


924 


world’s  homoeopathic  congress. 


Allen,  M.D.,  of  Middletown,  N.  Y.,  was  presented  by  the  Chairman 
with  a careful  review  of  the  subject  of  the  paper. 

Dr.  H.  R.  Arndt  was  called  for,  a paper  having  been  expected 
from  him.  It  was  announced  that  his  paper  would  be  forwarded 
to  the  Secretary  of  the  Section. 

An  interesting  discussion  followed  upon  the  subjects  treated  of  by 
the  last  series  of  papers.  This  discussion  was  participated  in  by 
Drs.  Talcott,  H.  P.  Skiles,  of  Chicago,  111.,  and  E.  R.  McIntyre, 
of  Topeka,  Kan. 

A paper  on  “ The  Bichloride  of  Gold  Treatment”  was  offered  by 
M.  O.  Terry,  M.D.,  of  Utica,  N.  Y. 

The  Section  then,  on  motion,  adjourned. 

[Note.-— The  reports  of  the  discussions  of  the  meeting,  also  the 
papers  by  Drs.  Arndt  and  Terry,  have  not  been  received  by  the 
Publication  Committee  of  the  Institute.— P.  D.] 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS  DISEASES.  925 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS 

DISEASES. 

A Review  of  Recent  Work  and  Progress  in  the  Field  of 

Psychology. 

By  Selden  H.  Talcott,  M.D.,  Middletown,  N.  Y.,  Chairman. 


Fellow  Members. — As  Chairman  of  the  Section  of  Mental  and  Ner- 
vous Diseases,  it  becomes  my  duty  to  present  an  address  before  this 
Society,  giving  a review  of  the  work  accomplished  during  the  past 
twelve  months,  together  with  the  general  trend  of  interest  and  pro- 
gress in  the  field  of  psychology. 

The  work  accomplished  by  this  bureau  may  be  summarized  by 
presenting  the  following  list  of  articles  relating  to  mental  and  ner- 
vous diseases,  together  with  the  names  of  their  authors  : 

“ Progress  in  the  Care  of  the  Insane  and  the  Development  of  the 
Hospital  Idea  in  the  Treatment  of  Mental  Invalids,”  Dr.  Selden  H. 
Talcott,  Chairman,  Middletown,  N.  Y. 

“ Puerperal  Insanity,”  Dr.  A.  P.  Williamson,  Minneapolis,  Minn. 

“Statistical  Facts  Relative  to  Insanity  and  its  Treatment,”  Dr, 
George  Allen,  Middletown,  N.  Y. 

“The  Care  of  the  Insane,”  Dr.  C.  Spencer  Kinney,  Middletown, 
N.  Y. 

“ Clinical  Instruction  to  Medical  Students  in  State  Hospitals  for 
the  Insane,”  Dr.  N.  Emmons  Paine,  West  Newton,  Mass. 

“ The  Causes  of  an  Increase  in  Melancholia,”  Dr.  William  M. 
Butler,  Brooklyn,  N.  Y. 

“ The  Octave  in  Nature  and  in  Man  as  a Key  to  Psychology,” 
Dr.  J.  D.  Buck,  Cincinnati,  O. 

“ Mental  Depressions  and  the  Influence  of  the  California  Climate 
Thereon,”  Dr.  H.  R.  Arndt,  San  Diego,  Cal. 

In  considering  these  papers  we  conclude  that  during  the  past  three 
years  there  has  been  a marked  tendency  to  an  increase  in  that  form 


926 


world’s  homceopathic  congress. 


of  insanity  known  as  melancholia,  and  due,  we  believe,  to  the  effects 
of  la  grippe  when  complicated  with  Allopathic  treatment. 

We  also  find  that  operative  surgery  is  having  an  influence  upon 
the  mental  condition  of  woman  which  should  receive  close  scrutiny 
and  careful  investigation. 

Again,  we  note  that  the  influence  of  climate  and  of  diet  and  of 
social  surroundings  are  most  marked  either  in  the  production  or 
prevention  of  that  most  dreaded  of  all  diseases — insanity. 

The  various  phaces  of  mental  disorder,  together  with  their  causes, 
and  the  conditions  under  which  they  most  flourish  or  decline,  have 
been  discussed  by  the  writers  already  named.  Hence,  we  shall  de- 
vote the  brief  space  of  time  allotted  to  us  for  a bureau  address  to  a 
consideration  of  the  general  progress  which  has  been  made  toward 
an  understanding  of  the  nature  of  insanity,  and  likewise  shall  seek 
to  consider  the  most  modern  method  of  treating  this  malady,  and 
attach  to  this  dissertation  a few  tabulated  statements  showing  the 
results  attained. 

It  may  be  interesting  to  some  of  you  to  know  that  the  history  of 
the  care  and  treatment  of  the  insane  may  be  divided  into  four  great 
epochs : 

1.  The  epoch  of  absolute  neglect,  when  these  sick  people  were 
outcasts  from  society  and  compelled  to  live  in  forests  and  in  caves. 
This  was  their  condition  when  the  Great  Physician  of  Galilee  began 
His  work  of  healing  the  nations. 

2.  The  epoch  of  the  dungeon,  the  chain,  the  strong  cord  and  the 
whip.  This  was  the  epoch  when  the  insane  were  treated  as  the 
worst  of  criminals,  and  that  treatment  still  constitutes  one  of  the 
horrors  of  the  Dark  Ages. 

3.  The  epoch  of  the  asylum,  where  the  insane  were  held  “ in  cus- 
tody,” and  made  to  feel  constantly  a sense  of  imprisonment;  but 
their  confinement  was  carried  on  in  substantial  and  imposing  build- 
ings, and  the  insane  were  kept  in  comfortable  rooms,  and  given  suf- 
ficient food,  and  clad  in  warm  raiment,  and,  generally,  they  were 
afforded  such  comforts  as  seemed  necessary  in  the  dim  light  of  a 
dawning  perception  of  the  needs  of  this  strange  class  of  human 
beings. 

4.  The  epoch  of  the  hospital.  In  this  latter  epoch  the  fact  that 
the  insane  are  sick  people  suffering  with  brain  disease,  and  needing 
medical  as  well  as  physical  care,  was  fully  disclosed  by  the  discov- 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS  DISEASES.  927 


ery  of  modern  science.  This  epoch  is  very  recent  in  its  origin. 
Although  Pinel  struck  many  shackles  from  the  limbs  of  the  insane 
one  hundred  years  ago,  and  although  at  that  time  Samuel  Hahne- 
mann taught  the  doctrine  of  kindness  to  the  insane,  it  was  but  re- 
cently that  insanity  was  considered  so  much  of  a physical  disease  as 
to  require  hospital  treatment  in  every  sense  of  the  word. 

I think  it  may  be  truthfully  stated  that  during  the  past  twenty 
years  greater  progress  has  been  made  in  the  acquirement  of  a cor- 
rect knowledge  of  brain  and  mind  diseases,  and.  in  treating  them 
successfully  upon  the  hospital  plan,  than  ever  before. 

It  took  nearly  eighteen  hundred  years  of  a Christian  era  to  so  far 
develop  the  human  understanding  as  to  inspire  Pinel  with  sufficient 
confidence  in  the  law  of  kindness  to  strike  shackles  from  the  limbs 
of  maniacs.  It  has  taken,  since  his  day,  a hundred  years  of  per- 
sistent teaching  to  change  the  dungeon  into  the  asylum  and  the  asy- 
lum into  the  hospital.  Th*e  “ Hospital  Idea  ” may  be  said  to  have 
been  practically  recognized  only  during  the  past  few  years.  Even 
now  its  recognition  is  but  partial,  but  its  beneficence  must,  we  think, 
speedily  be  acknowledged  by  the  charitable  and  sympathetic  masses 
of  philanthropists. 

The  cave  treatment  that  belonged  to  the  Healer  of  Gennesareth, 
and  the  dungeon  treatment  which  forms  a part  of  the  horrors  of  the 
Dark  Ages,  have  passed  away,  and  we  have  now  to  consider  only 
asylum  care  and  hospital  treatment  for  the  insane. 

Let  us  consider  now  the  difference  between  an  asylum  and  a hos- 
pital. An  asylum  is  a place  of  custody  where  the  insane,  dangerous 
to  themselves  or  others,  may  be  confined  for  the  safety  of  the  com- 
munity as  well  as  that  of  the  individual.  A hospital  is  a place  for 
the  treatment  of  the  insane,  and  where  cures  are  effected  if  possible. 
The  asylum  is  associated  with  strong  walls  and  barred  windows  and 
heavy  doors  and  generally  prison-like  and  custodial  attachments. 
The  asylum,  in  its  old-time  purpose,  is  constructed  upon  the  “ safe 
bind,  safe  find”  principle.  The  lunatic  has  often  been,  and  still  is 
in  some  quarters,  looked  upon  as  a being  who  is  almost,  if  not  quite, 
as  dangerous  to  humanity  as  the  most  hardened  and  reckless  crimi- 
nal. Hence,  close  custody  has  been  the  allotment  awarded  to  him 
by  judicial  proceedings  or,  at  least,  judicial  approval. 

The  “ Hospital  Idea”  recognizes  the  broad  and  conclusive  fact 
that  the  insane  man  is  suffering  with  an  actual  physical  disease. 


928 


world’s  homoeopathic  congress. 


The  lunatic  is  now  looked  upon  as  a person  suffering  with  some 
pathological  state  of  the  cerebral  mass — pathological  either  by  or- 
ganic change  of  the  brain  tissues,  or  by  functional  disturbances 
within  the  cranium,  or  by  reflex  irritation  of  the  cerebrum  through 
the  influence  of  disease  located  in  some  other  organ  of  the  body. 

The  fact  that  the  brain  of  the  insane  man  is  diseased  having  been 
recognized,  it  would  seem,  then,  the  most  natural  and  logical  conclu- 
sion to  arrive  at  that  he  should  be  favored  with  as  skillful,  and  sci- 
entific, and  thorough  hospital  care  as  a person  afflicted  with  any 
other  form  of  disease  in  any  part  of  the  body;  and  yet,  when  we 
come  to  advocate  and  recommend  hospital  treatment  for  the  insane, 
we  are  forced  likewise  to  consider  the  necessity  for  depriving  the 
individual  of  his  personal  liberty. 

In  the  minds  of  many,  this  personal  liberty  of  the  individual  is 
sacred,  and  should  not  be  infringed  upon  except  by  the  most  solemn 
sanction  of  the  law.  While  we  do  not  hesitate  to  consign  small-pox 
cases  to  the  pest-house,  and  typhus  and  cholera  cases  to  the  hospital 
for  infectious  diseases  without  a judicial  commitment  in  each  indi- 
vidual case,  we  recoil  from  the  idea  of  placing  an  insane  patient  in 
a hospital  against  his  will,  unless  a commitment  is  made  out  in  the 
most  elaborate  form  by  two  qualified  examiners  in  lunacy,  and  their 
certificate  must  receive  judicial  approval  by  a judge  of  a court  of 
record  before  the  commitment  of  the  sick  man  can  safely  be  com- 
menced. 

In  the  State  of  New  York,  a legal  commitment  of  an  insane  man 
to  a hospital  for  treatment  provides  for  the  following : 

(1)  Medical  examination  by  two  duly  qualified  physicians,  and  a 
certification  of  the  result. 

(2)  Judicial  approval  of  the  certificate  by  a judge  of  a court  of 
record. 

(3)  Approval  or  disapproval  of  these  judicially  approved  papers 
by  the  State  Commission  in  Lunacy. 

Here  is  a formidable  array  of  legal  measures  to  be  complied  with 
before  the  lunatic  can  receive  continued  treatment  in  a hospital. 
Here  is  an  instance  where  the  medical  care  of  the  sick  is  wrenched 
from  the  hands  of  physicians,  and  the  necessity  for  curative  meas- 
ures may  be  either  approved  or  denied  by  a non-medical  judge,  or  a 
commission  that  is  non-medical  by  a two-thirds  majority. 

Why  should  legal  proceedings  interfere  with  the  prompt  and  care- 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS  DISEASES.  929 


ful  application  of  medical  measures  in  behalf  of  the  sick  ? I sup- 
pose that  one  reason  to  be  assigned  is  this  : Insanity  is  not  a con- 
tagious disease;  if  it  were  then  legal  interference  would  be  consid- 
ered unnecessary.  Neither  a trial  by  jury,  nor  a judicial  approval, 
is  required  when  the  disposal  of  a small-pox  case  is  in  question. 
If  it  were,  how  many  unvaccinated  juries  or  judges  would  be  willing 
to  try  the  case?  No  one  seems  anxious  to  impanel  a jury  to  diag- 
nose a case  of  cholera  or  typhus  fever!  As  Editha’s  burglar  said, 
regarding  noise:  “ It  isn’t  considered  ’ealthy  in  the  perfession.” 

Now  these  legal  measures,  which  are  required  before  curative 
treatment  for  the  insane  can  be  applied,  are  not  taken  for  the  pur- 
pose of  promoting  the  interests  of  lunatics,  but  they  are  deemed 
necessary  for  the  purpose  of  preventing  the  incarceration  of  people 
who  are  alleged  to  be  sane,  rather  than  insane.  The  whole  drift  and 
tenor,  and  tendency  of  legal  commitment  of  the  insane,  is  against 
the  interest  of  those  who  are  sick  and  in  need  of  treatment.  The 
whole  trend  of  legal  commitment  is  toward  the  protection  of  the 
sane  to  the  neglect  and  injury  of  the  insane. 

Under  the  present  forms  of  legal  commitment  the  lunatic  is  ex- 
amined, and  probed,  and  tortured,  and  ignominiously  guillotined  in 
soul  before  the  public  gaze,  and  is  branded  as  a “ lunatic”  all  over 
his  dome  of  thought  before  he  can  be  allowed  to  receive  treatment 
in  a hospital  for  the  insane. 

Is  there  any  place  on  earth  where  the  physician  is  allowed  to  be 
the  sole  judge  of  the  necessities  of  the  sick  insane?  We  may  an- 
swer, in  the  affirmative,  that  in  the  freest  of  all  republican  coun- 
tries, Norway — the  “ Land  of  the  Midnight  Sun  ” — the  highest  and 
noblest  yet  simplest  form  of  commitment  is  to  be  found.  There, 
the  family  physician  is  called  to  examine  the  patient,  and  if  it  is  his 
opinion  that  the  case  needs  asylum  treatment,  he  makes  an  informal, 
unsworn  to,  and  unapproved  certificate  to  that  effect,  and  the  patient, 
armed  with  this  certificate,  and  without  any  legal  hindrances  or  re- 
strictions whatever,  is  admitted  to  a Norwegian  asylum  for  treatment 
and  cure.  Dr.  Lindboe,  the  distinguished  psychologist  in  charge  of 
the  State  Asylum  for  the  Insane  at  Gaustad,  near  Christiana,  Nor- 
way, told  me,  personally,  that  this  method  was  entirely  satisfactory, 
and  that  no  evil  results  ever  followed  the  practice  which  obtained  in 
that  country  in  behalf  of  the  insane.* 


* In  Scandinavia,  the  physician  must  study  medicine  for  ten  years  before  he  can. 

59 


930 


world’s  homceopathic  congress. 


Commitment  of  the  insane  for  treatment  in  a state  hospital  should 
be  made  as  easy  as  possible  or  necessary  for  the  sick,  and  it  should 
be,  in  my  judgment,  entirely  upon  medical  authority.  There  is  no 
good  reason  for  supposing  that  the  family  physician  will  send  his 
patient  to  a hospital  for  treatment,  thus  robbing  himself  of  fees,  so 
long  as  the  case  can  be  safely  and  properly  cared  for  at  home.  And 
even  though  insanity  may  continue  for  an  indefinite  time,  we  believe 
that  the  insane  may  safely  be  sent  to  hospitals  for  treatment  without 
judicial  approval,  because  these  institutions  are  now  examined  and 
watched  over  by  disinterested  boards  of  trustees,  commissions  in 
lunacy,  and  the  people  at  large;  and  those  in  immediate  charge 
of  these  hospitals  have  every  interest  to  discharge  their  patients 
cured  or  relieved,  as  soon  as  possible,  in  order  to  make  a favor- 
able showing  to  the  community  which  holds  them  responsible  for 
their  work. 

Not  only  should  commitments  be  made  easy,  but  voluntary  ad- 
missions should  be  permitted.  It  is  a recognized  and  accepted  axiom 
among  alienists  that  early  treatment  for  the  insane  is  the  most  suc- 
cessful. Many  victims  of  insanity  have  recognized  at  the  outset 
their  oncoming  mental  disasters,  and  have  sought  by  vague  personal 
efforts  to  avert  them.  Hence  we  urge,  as  a means  to  the  end,  that 
victims  of  incipient  insanity  may  receive  early  treatment  in  accord- 
ance with  their  own  wishes;  legal  enactments  whereby  the  doors  of 
our  state  hospitals  in  all  the  States  may  be  readily  opened  for  those 
who  desire,  even  voluntarily,  to  enter  them  for  treatment.  If  you 
would  cure  the  largest  possible  percentage  of  the  insane,  thus  keep- 
ing the  community  as  free  from  insanity  as  possible,  you  must  grant 
the  privilege  of  easy  and  voluntary  admissions  to  our  state  institu- 
tions to  all  the  victims  of  mental  disorder. 

If  men  and  women  could  be  permitted  to  freely  and  voluntarily 


be  licensed  to  practice;  but  he  is  then  permitted  to  perform  his  medical  duty  with- 
out interference  by  the  laity  or  by  another  learned  profession. 

In  this  country  we  should  compel  our  students  to  continue  their  college  courses 
for  eight  or  ten  years,  and  then  physicians  should  be  allowed  to  care  for  their  pa- 
tients without  the  specious  and  unwarranted  approval  or  disapproval  df  those  who 
may  be  rich  in  legal  lore  but  ignorant  of  the  compound  intricacies  of  physical  and 
mental  pathology. 

The  physician  should  be  thoroughly  educated,  and  then  he  should  be  free  in 
action,  and  should  have  supreme  and  unhindered  authority  in  the  care  and  dispo- 
sition of  invalids  who  may  be  suffering  with  either  physical  or  mental  disease. 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS  DISEASES.  931 


avail  themselves  of  hospital  treatment  in  the  early  stages  of  their 
disease,  they  would  come  to  accept  such  benefits  more  readily,  they 
would  recover  more  rapidly,  the  usefulness  of  the  hospital  would  be 
enhanced,  and  the  apparent  disgrace  now  attached  to  enforced  and 
involuntary  treatment  would,  to  a large  extent,  be  removed.  State 
hospitals  for  the  insane  should  be  as  free  for  the  admission  of  pa- 
tients needing  treatment  for  mental  disease  as  are  other  hospitals  for 
the  admission  of  those  affected  with  general  or  special  diseases.  Such 
freedom  of  entry  and  egress  (for  the  voluntary  patient  may  depart 
when  he  pleases)  to  and  from  our  state  hospitals  is  in  accordance 
with  the  spirit  which  pervades  the  Constitution  of  the  United  States, 
and  is  in  closest  harmony  with  that  memorable  assertion  contained 
in  the  Declaration  of  Independence:  “We  hold  these  truths  to  be 
self-evident;  that  all  men  are  created  equal  (that  is,  with  equal 
privileges);  that  they  are  endowed  by  their  Creator  with  certain 
inalienable  rights;  that  among  these  are  life,  liberty,  and  the  pur- 
suit of  happiness.” 

In  maintaining  integrity  of  freedom  in  one’s  life,  in  acquiring 
full  exercise  of  liberty,  and  in  engaging  in  the  pursuit  of  happiness, 
nothing  can  be  more  important  than  that  priceless  privilege  of  enter- 
ing a hospital  when  sick  in  body  or  mind  without  let  or  hindrance 
from  any  source  whatever.  It  is  wrong,  unjust,  unconstitutional  to 
stamp  the  name  of  a disease,  held  in  abhorrence  and  feared  as  a dis- 
grace through  all  time,  upon  the  forehead  of  an  individual  who, 
without  the  stamp,  is  willing  to  avail  himself  of  every  possible  op- 
portunity for  treatment  and  cure.  Individual  rights  and  aggregate 
interests  are  infringed  upon  by  unnecessary  legal  commitments.  Let 
us  have  laws  which  shall  grant  the  admission  of  voluntary  patients 
to  our  state  hospitals,  and  let  commitments  be  restricted  simply  and 
solely,  as  the  law  originally  designed,  to  those  who  must  be  confined 
against  their  wills  for  the  proper  protection  of  themselves  and  the 
community. 

Again,  if  any  of  the  insane  are  to  be  considered  as  the  wards  of 
tho  State,  let  all  be  treated  alike  and  fairly.  That  is,  if  the  State 
assumes  wardship  over  the  pauper  and  indigent  insane,  let  the  Com- 
monwealth also  assume  charge  and  wardship  over  those  who  have 
both  life  and  property  to  protect. 

Insanity  is  a disease  which  renders  its  victim  absolutely  helpless. 
Under  its  visitation  be  can  protect  neither  his  life  nor  his  property. 


932 


world’s  homoeopathic  congress. 


Legal  wardship  implies  protection  of  those  who  are  unable  to  care 
for  themselves,  and  who  have  both  life  and  propert}'  at  stake.  This 
is  the  case  when  a guardian  is  appointed  to  take  charge  of  the  life 
and  property  of  a minor.  We  claim  that  the  insane  who  have  both 
life  and  property  should  be  doubly  the  wards  of  the  State,  on  ac- 
count of  their  helplessness,  on  account  of  the  interests  involved,  and 
on  account  of  the  fact  that  the  insane  with  property  are  always  more 
or  less  liable  to  become  the  easy  prey  of  designing  individuals. 
While  we  believe  that  all  the  insane  should  enjoy,  if  they  or  their 
friends  so  elect,  the  benefits  of  wardship  from  the  State,  we  are  also 
willing  to  admit  that  principle  of  freedom  of  choice  which  enables 
an  insane  man  to  go  to  a private  asylum  for  treatment  if  he  or  his 
friends  prefer  that  method  of  care. 

It  is  claimed  by  some  that  the  asylums  of  Europe  are  in  many 
respects  superior  to  the  asylums  of  the  United  States.  If  we  can 
find  in  the  institutions  of  the  East  anything  better  than  that  which 
is  now  established  here,  we  should  certainly  seek  to  monopolize  it. 
In  France  and  Belgium  and  North  Germany  and  Sweden  and  Scot- 
land we  find  institutions  for  the  insane  where  all  classes,  both  poor 
and  rich,  can  be  admitted,  and  where  voluntary  patients  are  received 
as  well  as  the  involuntary. 

We  should  seek  to  acquire  the  best  from  every  source,  and  then 
bend  all  our  energies  to  the  making  of  such  improvements  as  shall 
conduce  not  only  to  the  comfort  of  the  inmates,  but  to  the  exempli- 
fication of  hospital  treatment  for  the  purpose  of  curing  the  largest 
possible  percentage  of  the  insane. 

During  the  past  few  years  the  asylums  in  the  State  of  New  York 
have  been  converted,  by  legal  enactments,  into  “ State  Hospitals/’ 
More  than  that,  these  institutions  have  been  transformed  in  many 
particulars.  The  rooms  and  wards  and  parlors  have  been  renovated 
and  decorated  and  supplied  with  comfortable  and  easy  furniture. 
Soft  lounges  and  cushioned  reclining-chairs  have  taken  the  place  of 
hard  wooden  benches ; bare  floors  have  been  relieved  by  bright  and 
cheerful  carpets;  the  casements  and  the  walls  have  been  garnished 
with  curtains  and  pictures;  the  windows  have  been  made  larger  and 
more  numerous,  and  thus  more  light  has  been  let  into  the  dark  and 
gloomy  corners  of  the  buildings;  the  dingy  walls  have  been  painted 
and  frescoed  and  beautified  with  harmonious  tints;  large  rooms 
have  been  fitted  up  for  hospitals  where  the  best  and  softest  of  beds 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS  DISEASES.  933 


are  prepared  for  the  reception  of  weak  and  exhausted  patients.  The 
grounds  of  our  public  institutions  have  been  made  beautiful  with 
trees,  and  shrubs  and  plants  and  gaily-colored  flowers  which,  from 
balsamic  leaf  and  open  petal,  exhale  invigorating  and  inspiring  fra- 
grance for  the  stimulation  and  delectation  of  the  sick.  Heavy  iron 
guards  have  been  removed,  and  light  wire  screens,  for  simple  pur- 
poses of  protection,  have  been  substituted ; trained  nurses,  with 
helpful  hands  and  sympathetic  hearts,  have  taken  the  place  of  grim- 
visaged  and  hard-souled  keepers;  smiles  have  ruled  out  frowns,  and 
the  soft  folds  of  snow-white  cloth  have  been  substituted  as  all  that 
is  needful  in  place  of  the  old-time  and  harsher  restraints  of  leather 
and  wood  and  iron. 

In  this  general  improvement  the  matter  of  diet  has  been  carefully 
studied,  and  it  has  been  found  that  a generous  and  varied,  carefully- 
prepared  and  daintily-served  bill  of  fare  is  far  better  and  more 
fruitful  of  curative  results  than  the  pie  in,  hard,  unattractive  prison 
fare  of  the  past.  Hot  milk  is  the  beneficent  substitute  for  cold 
potatoes ! 

The  Hospital  Idea  seeks  to  monopolize  everything  that  can  be 
inspired  or  suggested  by  the  spirit  of  kindness  and  sympathy,  and 
it  seeks  to  embody  in  the  line  of  practical  utility  everything  that 
can  be  acquired  in  behalf  of  the  sick  by  intelligent  human  thought 
or  action.  The  Hospital  Idea  embraces  all  that  is  known  in  sani- 
tary science  as  applied  to  the  protection  of  human  life ; it  embraces 
all  that  is  known  of  diet  as  applied  to  restoration  of  impaired  phys- 
ical energy,  and  it  embraces  the  education  and  training  of  nurses, 
whose  nightly  vigils  are  to  supplement  the  daily  visits  of  the  physi- 
cian. The  Hospital  Idea  is  the  loftiest  embodiment  of  that  mighty 
and  far  reaching  rule:  “Do  unto  others  as  ye  would  that  they  should 
do  unto  you.”  The  Hospital  Idea  is  a topic  as  vast  as  ocean  depths, 
as  magnificent  as  mountain  peaks,  as  enduring  as  are  the  experiences 
of  sin  and  sorrow  among  men.  Its  application  is  the  last  and  grand- 
est work  of  the  philanthropist,  and  a sure  forerunner  of  the  mil- 
lennial dawn.  God  hasten  the  day  when  this  Hospital  Idea  shall 
be  exemplified  in  the  care  of  every  victim  of  mental  disease  within 
the  borders  of  all  the  nations  of  the  earth. 

The  cry  of  the  ages  is  for  universal,  not  limited  or  restricted, 
liberty;  the  cry  of  humanity’s  heart  is  for  universal  brotherhood; 
the  cry  of  those  who  sit  in  darkness  is:  “Let  in  the  light  of  uni- 
versal truth;”  the  cry  of  man’s  soul  is  for  universal  knowledge  and 


934 


world’s  homoeopathic  congress. 


everlasting  life;  and  the  cry  of  the  suffering  sick,  while  life  lasts  on 
earth,  is  that  the  spirit  of  sympathy  and  the  hand  of  charity  may 
encompass  and  help  universally,  and  without  limitation  of  class,  all 
those  who  have  been  bereft  of  the  use  of  their  reason,  and  who  need 
the  generous  protection  and  the  ample  wardship  of  the  State. 

We  now  present  a few  tables  showing  the  results  attained  in  the 
State  Hospital  at  Middletown,  where  the  patients  are  afforded  not 
only  the  physical  comforts  of  life — the  bright  and  beautiful  sur- 
roundings of  architectural  buildings,  sanitary  resources  and  artistic 
grounds,  and  where  trained  nurses  minister  constantly  to  the  neces- 
sities of  the  sick — but  also  where  strict  Homoeopathic  treatment 
constantly  and  uniformly  prevails.  In  presenting  these  statistics 
we  make  a modest  contrast  of  our  work  with  the  work  of  institu- 
tions where  Homoeopathic  treatment  does  not,  as  yet,  prevail. 

Table  I. 

This  table  shows  the  number  of  patients  discharged,  recovered, 
from  the  various  State  hospitals  of  the  State  of  New  York  during 
the  year  ending  September  30,  1892,  and  comparative  percentage 


of  recoveries. 

Middletown  (Homoeopathic), 125 

Buffalo  (Old  School),  108 

Utica,  “ . 87 

Hudson  River  (Old  School), 85 

St.  Lawrence,  “ 77 

Willard,  “ 31 

Binghamton,  “ . 26 

Rochester,  “ 22 

Total  number  treated  at  Middletown  State  Homoeopathic  Hos- 
pital,   .....  1104 

Recovered, 125 

Total  number  treated  at  all  other  State  hospitals,  . . . 8340 

Recovered,  436 

Number  of  recoveries  per  thousand  under  treatment : 

At  Middletown, 113 

At  all  other  hospitals, 52 


Comparative  Table  II. 

This  table  shows  comparative  percentage  of  recoveries  after  four 
methods:  1.  Percentage  on  whole  number  treated;  2.  Percentage 
on  daily  average ; 3.  Percentage  on  number  admitted ; and  4. 
Percentage  on  the  number  discharged  for  the  year  ending  Septem- 
ber 30,  1892. 


SECTIONAL  ADDRESS  IN  MENTAL  AND  NERVOUS  DISEASES.  935 


State  Hospitals, 

Whole  No.  treat’d. 

No.  recovered. 

Percentage. 

Daily  average. 

No.  recovered. 

Percentage. 

No.  admitted. 

No.  recovered. 

Percentage. 

No.  discharged. 

No.  recovered. 

• 

Percentage. 

Utica 

1123 

87 

7.74 

811 

87l 

10.72 

845 

87 

25.21 

286 

87 

30.41 

Hudson  River 

1150 

85 

7.39 

848 

85 

10.02 

297 

85 

28.61 

289 

85 

29.41 

Middletown, 

Homoeopathic 

1104 

125 

11.32 

827 

125 

15.11 

338 

125 

34.02 

250 

125 

50.00 

Buffalo 

935 

108 

11.55 

614 

108 

17.58 

350 

108 

30.85 

310 

108 

34.83 

Willard 

2510 

31 

1.23 

2062 

31 

1.50 

440 

31 

7.04 

395 

31 

7.85 

Binghamton 

1364 

26 

1.89 

1143 

26 

2.27 

207 

26 

12.56 

168 

26 

15.47 

St.  Lawrence 

759 

77 

10.14 

486 

77 

15.84 

372 

77 

20.69 

164 

77 

46.95 

Rochester 

499 

22 

4.40 

382 

22 

5.75 

124 

22 

17.74 

89 

22 

24.72 

All  Old  School  Hos- 
pitals  

8340 

436 

5.22 

6346 

436 

6.85 

2135 

436 

20.42 

1701 

436 

25.04 

All  Old-School  Hos- 
pitals, except  Wil- 
lard and  Bing- 
hamton  

4466 

379 

8.48 

3141 

379 

12.06 

1488 

379 

25.47 

1138 

379 

34.19 

Middletown  State 
Homceo.  Hospital.. 

1104 

125 

| 

11.32 

827 

125 

15.11 

1 

338 

125 

1 

36.98 

250 

125 

50.00 

Table  III. 

Table  III.  shows  death-rates  on  the  same  methods,  for  the  year 
ending  September  30,  1893. 


State  Hospitals. 

Whole  No.  treated. 

No.  of  deaths. 

Percentage. 

Daily  average. 

No.  of  deaths. 

Percentage. 

No.  of  admissions. 

No.  of  deaths. 

Percentage. 

J 

No.  discharged. 

No.  of  deaths. 

Percentage. 

Utica 

1123 

80 

7.12 

811 

80 

9.86 

345 

80 

23.18 

286 

80 

27.97 

Hudson  River 

1150 

113 

9.82 

848 

113 

13.32 

297 

113 

38.04 

289 

113 

.39.10 

Middletown, 

Homoeopathic 

1104 

67 

6.06 

827 

67 

8.10 

338 

67 

19.82 

250 

67 

26.80 

Buffalo 

935 

57 

6.09 

614 

57 

9.26 

350 

57 

16.28 

310 

57 

18.38 

Willard 

2510 

191 

7.60 

2062 

191 

9.26 

440 

191 

43.40 

395 

191 

48.35 

Binghamton 

1364 

87 

6.37 

1143 

87 

7.61 

207 

87 

41.02 

168 

87 

51.78 

St.  Lawrence 

759 

42 

5.53 

486 

42 

8.62 

372 

42 

11.29 

164 

42 

25.60 

Rochester 

499 

35 

7.01 

382 

35 

9.16 

124 

35 

28.22 

89 

35 

39. 331 

All  Old-School  Hos- 
pitals  

8340 

605 

7.25 

6346 

605 

9.53 

2135 

605 

28.33 

1701 

605 

35.56 

All  Old-School  Hos- 
pitals, except  Wil- 
lard and  Bing- 
hamton  

4466 

327 

7.32 

3141 

327 

10.41 

1488 

327 

21.97 

1138 

327 

28.73 

Middletown  Homoe. 

1104 

67 

6.061 

827 

67 

8.10 

339 

67 

16.81 

250 

67 

26.80 

936 


world’s  homoeopathic  congress. 

Table  IV. 

This  table  shows  the  average  percentages  upon  the  four  methods 
of  computation  united,  one  section  showing  united  average  percent- 
ages for  all  Old-School  hospitals,  another  section  showing  the  same 
for  Old-School  hospitals  except  Binghamton  and  Willard  State 
Hospitals,  in  which  are  many  chronic  cases;  and  a third  section 
showing  united  average  percentages  at  the  Middletown  State  Hom- 
oeopathic Hospital. 


Recoveries. 

Percentage  on 
whole  No.  treated. 

Percentage  on 
daily  av’age  popu- 
lation. 

Percentage  on 
admissions. 

Percentage  on 
discharges. 

Total. 

Total  on  4 prece- 
ding methods 
averaged. 

Utica  State  Hospital 

7.74 

10.72 

25.21 

30.41 

74.08 

18.52 

Hudson  River  “ 

7.39 

10.02 

28.61 

29.41 

75.43 

18.85 

Buffalo  “ 

11.55 

17.58 

30.85 

34.83 

94.81 

23.70 

Willard  “ 

1.23 

1.50 

7.04 

7.85 

17.62 

4.42 

Binghamton  “ 

1.89 

2.27 

12.56 

15.47 

32.19 

8.04 

St.  Lawrence  “ 

10.14 

15.84 

20.69 

46.95 

93.62 

23.40 

Rochester  “ 

4.40 

5.75 

17.74 

24.72 

52.61 

13.15 

Total  for  Old-School  Hospit’ls 

44.34 

63.68 

142.70 

189.64 

Average  for  same, 

6.33 

9.09 

20.38 

27.09 

62.89 

15.72 

Total  for  Old-School  Hospitals 

except  Binghamton  and 

Willard 

41 .22 

59.91 

123.10 

166.32 

Average  for  same 

8.24 

11.98 

24.62 

33.26 

78.10 

19.52 

Middletown  State  Homoeo- 

11.34 

15.11 

34.02 

50.00 

110.47 

27.61 

pathic  Hospital 

The  general  average  of  recoveries  for  all  Old-School  Hospitals,  is 15.72 

• The  general  average  of  recoveries  for  all  Old-School  Hospitals,  except 

Binghamton  and  Willard,  is 19.52 

The  general  average  of  recoveries  for  the  Middletown  State  Homoeopathic 
Hospital,  is 27.61 


PSYCHIATRY  AND  THE  HOMCEOPATHIC  MEDICAL  COLLEGES.  937 


PSYCHIATRY  AND  THE  HOMCEOPATHIC  MEDICAL 

COLLEGES. 

By  N.  Emmons  Paine,  A.M.,  M.D.,  West  Newton,  Mass. 


In  1871  there  was  no  State  hospital  for  the  insane,  in  the  world, 
under  Homoeopathic  management.  To-day  there  are  five.  In  that 
year  there  was  no  Homoeopathic  member  of  the  National  Society 
of  Asylum  Superintendents ; to-day  there  are  six.  In  that  year 
decided  action  was  taken  by  that  Association,  which  makes  it  almost 
a starting  point  in  the  newer  methods  of  instruction  in  psychiatry. 
As  none  of  the  members  of  the  Institute  were  then  members  of 
the  Association,  it  seems  to  me  desirable  that  its  action  and  the  sub- 
sequent changes  in  teaching  should  be  brought  to  the  attention  of 
the  Institute,  for  our  information  and  for  directing  our  course  in 
the  future. 

It  was  in  1871,  then,  that  the  Association  of  Medical  Superin- 
tendents of  American  Institutions  for  the  Insane  passed  the  follow- 
ing resolutions : 

Resolved , That  in  view  of  the  frequency  of  mental  disorders 
among  people  of  all  classes,  and  in  recognition  of  the  fact  that  the 
first  care  of  nearly  all  these  cases  devolves  upon  physicians  engaged, 
in  general  practice,  and  this  at  a period  when  sound  views  of  the 
disease  and  judicious  modes  of  treatment  are  especially  important, 
it  is  the  unanimous  opinion  of  this  Association  that  in  every  school 
confering  medical  degrees,  there  should  be  delivered,  by  competent 
professors,  a complete  course  of  lectiires  on  insanity  and  on  medical 
jurisprudence,  as  connected  with  disorders  of  the  mind. 

Resolved , That  these  lectures  should  be  delivered  before  all  the 
students  attending  these  schools,  and  that  no  one  should  be  allowed 
to  graduate  without  as  thorough  an  examination  on  these  subjects  as 
on  the  other  branches  taught  in  the  schools. 

Resolved , That  in  connection  with  these  lectures,  whenever  prac- 
ticable, there  should  be  clinical  instruction,  so  arranged  that,  while 


938  world’s  homoeopathic  congress. 

giving  the  student  practical  illustrations  of  the  different  forms  of 
insanity  and  the  effects  of  treatment,  it  should  in  no  way  be  detri- 
mental to  the  patients. 

This  action  of  the  Association  has  recently  been  quoted  and  en- 
dorsed by  the  New  York  State  Commission  in  Lunacy,  in  a circular 
to  the  managers  of  hospitals,  dated  December  10,  1892. 

In  order,  therefore,  to  ascertain  as  definitely  as  possible  what  had 
been  done  in  the  direction  of  these  resolutions,  I addressed  a cir- 
cular in  January  to  the  dean  of  each  of  the  144  medical  colleges 
of  the  United  States  and  Canada.  Fearing  that  not  all  would  re- 
spond, and  hoping  for  additional  information  from  another  direc- 
tion, I also  sent  a similar  circular  to  each  one  of  the  superintendents 
of  state  hospitals  for  the  insane  and  certain  other  members  of  the 
Association,  one  hundred  and  seventy  in  number.  Most  of  the 
superintendents  responded  quickly  and  fully,  and  this  informatiom 
was  added  to  that  from  the  deans  and  secretaries  of  the  faculties. 
Few  sent  no  report,  and  fifty  sent  answer  that  they  did  not  teach  in 
any  college.  On  the  other  hand,  the  responses  from  the  colleges 
were  unsatisfactory  as  to  number,  and  they  could  have  been  of 
little  value  if  taken  alone  and  without  the  information  given  by 
the  superintendents.  As  it  is,  we  shall  observe  what  is  done  for 
teaching  psychiatry  in  the  United  States  and  Canada  in  sixty-one 
colleges.  Of  the  other  eighty-three,  it  seems  fair  to  suppose  that 
most  of  them  do  nothing  in  this  particular  direction,  and,  therefore, 
have  nothing  to  report.  (A  list  of  the  sixty-one  colleges  is  appended.) 

In  all  of  the  sixty-one  colleges,  with  one  exception  for  this  year 
only,  psychiatry  is  taught  either  by  alienists  or  specialists.  The  ap- 
parent growth,  in  twenty-two  years,  has  been  from  eight  to  sixty, 
for  eight  is  the  number  reporting  definitely  that  this  subject  was 
taught  in  1871.  The  next  interesting  fact  is  that  thirty -four  of  the 
sixty-one  colleges  have  obtained  the  services  of  superintendents  of 
hospitals  for  the  insane  as  teachers,  while  two  have  obtained  assist- 
ant physicians  of  hospitals;  and  twenty-four  have  filled  the  chairs 
with  specialists,  the  latter  class  including  many  grades  of  fitness  for 
their  duties. 

Our  next  inquiry  will  be  whether  students  are  examined  in 
psychiatry  as  a requisite  for  graduation,  the  second  of  the  resolu- 
tions. Of  the  sixty-one  colleges,  twenty  have  no  examination  in 
this  branch ; six  are  unknown ; in  five,  the  students  are  examined, 


PSYCHIATRY  AND  THE  HOMOEOPATHIC  MEDICAL  COLLEGES.  939 


but  not  by  the  lecturer;  and  in  thirty  the  lecturer  examines  in  his 
own  specialty.  The  conclusion  is,  therefore,  that  in  fifty-seven  per 
cent,  of  the  colleges  where  psychiatry  is  taught  an  examination  is  re- 
quired. 

The  last  of  the  three  resolutions  refers  to  clinical  teaching.  In 
forty-two  of  the  sixty-one  colleges,  clinics  are  held  ; in  fifteen  there 
are  none ; and  from  four  there  was  no  answer  to  this  question. 
That  shows  a majority,  or  sixty-seven  per  cent.,  in  favor  of  illustrat- 
ing the  lectures  on  insanity  by  cases  of  insanity.  Further,  it  seems 
fair  to  infer  that  the  remaining  thirty-three  per  cent,  would  be  glad 
to  furnish  clinical  material  if  circumstances  allowed  ; and  it  is  in- 
teresting to  note  that  not  one  of  the  officials,  replying  for  the  col- 
leges where  clinical  teaching  has  been  tried,  has  referred  to  it  in  any 
way  but  with  satisfaction  and  commendation. 

If  any  one  will  look  over  the  map  of  our  country  and  see  the 
location  of  our  colleges  and  hospitals  for  the  insane,  he  will  be  sur- 
prised that  no  more  colleges  have  already  made  use  of  the  enor- 
mous amount  of  material  at  their  doors.  He  would  be  convinced 
that  a large  majority  of  the  colleges  could  teach  psychiatry  as  readily 
and  as  graphically  as  surgery  if  they  only  used  their  advantages 
and  arranged  with  the  state  hospitals  and  their  superintendents  for 
lectures  and  clinics.  How  this  could  be  done  is  well  shown  at  the 
Middletown  State  Homoeopathic  Hospital,  whose  superintendent, 
Dr.  Selden  H.  Talcott,  is  also  professor  of  mental  diseases  in  the 
New  York  Homoeopathic  Medical  College.  He  delivers  a course 
of  lectures  at  the  college,  and,  in  addition,  on  one  or  two  days  he 
invites  the  whole  senior  class  to  spend  a day  at  the  hospital,  sixty- 
six  miles  from  New  York.  There  they  go  through  the  whole  hos- 
pital, become  acquainted  with  its  construction  and  the  arrangement 
of  the  wards,  and,  under  suitable  circumstances,  have  selected  cases 
presented  to  them.  In  addition  to  this  general  invitation,  there 
may  be  further  visits  by  sections  of  the  class  at  other  times. 

The  same  method  of  teaching  is  practiced  at  the  Boston  Univers- 
ity School  of  Medicine.  Dr.  N.  Emmons  Paine  gives  five  lectures 
on  the  anatomy  and  physiology  of  the  brain  and  nervous  system,  re- 
viewing the  work  of  an  early  portion  of  the  course,  and  also  gives 
five  lectures  on  insanity  at  the  college.  Further,  the  students  visit 
Westborough  Insane  Hospital,  thirty-two  miles  from  Boston,  in  a 
body,  five  times  during  the  autumn  for  the  fortnightly  clinics,  which 


940 


world’s  homoeopathic  congress. 


alternate  with  the  lectures  at  the  college.  The  superintendent  of 
the  hospital,  Dr.  George  S.  Adams,  presents  a variety  of  cases  to 
them,  as  well  as  a large  number.  Perhaps,  in  one  day,  they  will 
have  brought  before  them  ten  or  twenty  cases  of  mania,  and  on  an- 
other occasion  as  many  persons  with  melancholia ; so  that,  without 
any  special  study  the  students  learn  to  diagnose  readily  and  accu- 
rately the  various  forms  of  insanity,  and,  better  than  all,  this  ability 
is  acquired  in  a natural  way,  and  is  not  forgotten  in  later  years. 
They  hear,  also,  a large  number  of  commitments  read  and  criticized, 
and  they  become  skilled  in  writing  them  by  actual  practice,  with 
patients  before  them  as  models. 

The  trip  to  Westborough  seems  to  be  regarded  with  favor  by  the 
students,  although  not  obligatory  upon  them,  for  the  attendance  is 
quite  as  full  as  at  the  lectures,  and  members  of  other  classes  accept 
the  privilege  of  joining  the  seniors  in  these  excursions,  when  their 
duties  will  permit.  The  only  difficulty  has  been  the  cost,  which 
must  be  added  to  the  ordinary  expenses  of  student  life,  but  the 
railroad  assists  us  by  reducing  its  rate  to  one  dollar  for  the  round 
trip.  A lady  friend  had  given  the  beginning  of  a fund,  the  interest 
of  which  is  used  for  defraying  these  travelling  expenses,  and  wdiich 
is  hoped  may  become  large  enough  eventually  to  remove  this  one 
and  only  drawback. 

Another  fact  must  not  be  overlooked,  that  aside  from  the  ordi- 
nary forms  of  insanity  with  which  they  become  familiar,  the  stu- 
dents may  have  introduced  to  them  some  of  the  rare  and  curious 
forms  of  disease.  A hospital,  with  five  hundred  or  a thousand  in- 
sane, will  probably  have  examples  of  myxoedema,  cerebral  syphilis, 
epilepsy  of  the  Jacksonian  type,  locomotor  ataxia,  chronic  alcohol- 
ism and  multiple  sclerosis ; so  that  their  clinical  advantages  are 
not  limited  solely  to  insanity. 

Anoter  State  hospital  to  furnish  an  alienist  as  lecturer  in  a 
Homoeopathic  college  is  the  one  at  Fergus  Falls,  Minnesota.  Dr. 
Alonzo  P.  Williamson,  who  recently  resigned  the  superintendency, 
has  been  lecturing  in  the  College  of  Homoeopathic  Medicine  and 
Surgery  at  Minneapolis,  and  has  furnished  some  clinical  cases  at  the 
college,  but  not  at  the  hospital,  as  that  is  too  far  away. 

In  Michigan,  Dr.  Oscar  R.  Long,  superintendent  of  the  Michigan 
Asylum  for  Dangerous  and  Criminal  Insane,  lectures  in  the  Hom- 
oeopathic Medical  College  at  Ann  Arbor,  and  he,  too,  cannot  take 


PSYCHIATRY  AND  THE  HOMCEOPATHIC  MEDICAL  COLLEGES.  941 


his  classes  to  the  asylum,  as  the  distance  is  more  than  a hundred 
miles  in  a straight  line  from  the  college. 

It  may  be  remembered  that  sixty-one  was  the  number  of  the  col- 
leges having  lectures  by  specialists,  but  that  one  was  deducted  for 
this  year,  and  that  one  was  the  Hahnemann  Medical  College  of 
Philadelphia.  It  was  there  that  Dr.  S.  H.  Talcott  lectured  from 
1881  to  1885,  and  then  was  followed  by  Dr.  A.  P.  Williamson 
until  1890.  No  successor  seems  to  have  been  found  to  Dr.  Wil- 
liamson. 

Upon  glancing  back  for  a moment,  we  are  surprised  to  find  that 
in  five  States  the  Homoeopathic  medical  colleges  have  been  receiving 
lectures  from  alienists  of  our  own  school,  every  one  a superintendent 
of  a State  hospital.  This  fact  is  well  worth  noting  in  passing. 

In  the  Homoeopathic  Medical  College  of  Missouri  at  St.  Louis,  I. 
D.  Toulon,  LL.B.,  M.D.,  teaches  insanity  with  jurisprudence,  but 
he  holds  no  clinics. 

The  New  York  Medical  College  and  Hospital  for  Women  is  for- 
tunate in  having  in  its  faculty  Dr.  Joseph  T.  O’Connor,  who  in- 
cludes insanity  in  his  course  in  nervous  diseases,  and  who  furnishes 
some  clinical  cases  at  the  college. 

In  one  other  college,  the  Cleveland  Medical  College,  instruction 
in  insanity  is  given  by  Dr.  John  A.  Gann,  in  connection  with  ner- 
vous diseases,  but  no  special  clinics  are  held. 

This  completes  the  list  of  the  Homoeopathic  colleges  that  replied  to 
my  circular;  eight  are  accounted  for  out  of  sixteen.  What  is  done 
in  the  other  eight  for  the  instruction  of  their  students  is  impossible 
for  me  to  state. 

Just  here  let  me  diverge  for  a moment  from  our  subject.  So  far, 
our  attention  has  been  given  to  the  education  of  students.  Now  let 
us  turn  to  the  instruction  of  practitioners.  More  information  on 
the  subject  of  insanity  would  be  most  gladly  received  by  the  mem- 
bers of  our  school  all  over  our  country  ; and  when  we  have  State 
hospitals  already  established,  this  want  can  be  easily  supplied.  It 
can  be  done  in  this  way : Let  him  select  and  present  to  the  Society  a 
larger  number  of  typical  cases  of  the  easily  recognized  forms  of  in- 
sanity, or  others  that  may  be  odd  and  interesting.  Guide  the  mem- 
bers through  every  part  of  the  institution.  Give  them  a dinner; 
and,  last  of  all,  do  not  let  him  neglect  to  invite  the  wives.  Such  a 
course  systematically  carried  out  would  be  a great  benefit  to  the 


942 


world’s  homoeopathic  congress. 


hospital  itself,  and  of  the  greatest  possible  advantage  to  it ; but  the 
most  valuable  results  would  really  be  found  in  the  better  informa- 
tion among  physicians,  and  the  feeling  of  confidence  in  the  hospital 
and  its  work  among  their  patrons  throughout  the  whole  State. 

Now  let  us  return,  after  this  digression,  to  our  subject. 

The  conclusions  to  be  drawn  by  members  of  the  Institute  are 
these:  First,  that  psychiatry  is  receiving  more  attention  every  year 
from  the  medical  colleges  of  this  country. 

Secondly.  That  alienists  and  specialists  are  being  selected  as  in- 
structors, with  a noticeable  preference  for  the  superintendents  of 
hospitals. 

Thirdly.  That  an  examination  in  this  specialty  is  required  for 
graduation  in  a larger  number  of  colleges  every  year. 

Fourthly.  That  clinics  are  becoming  recognized  as  a necessary 
part  of  the  teaching  in  this  branch. 

Fifthly.  That  in  order  to  obtain  these  advantages,  every  Homoeo- 
pathic college  should  labor  for  the  establishment  of  a hospital  for  the 
insane  in  the  States  where  they  do  not  now  exist,  and,  when  success- 
ful, the  hospital  should  be  located  within  a few  miles  of  the  college. 

Sixth,  and  finally.  The  Institute,  as  our  national  association, 
should  place  itself  on  record  in  favor  of  this  advance  in  medical 
education  by  adopting  the  following  resolution: 

Resolved,  That  the  American  Institute  of  Homoeopathy  favors  the 
inclusion  of  psychiatry  in  the  curriculum  of  all  medical  colleges  of 
the  United  States.  It  favors  an  examination  in  psychiatry  as  in 
other  specialties,  and  recommends  that  clinical  teaching  should  be 
added  to  the  didactic  wherever  possible. 

Appendix. 

The  statistics  of  the  foregoing  article  are  based  on  replies  from 
the  following  sixty-one  medical  colleges: 

Medical  Department  Arkansas  Industrial  University,  Little  Rock, 
Ark. 

Cooper  Medical  College,  San  Francisco,  Cal. 

University  of  California,  Med.  Dept.,  San  Francisco. 

University  of  Denver,  Med.  Dept.,  Denver,  Colo. 

Yale  University,  Med.  Dept.,  New  Haven,  Conn. 

University  of  Georgetown,  Med.  Dept.,  Washington,  D.  C. 

Rush  Medical  College,  Chicago,  111. 


PSYCHIATRY  AND  THE  HOMOEOPATHIC  MEDICAL  COLLEGES.  943 


Medical  College  of  Indiana,  Indianapolis,  Ind. 

Central  College  of  Physicians  and  Surgeons,  Indianapolis. 

State  University  of  Iowa,  Med.  Dept.,  Iowa  City,  Iowa. 

College  of  Physicians  and  Surgeons,  Keokuk. 

Kansas  Medical  College,  Topeka,  Kansas. 

New  Orleans  University,  Med.  Dept.,  New  Orleans,  La. 

College  of  Physicians  and  Surgeons,  Baltimore,  Md. 

Harvard  University  Medical  School,  Boston,  Mass. 

Boston  University  School  of  Medicine,  Boston. 

University  of  Michigan,  Department  of  Medicine  and  Surgery, 
Ann  Arbor,  Mich. 

University  of  Michigan  Homoeopathic  Medical  College,  Ann 
Arbor. 

Detroit  College  of  Medicine,  Detroit. 

The  College  of  Medicine  and  Surgery  of  the  University  of  Min- 
nesota, Minneapolis,  Minn. 

The  College  of  Homoeopathic  Medicine  and  Surgery  of  the  Uni- 
versity of  Minnesota,  Minneapolis. 

Minneapolis  College  of  Physicians  and  Surgeons,  Minneapolis. 
Kansas  City  Medical  College,  Kansas  City,  Missouri. 
Homoeopathic  Medical  College  of  Missouri,  St.  Louis. 

University  Medical  College  of  Kansas  City,  Kansas  City. 
Ensworth  Medical  College,  St.  Joseph. 

Barnes  Medical  College,  St.  Louis. 

Omaha  Medical  College,  Omaha,  Nebraska. 

Medical  Department  Cotner  University,  Lincoln. 

Dartmouth  Medical  College,  Hanover,  New  Hampshire. 

College  of  Physicians  and  Surgeons  in  the  City  of  New  York, 
New  York,  N.  Y. 

Bellevue  Hospital  Medical  College,  New  York. 

University  of  the  City  of  New  York,  Med.  Dept.,  New  York. 
New  York  Homoeopathic  Medical  College  and  Hospital,  New 
York. 

Woman’s  Medical  College  of  the  New  York  Infirmary,  New 
York. 

New  York  Medical  College  and  Hospital  for  Women,  New  York. 
Eclectic  Medical  College  of  the  City  of  New  York,  New  York. 
Albany  Medical  College,  Med.  Dept.,  Union  University,  Albany. 
Syracuse  University,  College  of  Medicine,  Syracuse. 


944 


world’s  homoeopathic  congress. 


University  of  Buffalo,  Med.  Dept.,  Buffalo. 

Niagara  University,  Med.  Dept.,  Buffalo. 

University  of  Wooster,  Med.  Dept.,  Cleveland,  Ohio. 

Eclectic  Medical  Institute,  Cincinnati. 

Miami  Medical  College,  Cincinnati. 

Cleveland  Medical  College,  Cleveland. 

University  of  the  State  of  Oregon,  Med.  Dept.,  Portland,  Oregon. 
Department  of  Medicine  of  the  University  of  Pennsylvania,  Phila- 
delphia, Penna. 

Hahnemann  Medical  College,  Philadelphia. 

Western  Pennsylvania  Medical  College,  Pittsburgh. 

University  of  Nashville  and  Vanderbilt  University,  Med.  Depts., 
Nashville,  Tenn. 

Nashville  Medical  College,  Med.  Dept,  of  the  University  of  Ten- 
nessee, Nashville. 

Tennessee  Medical  College,  Knoxville. 

Chattanooga  Medical  College,  Med.  Dept,  of  Grant  University, 
Chattanooga. 

University  of  Vermont,  Med.  Dept.,  Burlington,  Vermont. 
Toronto  University,  Medical  Faculty,  Toronto,  Ontario,  Canada. 
Faculty  of  Medicine  of  Queen  University,  Kingston. 

Kingston  Women’s  Medical  College,  Kingston. 

Western  University,  Med.  Dept.,  London. 

McGill  University,  Med.  Dept.,  Montreal,  Quebec. 

Laval  University,  Med.  Depts.,  Quebec. 

Halifax  Medical  College,  Halifax,  Nova  Scotia. 

Manitoba  Medical  College,  Winnipeg,  Manitoba. 


THE  OCTAVE  AS  THE  KEY  TO  PSYCHOLOGY. 


945 


THE  OCTAVE  (SEPTENARY)  IN  NATURE  AND  IN 
MAN  AS  THE  KEY  TO  PSYCHOLOGY. 

By  J.  D.  Buck,  M.D.,  Cincinnati,  O. 


Every  school-bo}7  is  aware  that  there  is  a mysterious  power  in 
certain  numbers  like  the  seven  and  the  nine,  and  that  in  permuta- 
tions to  which  such  numbers  may  be  subjected  the  most  curious  re- 
sults are  continually  brought  to  light.  The  school-boy,  however,  is 
not  likely,  from  such  phenomena,  to  draw  the  conclusion  that  pure 
mathematics  and  exact  geometry  underlie  every  process  in  nature, 
and  determine  also  every  fact  and  function  of  what  we  call  life.  It 
is  not  the  object  of  the  present  essay  to  discover  a new  or  to  formu- 
late an  old  hypothesis,  but  rather  to  call  attention  to  certain  well- 
known  facts  and  to  show  that  the  logical  and  inevitable  deductions 
that  lie  very  near  the  surface  of  all  phenomena  whatsoever  point  out 
a law  of  nature  hitherto  overlooked  by  the  western  world  but  well 
known  to  the  ancients.  The  apprehension  of  this  law  becomes,  in 
the  hands  of  the  intelligent  and  unbiassed  student,  a key  to  psy- 
chology. 

I shall  assume  nothing  that  is  not  demonstrable  either  by  scientific 
research  in  the  realm  of  physics  or  by  logical  reasoning  in  the  realm 
of  metaphysics.  These  are  the  two  realms  in  which  man’s  being 
exists,  and  the  two  methods  by  which  we  derive  what  we  call  knowl- 
edge. Exact  observation  and  correct  reasoning  are  the  agencies 
in  all  our  investigations.  As  the  base  and  the  capital  stand  to 
the  perfect  column,  so  stand  observation  and  reason  to  exact 
knowledge. 

The  physicist  resolves  the  universe  into  matter  and  force,  or  mass- 
and  motion  ; the  metaphysician  into  law  and  order ; the  physiolo- 
gist into  structure  and  function  ; the  psychologist  into  consciousness 
and  intelligence;  while  the  philosopher,  through  his  apprehension 
of  universal  order  and  harmony — diversity  in  unity  and  unity  in 
diversity — sees  behind  a boundless  and  eternal  nature,  an  intelli- 
gence that  works  by  law  and  determines  evolution.  Knowledge  is 

60 


946 


world’s  homoeopathic  congress. 

the  combined  result  of  all  these  forces  and  processes.  Nature,  in 
order  to  be  apprehended,  must  be  viewed  and  studied  from  every 
point  of  observation.  Hence  the  knower  must  be  at  once  the  physi- 
cist, the  metaphysician,  the  physiologist,  psychologist,  and  philoso- 
pher. All  fragmentary  or  one-sided  views  are  not  only  incomplete, 
they  are  generally  misleading. 

Nature  exists  as  an  eternal  unity,  without  beginning  or  end  in 
time ; creation  and  duration  are  aspects  of  eternity.  What  we  call 
“ beginning  ” and  “ end  ” are  but  the  succeeding  changes  when  end- 
less duration  is  broken  into  fragments  called  time.  Every  beginning 
has  been  preceded  by  what  we  call  an  ending,  or  the  close  of  a pre- 
vious cycle.  Every  so-called  end  will  be  followed  by  a new  begin- 
ning, or  the  dawn  of  a new  cycle. 

The  first  postulate  in  the  last  analysis  attainable  thus  far  by  man 
is  the  idea  of  space.  The  idea  of  abstract  space  is  not  emptiness  but 
a conditioned  fulness.  It  is  the  boundless  and  eternal  potency,  con- 
tinually evolving  into  universal  actuality,  and  again  receding  into 
its  source.  This  appearance  and  disappearance  is  periodical  and 
rhythmical,  and  time  is  but  the  measure  of  its  pace.  Evolution  is 
the  wave  of  its  ebb  and  flow;  the  ceaseless  impulse  that  differen- 
tiates the  one  into  the  many,  the  universal  into  the  particular,  and, 
in  this  differentiation,  the  individual  epitomizes  the  universal.  Every 
atom,  like  a mirror,  reflects  the  face  of  the  universe.  Space  is, 
therefore,  full  of  substance,  and  this  substance  is  the  root  of  all  mat- 
ter. Space  is  full  of  energy,  and  this  energy  is  the  parent  of  all 
force  and  determines  all  motion.  We  have  thus  a trinity  of  concepts 
flowing  from  out  first  unity — space — and  this  trinity  is  space,  sub- 
stance, and  energy.  Behind  all  matter  and  motion  we  discern 
rhythm,  order  and  proportion,  or  intelligence,  and  the  form  of  this 
manifestation,  that  is,  its  persistency,  recurrence,  periodicity,  and 
harmony,  we  call  law.  As  the  whole  must  necessarily  include 
all  of  its  parts,  every  essence  and  phenomenon,  manifesting  in  a 
part,  must  be  latent  in  the  whole,  and  this  includes  life  and  con- 
sciousness. 

Starting  thus  with  our  concept  of  boundless  and  eternal  nature, 
we  have  universal  substance  endowed  with  universal  energy,  gov- 
erned by  universal  law,  and  manifesting  universal  life,  universal  in- 
telligence, and  universal  consciousness.  The  terms,  “ living  ” and 
“ dead,”  whether  applied  to  atom  or  sun,  to  microbe  or  to  man,  are 


THE  OCTAVE  AS  THE  KEY  TO  PSYCHOLOGY. 


947 


relative  only.  Back  of  all  apparent  death  lies  the  eternal  potency 
that  we  call  life,  that  has  made  it  possible  to  die.  Back  of  all  ap- 
parent unconsciousness  lies  the  universal  consciousness  from  which 
individual  consciousness  springs,  into  which  it  returns  periodically 
only  to  again  emerge  from  the  latent  to  the  actual  or  manifesting. 
Hence  are  derived  the  cycles  of  time,  as  the  cycles  of  life ; the  whirl- 
ing of  suns  and  the  circulation  of  the  blood.  It  is  but  the  motion, 
the  periodicity,  the  rhythm  and  harmony  of  the  universal  manifest- 
ing in  the  individual. 

Here,  then,  lies  the  basis  of  psychology,  psyche-logos  : a knowl- 
edge of  the  soul.  But  where  is  the  key  to  its  knowledge  and  inter- 
pretation ? 

Let  us  take  two  functions  in  man  with  which  we  are  quite  familiar, 
sight  and  hearing.  With  all  the  diversity  and  multiplicity  of  the 
phenomena  of  sight  and  hearing,  we  find  an  underlying  harmony. 
If  we  were  never  conscious  of  but  one  color  and  one  sound,  if  mono- 
chrome and  monotone  took  the  place  of  the  endless  diversity  in  these 
two  realms,  we  would  be  unconscious  of  either  sound  or  color. 
These  functions  exist  only  by  virtue  of  diversity  in  harmony.  To 
illustrate  this,  we  may  imagine  ourselves  living  in  a world  of  abso- 
lute light,  where  no  object  ever  cast  a shadow,  and  from  which  all 
gradations  of  light  and  darkness  had  disappeared.  The  result  would 
be  that  we  could  have  no  knowledge  or  experience  of  light  at  all. 
Absolute  light  is  thus  synonymous  with  absolute  darkness.  This 
concept  is  the  basis  of  what,  in  the  oldest  philosophies,  is  called  the 
“ pairs  of  opposites.”  The  same  reasoning  and  the  same  conclu- 
sions are  applicable  to  sound,  color,  taste,  and  smell,  and,  finally, 
to  the  very  basis  of  mind  no  less  than  of  sensation.  What  we 
call  thought  is  but  the  changes  occurring  in  our  state  of  conscious- 
ness. 

To  return  to  our  analysis  of  sight  and  hearing,  we  thus  see  that 
perception  and  sensation  depend  on  change  and  diversity.  The  basis 
of  all  this  change  is  number  and  harmony.  Not  only  have  we  pri- 
mary colors  and  primary  tones,  but  every  color  and  sound  is  related 
to  every  other  in  nature  by  concrete  degree,  just  as  every  chemical 
substance  has  its  combining  number,  and  is  related  to  every  other 
substance  by  a fixed  and  inherent  law  of  proportion  by  which  it 
enters  into  combination.  Number  also  determines  form,  so  that  the 
saying  of  Plato,  that  “God  geomatrizes  ” expresses  a universal  law. 


948 


world’s  homoeopathic  congress. 


The  key-note  of  all  this  rhythm  and  harmony  of  relation  and  com- 
bination is  the  septenary,  called  in  music  or  harmony  the  “ octave.” 
Every  octave  is  simply  a series  of  septenaries,  the  last  tone  of  one 
octave  being  the  first  of  the  succeeding  scale.  Now,  if  we  begin 
with  the  lowest  tone  apprehensible  to  the  human  ear  and  raise  the 
pitch  octave  after  octave  until  the  tone  again  becomes  inaudible  to 
the  average  ear,  science  has  estimated  that  about  thirty-four  octaves 
would  intervene  between  the  vanishing  point  of  sound  before  reach- 
ing those  ethereal  vibrations  which  give  us  the  color  red  of  the  solar 
spectrum.  What  becomes  of  the  vibrations  of  these  intervening 
octaves?  There  are  certainly  vibrations  below  these  audible  to  us 
as  above,  and  colors  that  our  eyes  cannot  see.  The  colors  of  the 
spectrum  from  red  to  violet  are  as  definitely  related  to  each  other 
and  to  their  primaries  as  are  the  vibrating  notes  of  a musical  scale. 
If  we  discern  the  underlying  principle  of  a medium  vibrating  rhyth- 
mically, according  to  mathematical  proportion,  and  each  sense-per- 
ception of  a definite  sound  or  color  as  a response  or  repetition  in 
consciousness  of  that  particular  vibration,  we  shall  discover  that 
every  audible  sound  is  a visible  color  and  every  invisible  color  an 
audible  sound,  and  the  basis  of  consciousness  of  both  sound  and  color 
a common  coefficient  of  both.  In  other  words,  consciousness  holds 
the  ground  where  sound  and  color  merge  in  one,  and  sense-percep- 
tion corresponds  to  the  varying  scales  of  colors  and  tones. 

Thus  the  perceptions  and  sensations  bear  the  same  relation  to  con- 
sciousness as  does  thought,  viz.,  each  and  all  represent  changes — 
orderly  and  harmonious — in  our  states  of  consciousness.  The  meas- 
ure of  this  rhythm,  the  pattern  upon  which  it  rests  and  builds,  is  the 
septenary.  That  this  key-note  and  octave  exist,  and  are  funda- 
mental in  nature  no  less  than  in  man,  Professor  Crookes  has  shown 
in  his  lecture  on  the  “ Origin  of  the  Elements”  where  elements  unite 
in  groups  of  seven.  Equally  remarkable  was  Deslandre’s  account 
of  his  discovery  of  fourteen  lines  in  hydrogen  rendered  possible  by 
spectral  observations  of  the  sun  and  stars,  resulting  in  the  detection 
of  a striking  analogy  between  these  lines  and  certain  harmonies  of 
sound.  When  we  remember  that  hydrogen  is  the  lightest  of  known 
gases,  and  has  long  been  theoretically  regarded  as  the  possible  basis 
of  all  other  elements,  and  believed  to  be  the  nearest  approach  to 
Professor  Crooke’s  protyl,  we  find  how  closely  modern  science  is 
treading  on  the  borders  of  ancient  philosophy. 


THE  OCTAVE  AS  THE  KEY  TO  PSYCHOLOGY. 


949 


It  may  be  further  illustrated  with  an  -ZEolian  harp  where  a num- 
ber of  strings  tuned  in  unison,  and  giving  forth  a key-note,  will 
successively  give  forth  the  octave,  the  third,  fifth,  etc.,  according  as 
the  air  gives  a forcible  or  weak  impulse  to  the  strings.  The  number 
seven  as  a unit  of  measure,  and  as  the  universal  factor  in  all  common 
multiples  in  nature  and  in  life,  is  everywhere  apparent.  The  func- 
tions of  respiration  and  circulation  in  man  show  very  clearly  this 
same  principle,  having  the  octave  as  a basis.  In  round  numbers,  in 
a perfectly  healthy  individual,  respiration  is  related  to  circulation  as 
one  to  four.  If  the  respiration  is  eighteen  per  minute,  the  pulse- 
wave  will  be  seventy-two  per  minute.  The  impulse  derived  from 
the  auricular  contraction  is  related  to  that  derived  from  the  ventricles 
as  an  octave.  If  a single  impulse  of  the  heart  be  divided  into  four 
parts,  one-half  of  said  impulse,  that  is  two  parts,  are  assigned  to  the 
ventricular  contraction  and  the  first  sound,  one  part  to  the  second 
sound,  and  one  to  an  interval  of  rest.  The  direct  wave  arising  from 
the  ventricular  contraction  is  followed  by  another  of  just  one-half  its 
force,  though  of  uniform  recurrence.  Now  illustrate  this  diagram- 
atically,  and  it  will  be  seen  that  the  second  wave  is  related  to  the 
first  as  an  octave. 

The  lunar  month  of  twenty-eight  days  or  four  weeks  of  seven  days 
is  well  known  as  the  basis  of  the  menstrual  function.  The  quicken- 
ing of  the  foetus  occurs  in  eighteen  weeks,  the  period  of  viability 
consists  of  thirty  times  seven  days.  The  completion  of  gestation 
occurs  in  forty  times  seven  days.  The  monuments  of  antiquity,  the 
symbolism  of  ancient  mythologies  and  religions,  including  the 
Christian,  are  all  based  on  this  septenary  division  of  time.  The 
evidence  is  overwhelming  that  this  factor  is  basic  and  universal  in 
nature  and  in  man,  and  it  would  not  be  profitable  to  elaborate  it 
here,  as  any  one  can  examine  the  evidence  for  himself.  I hasten, 
therefore,  to  the  special  illustrations  as  furnishing  the  basis  of  sight 
and  hearing,  and  finally  of  all  sensation,  thought  and  consciousness. 

The  phenomena  of  light  and  color,  and  of  sound,  occurring  in 
space  through  the  agency  of  the  universal  ether,  may  be  apprehended 
as  definite  vibrations.  Short  vibratory  undulations  produce  light 
and  color,  while  long  ones  produce  sound.  Thus,  upon  the  length, 
amplitude  and  intensity  of  the  vibratory  wave  depend  the  quality  of 
color  and  sound.  Mixed,  pure,  concordant  and  dissonant  tones  de- 
pend on  the  combinations  of  waves,  according  to  the  septenary  basis, 
and  the  same  may  be  said  of  the  laws  of  harmony  in  color. 


950 


world’s  homoeopathic  congress. 


Now  the  apprehension  of  all  these  varying  phenomena  and  their 
transmission  to  human  consciousness  imply  the  same  ethereal  vibrat- 
ing medium  within  the  body  as  without,  and  instruments  capable  of 
cognizing,  repeating,  or  duplicating  each  specific  vibration.  The 
soul  of  man  has  been  aptly  compared  to  a “harp  of  a thousand 
strings,”  and  this  is  far  more  fact  than  fancy.  In  order  to  cognize 
the  phenomena  of  nature  in  these  two  realms  of  sight  and  hearing, 
the  ethereal  basis  and  organic  development  must  be  an  epitome  of 
the  whole.  Whatsoever  nature  is  in  magnitude,  in  substance,  form, 
or  energy,  that,  potentially  at  least,  man  is  in  miniature.  The  eye 
is  essentially  a space-organ,  and  the  ear  a time-organ.  Time  is  the 
phenomenal  aspect  of  duration.  Infinity,  itself  forever  concealed, 
yet  manifests  as  rest  and  motion,  or  space  and  time.  The  phenomena 
of  space  and  time,  all  that  the  eye  can  see  of  space  and  color  and  all 
that  the  ear  can  sense  of  sound  and  harmony  through  the  organs  of 
sense,  are  made  apprehensible  as  changes  in  our  states  of  conscious- 
ness. What  space  is  to  the  phenomena  of  visible  nature,  the  all- 
pervading  and  all-containing,  that  consciousness  is  to  the  sense-motor 
and  intellectual  life  of  man.  The  consciousness  of  the  individual 
is  one  ; his  organs,  senses,  feeling,  and  mental  states  are  many*  The 
consciousness  of  man,  therefore,  corresponds  to  abstract  space,  the 
noumenon  of  all  phenomena.  As  space  in  the  outer  world  is  the 
all-containing,  so  consciousness  in  man  is  the  all-container.  As  cos- 
mic intelligence  in  the  outer  world  manifests  as  law,  determining 
order  and  harmony,  even  so  the  intelligence  or  mind  of  man  relates 
him  to  the  outer  world,  and  presents  it  to  his  consciousness  in  minia- 
ture. We  thus  see  how  man  in  every  part  of  his  being  is  involved 
with  and  evolved  from  universal  nature,  so  that  when  fully  evolved 
he  will  be  its  perfect  epitome. 

if,  now,  we  realize  how  large  a part  of  man’s  conscious  life  is 
apprehended  through  the  phenomena  and  organs  of  space  and  time, 
and  if  we  find,  as  representing  these,  in  light  and  color,  and  in 
sound,  the  rhythm  of  .all  vibrations  and  the  harmony  of  all  combi- 
nations determined  by  the  octave  or  septenary  basis ; and,  further- 
more, the  interval  between  the  highest  audible  sound  and  the  lowest 
vibration  as  visible  color  already  defined  by  science,  approximately, 
at  least,  as  thirty-four  octaves,  thus  taking  the  whole  range  of  etheric 
waves  from  the  lowest  note  of  the  grand  organ  to  the  violet  ray  of 
the  solar  spectrum,  we  are  forced  to  one  of  two  conclusions,  either 
the  analogy  breaks,  and  the  basis  of  harmony  fails,  or  we  are  forced 


THE  OCTAVE  AS  THE  KEY  TO  PSYCHOLOGY. 


951 


to  the  conclusion  that  the  septenary  division  as  the  basis  of  harmony 
in  light  and  sound  so  completely  demonstrated  in  the  functions  of 
sight  and  hearing,  is  basic  in  the  whole  organism  of  man,  and  thus 
affords  the  key  to  psychology. 

A still  further  conclusion  remains  to  be  drawn.  The  basic  or  per- 
manent factor  in  the  life  of  man  is  consciousness.  All  mental  states, 
like  all  perceptions,  sensations,  and  emotions,  occur  as  changes  in 
our  states  of  consciousness.  Helmholtz  has  shown  that  the  differ- 
ence between  consonant  and  dissonant  intervals  is  not  merely  arbi- 
trary, but  is  the  result  of  the  nature  of  the  intervals  themselves  . 
The  effect  of  discordant  intervals  or  tones  is  expectancy,  discomfort, 
unrest,  while  the  effect  of  concordant  intervals  is  just  the  opposite, 
thus  showing  the  intimate  relation  existing  between  the  conscious 
life  of  man  and  universal  nature.  Aside  from  all  changes  occurring 
in  our  states  of  consciousness,  consciousness  itself  may  exist  on  dif- 
ferent planes.  That  is,  while  still  subject  to  constant  change  in 
momentary  experience  of  phenomena,  it  may  change  its  entire 
relation  as  to  planes  in  space. 

The  reason  why  comparatively  little  progress  has  been  made  in 
psychology,  is  because  the  true  relation  of  thought  or  mind  to  con- 
sciousness has  been  overlooked.  This  true  relation  is  best  discerned 
from  the  basis  of  synthesis  evolved  to  a complete  system  of  philoso- 
phy. Such  a philosophy  is  concealed  in  the  Rig  Veda  and  furnishes 
the  key  to  the  Upanishads.  It  is,  therefore,  among  the  oldest  of 
literatures.  Pythagoras  and  Plato  derived  from  this  source  their 
entire  philosophy,  while  Descarte,  Leibnitz,  Spinoza,  and  Schopen- 
hauer, each  gained  lasting  fame  from  a few  of  its  fragments. 

The  consciousness  of  man  displays  itself  on  seven  planes,  each 
plane  divided  into  seven  sub-planes;  and  all  these  planes  and 
sub-planes  are  derived  from  and  correspond  with  like  planes 
in  universal  and  eternal  nature.  It  is  true  that  it  would  be 
difficult  to  demonstrate  this  in  the  present  stage  of  man’s  evolu- 
tion, and  that  it  would  require  a good  sized  volume  to  outline 
and  illustrate  it.  But  it  may  be  easily  grasped  as  a philosophical 
concept,  and  we  shall  then  find  that  all  that  we  know  of  sound  and 
color  justifies  this  concept,  and  that  if  the  law  of  analogy  holds,  the 
law  that  underlies  sensation  and  perception  here  is  common  to  the 
whole  range  of  man’s  sensuous  and  intellectual  life.  The  idea  re- 
garding the  physical  universe  is  of  one  substratum,  universal  and 


952 


world’s  homoeopathic  congress. 


eternal,  differentiating  into  seven  planes ; and  each  plane  is  to  be 
regarded  as  related  to  the  next  by  definite  wave-lengths  or  rates  of 
vibration  of  the  one  universal  substance.  This  inherent  and  definite 
relation  enables  substance  from  one  plane  to  be  converted  into  that 
of  another  by  a change  of  vibration,  and  as  a tone  in  music  may 
sweep  throughout  the  entire  range  of  the  octave  and  pass  on  to  the 
next,  so  any  substance  in  nature  may  be  transferred  from  plane  to 
plane  by  a change  of  vibration  of  its  atoms  or  molecules.  This  is 
what  actually  occurs  when  water  is  converted  into  steam,  and  is  the 
principle  by  which  the  “ radiant  matter”  of  Crookes  and  the 
“ inter-etheric  force”  of  Keeley  are  derived. 

Now,  if  man  be  regarded  as  an  epitome  of  nature,  and  as  Dryden 
expressed  it,  “The  diapason  closing  full  in  man,”  then  every  prin- 
ciple in  nature,  either  potentially  or  actually,  must  be  represented  in 
him.  It  is  the  diversity  and  complexity  of  man’s  nature  that  be- 
wilder, and  in  the  absence  of  any  key  to  its  comprehension  confusion 
alone  reigns.  Consciousness  is  the  basis  of  man’s  sensuous  and 
intellectual  life.  All  avenues  of  feeling,  sensation,  and  perception 
lead  to  and  merge  in  consciousness;  and  all  mental  changes  and  in- 
tellectual operations  occur  as  changes  in  our  states  of  consciousness. 
If  there  are  really  seven  planes  in  the  differentiation  of  matter  in 
nature,  then  corresponding  therewith  there  are  seven  planes  of  con- 
sciousness in  man.  It  may  be  impossible  to  demonstrate  this  em- 
pirically at  present,  but  it  may  be  justified  by  analogy  and  sound 
philosophy. 

We  speak  of  persons  in  syncope  and  under  the  influence  of  anaes- 
thetics as  unconscious,  when  this  is  really  not  the  case.  They  have, 
it  is  true,  lost  for  the  time  ordinary  consciousness  of  sensation  in  the 
tissues,  and  of  outward  things,  but  they  are  still  conscious  on  other 
planes,  of  which  perhaps  only  a glimpse  remains  in  memory. 

Consciousness  is  regarded  as  the  changing,  evanescent  factor,  and 
mind  as  the  real  substratum,  when  the  fact  is  precisely  the  opposite. 
Now,  in  the  ordinary  affairs  of  life,  we  are  more  or  less  familiar 
with  three  planes  of  consciousness,  viz.,  the  ordinary  waking  state, 
the  dream  state,  and  the  condition  of  dreamless  sleep.  Memory, 
however,  is  something  as  distinct  from  consciousness  as  is  thought 
or  perception.  To  say  that  we  are  entirely  unconscious  is  one  thing, 
to  say  that  we  have  no  memory  of  any  event  is  quite  another  thing. 
Memory  is  the  principle  and  the  process  of  association  of  events  and 


THE  OCTAVE  AS  THE  KEY  TO  PSYCHOLOGY. 


953 


ideas  occurring  in  consciousness.  If  there  are  no  events,  no  ideas, 
no  changes,  then  there  are  no  elements  for  association,  and  hence  no 
memory.  We  may  say,  that  for  the  time,  the  bodily  avenues  are 
closed  to  sensation  and  perception,  and  that  the  brain  ceases  to  func- 
tion, and  hence,  that  for  the  time,  there  is  no  thought.  We  are, 
then,  not  sensitive,  not  perceptive,  toward  outer  nature,  and  we  are 
unthinking  but  never  unconscious.  The  missing  link  is  memory, 
which  foils  to  connect  the  shifting  experiences  of  outer  life  with  those 
of  dreamless  sleep,  syncope,  hypnotic  states,  anaesthesia,  and  the  like, 
while  to  say  that  we  lose  consciousness  is  to  entirely  mistake  its 
nature. 

In  day-dream  or  reverie,  we  are  as  unconscious  sometimes  of  the 
outer  world  as  in  dreamless  slumber,  the  difference  consisting  in  the 
function  of  memory,  and  this  is  often  largely  absent  or  in  abeyance 
in  reverie.  Experiments  in  hypnotism  give  many  facts  in  full- sup- 
port of  this  line  of  reasoning.  No  one  pretends  to  say  that  the  sub- 
ject in  hypnotism  is  unconscious,  and  the  hypnotizer  can  determine 
whether  the  hypnotic  consciousness  shall  be  connected  with  that  of 
ordinary  life  by  the  link  of  memory  or  not.  If  we  regard  all  these 
varying  conditions  as  a shifting  of  our  planes  of  consciousness,  and 
in  no  case  as  loss  of  consciousness  itself,  a great  deal  of  obscurity 
will  disappear  from  the  realm  of  psychology.  In  delirium,  mono- 
mania, hallucination,  alcoholism  and  insanity,  the  planes  of  con- 
sciousness become  disordered,  disjointed,  or  wholly  changed. 

It  is  the  orderly  association  of  ideas  that  is  disturbed.  Undue 
prominence  is  given  to  one  idea,  and  it  becomes  a hallucination.  Its 
relation  to  consciousness  is  therefore  abnormal  and  the  whole  mental 
realm  “ deranged,”  while  consciousness,  per  se , remains  unaltered. 
Consciousness  is  like  a double  mirror  presenting  one  face  to  the  phe- 
nomenal world  of  change,  reflecting  the  shifting  panorama  of  the 
mind,  and  indirectly,  through  the  mind,  the  sensations  derived 
through  the  avenues  of  feeling  and  emotion  from  the  outer  world. 
The  other  face  of  the  mirror  is  turned  within  towards  its  original 
source  in  the  principle  of  cosmic  ideation,  or  the  ideas  of  eternal 
nature. 

At  least  two  distinct  planes  of  consciousness  were  long  ago  recog- 
nized by  medical  science  in  the  so-called  double  consciousness  of 
somnambulism.  Here  the  individual  leads  two  distinct  lives,  with 
no  connection  between  them  except  that  they  exist  in  the  same  indi- 


954 


world’s  homoeopathic  congress. 


vidual.  The  ease  of  Bark  worth,  quoted  by  A.  Moll,  who  can  add 
up  long  rows  of  figures  while  carrying  on  a lively  discussion  without 
allowing  his  attention  to  be  at  all  diverted  from  the  discussion ; or 
of  a lecturer,  F.  Myers,  who,  for  a whole  minute,  allows  his  mind 
to  wander  entirely  from  the  subject  in  hand  and  imagines  himself 
to  be  sitting  beside  a friend  in  the  audience  and  to  be  engaged  in 
conversation  with  him,  and  who  wakes  up  to  find  himself  still  on 
the  platform  lecturing  away  with  perfect  ease  and  coherency,  serve 
to  show  separate  and  distinct  planes  of  consciousness  as  existing  in 
man.  The  philosophy  of  acquired  habit,  or  automatism,  whether 
muscular  or  intellectual,  only  confirms  this  view  of  multiple  planes 
of  consciousness;  for  the  body,  no  less  than  the  mind,  the  senses  and 
feelings,  no  less  than  the  intellectual,  pertain  to  our  states  of  con- 
sciousness. 

I have  thus  dwelt  on  this  principle  of  consciousness  because  I re- 
gard it  as  a matter  of  the  very  greatest  importance,  and  the  point  of 
departure  from  which  all  mental  processes  and  intellectual  operations 
should  be  studied.  Consciousness,  per  se,  is  the  one  persistent  and 
unchanging  factor  in  the  life  of  man.  Its  function  is  to  note  the 
changes  that  elsewhere  occur.  It  is  hence  the  noumenon  of  all  phe- 
nomena, the  citadel  of  the  soul,  the  spark  of  the  infinite  in  the  finite 
being,  man.  Consciousness  is  to  man  what  the  pure  white  ray  is  to 
the  solar  spectrum.  The  pure  white  light  is  the  vehicle  of  the  rain- 
bow, the  chariot  of  the  sun ; and  whenever  this  vehicle  divides  and 
differentiates  it  does  so  with  mathematical  exactness  and  with  perfect 
proportion  or  rhythm  into  planes  of  seven.  Helmholtz  says  the 
musical  scale,  with  its  recognized  intervals  and  laws  of  harmony, 
are  “ not  merely  arbitrary,”  but  “ are  the  result  of  the  nature  of  the 
intervals  themselves.”  If  these  planes  and  principles  exist  in  nature 
under  the  universal  laws  of  harmony  and  order,  and  are  apprehen- 
sible to  man  as  such  through  his  bodily  organs  and  functions  in  the 
realm  of  consciousness,  then  all  that  the  musical  scale  is  in  the 
realm  of  sound,  and  all  that  the  solar  spectrum  is  in  the  realm  of 
light,  such  also  I think  are  the  planes  and  principles  of  conscious- 
ness in  the  life  of  man.  Consciousness  is  one,  persistent  and 
itself  unchanging,  while  noting  all  other  changes  and  reflecting 
every  state,  and  its  key  is  the  octave  or  the  universal  septenary  in 
nature. 

“Thus  we  see  that  from  the  prime  original  (nature)  infinity  are 


THE  OCTAVE  AS  THE  KEY  TO  PSYCHOLOGY. 


955 


evolved  by  means  of  definite  proportions  of  it  either  in  rest  or  in 
motion,  the  various  measures  of  space  and  time,  the  lines  and  metres, 
and  in  a manner  so  analogous  that  they  must  be  considered  counter- 
parts of  one  another.  And  these  lines  and  metres,  by  being  min- 
gled in  an  infinite  variety  of  ways,  become  the  forms  of  space  and 
the  rhythms  of  time.  These  forms  and  rhythms  are  then  made 
manifest  by  vibrations  to  the  eye  and  ear,  and  so  are  clothed  by 
them,  as  it  were,  with  colors  and  tones.  In  its  innermost  nature, 
therefore,  the  forms  in  space  and  time  (though  seemingly  so  totally 
unlike)  aVe  in  reality  only  different  manifestations  of  one  idea — 
visible  nature  and  music  are  aesthetically  considered  counterparts  of 
one  another.” 


956 


world’s  homceopathic  congress. 


« 


PUERPERAL  INSANITY. 

By  A.  P.  Williamson,  M.D.,  Minneapolis,  Minn. 


The  most  fearful  calamity  which  can  possibly  befall  the  puerperal 
chamber,  not  excepting  death  itself,  is  insanity.  The  term  ‘puerperal 
insanity,  like  many  expressions  in  medical  nomenclature,  has  been 
used  in  a most  careless  and  elastic  manner,  and  has  been  made  to  do 
service  in  describing  every  variety  of  mental  alienation  connected 
in  any  way  with  child-bearing,  from  the  mental  disturbance  some- 
times seen  in  neurotic  subjects  during  the  early  stages  of  pregnancy 
to  that  which  follows  the  exhaustion  of  prolonged  lactation,  two 
years  after  delivery. 

This  evening  we  propose  being  more  exact  in  our  use  of  this  term, 
and  to  confine  the  meaning  of  puerperal  insanity  to  its  most  con- 
tracted sense.  We  shall  limit  the  use  of  the  phrase  to  describing 
a condition  of  departure  from  mental  health  coming  within  two 
weeks  after  labor. 

The  basis  of  this  paper  will  be  thirty-nine  cases  of  puerperal  in- 
sanity, which  came  under  the  writer’s  care  while  first  assistant  physi- 
cian at  the  hospital  for  insane  at  Middletown,  N.  Y. 

The  disease  is  fairly  prevalent,  and  about  4 per  cent,  of  all  cases 
of  insanity  are  of  this  variety.  It  is  said  to  follow  once  in  every 
four  hundred  deliveries. 

It  is  also  claimed  to  be  more  frequent  in  obstetric  hospital  service 
than  in  private  practice,  and  it  seems  to  vary,  too,  in  hospitals.  In 
Bellevue,  one  of  the  largest  of  the  general  hospitals  in  this  country, 
the  proportion  of  such  cases  to  the  number  of  deliveries  reaches  the 
appalling  figures  of  1 to  80.  In  Westminster,  London,  the  pro- 
portion is  1 to  382,  and  in  the  celebrated  Dublin  Obstetric  Hospital 
the  proportion  is  ouly  1 to  528.  I have  no  statistics  at  hand  to  show 
the  proportion  in  private  practice,  but  it  is  asserted  that  fewer  cases 
occur  than  in  hospital  work.  All  forms  of  insanity  are  seen 
among  these  patients — melancholia,  mania,  dementia,  and  general 
paresis. 


PUERPERAL  INSANITY. 


957 


Mania  is  said  to  be  the  form  in  75  per  cent,  of  the  cases,  melan- 
cholia in  about  20  per  cent.,  and  the  other  two  varieties  much  less 
frequently. 

Before  discussing  a typical  case,  we  will  describe  a mild  form 
which  is  occasionally  seen  in  young  women  who  inherit  strongly  a 
neurotic  tendency,  and  in  whose  unmarried  life  they  displayed  indi- 
cations of  hysteria.  In  such  cases,  a few  days  after  labor,  when 
everything  is  apparently  doing  well,  there  suddenly  develops  an  in- 
tolerance of  husband  or  child,  a wilful  disregard  of  the  doctor’s  di- 
rections, a peevish  irritability  of  temper  toward  everybody,  accom- 
panied by  restlessness,  sleeplessness,  and  constipation.  There  is  no 
especial  rise  of  temperature  or  diminution  of  the  discharges. 

These  symptoms  characterize  the  mildest  form  of  puerperal 
mania. 

The  treatment  consists  of  the  removal  of  any  discoverable  cause, 
absolute  rest  of  body  and  mind,  freedom  from  the  exhausting  influ- 
ences of  talkative  friends,  weaning  the  baby  and  its  removal  from 
its  mother’s  sight  and  hearing,  restricted  diet,  and  the  exhibition  of 
the  properly  indicated  remedy,  which  is  most  frequently  Aconite. 

As  a rule,  these  changes  in  the  care  of  the  case  are  sufficient  to 
remove  the  symptoms  within  a few  days.  In  a few  cases,  unfortu- 
nately, the  symptoms  just  described  are  the  forerunners  of  a more 
serious  illness. 

In  the  typical  form  of  puerperal  insanity  the  disease  may  be  sud- 
den in  its  onset,  but,  as  a rule,  it  is  gradual,  and  is  preceded  for 
some  days  by  the  symptoms  we  have  already  given  you,  or  else  by 
suppression  of  the  lochia  and  milk,  high  temperature,  rapid  pulse, 
dilated  pupils,  flushed  face  or  pallor  of  the  face  with  quick  flushing, 
great  physical  restlessness,  and  constant  talking.  There  is  also  an 
irascibility  and  great  mental  unrest.  Soon  she  begins  to  place  every 
one’s  motives  under  suspicion  ; she  talks  very  rapidly  and  sometimes 
incoherently;  she  mistakes  the  identity  of  her  nurse,  doctor,  hus 
band,  or  parents;  takes  strong  and  unaccountable  dislikes  to  those 
nearest  and  dearest  to  her;  charges  them  with  unkindness  and 
neglect. 

She  is  sarcastic  in  her  statements  and  imperious  in  her  demands. 
All  these  symptoms  within  a week  or  ten  days  increase  in  violence, 
and  others  are  added,  until  finally  there  in  an  outburst  of  uncontrol- 
lable frenzy.  After  the  appearance  of  violence,  delusions  and  hal- 


958 


world’s  homceopathic  congress. 


lucinations  follow.  She  carries  on  conversations  with  imaginary 
persons,  or  she  imagines  herself  poisoned,  or  she  entertains  the  delu- 
sion that  she  is  some  royal  person.  At  this  stage,  an  impulse  to 
kill  her  husband,  child,  or  herself  may  appear.  It  is  likely  that 
among  the  prominent  symptoms  at  this  time  is  nymphomania,  dis- 
played by  a desire  to  expose  her  person  and  by  the  use  of  the  most 
obscene  language.  Unless  she  is  now  too  incoherent  to  be  under- 
stood, she  is  quite  likely  to  charge  her  husband  with  marital  infi- 
delity. In  a small  proportion  of  cases  the  earliest  symptoms  which 
appear  are  the  opposite  to  those  described,  and  consist  of  a disposi- 
sion  to  be  unnaturally  quiet  and  taciturn,  with  an  inclination  to  be 
alone  and  to  gloomy  conversation.  She  may  entertain  delusions  of 
a depressed  character,  and  imagine  she  is  unworthy  of  her  husband, 
or  that  she  has  been  very  wicked,  with  a strong  desire  to  commit 
suicide.  The  physical  symptoms  in  the  melancholic  type  are  asthe- 
nic. The  temperature  is  usually  slightly  subnormal,  the  skin  is  dry 
and  harsh,  the  extremities  are  cold,  the  tongue  is  coated  a brown  or 
dirty- white,  and  there  is  persistent  constipation.  Sleeplessness  is  a 
prominent  symptom  in  all  forms  of  this  disease.  Puerperal  insanity 
is  peculiarly  liable  to  attack  primiparse  and  those  who  have  borne 
few  children.  The  exhaustion  which  follows  too  frequent  maternity 
has  very  little,  if  any,  influence  in  its  production.  In  our  thirty- 
nine  cases,  twenty  were  primiparse,  seven  had  two  children,  five 
had  three,  four  had  four,  one  had  seven,  and  two  had  eight. 
Thus,  51  per  cent,  had  but  one  child,  41  per  cent,  had  between 
two  and  five  children  ; that  is,  92  per  cent,  had  given  birth  to 
less  than  five  children,  and  only  7 per  cent,  had  more  than  five 
children. 

On  studying  our  cases  we  find  the  most  frequent  remote  cause  to 
have  been  an  inherited  predisposition  to  diseases  of  the  nervous  sys- 
tem. Thus,  twenty-one,  or  52  per  cent.,  displayed  a history  of 
insanity  in  their  immediate  progenitors — ten  from  the  mother’s  side, 
eight  from  the  father’s  side,  and  three  from  both  sides  ; and  in  every 
case  in  which  the  disease  attacked  those  who  had  borne  more  than 
one  child,  this  inheritance  was  very  strong,  and  in  three  such  in- 
stances the  insanity  was  inherited  from  both  paternal  and  maternal 
sides.  In  only  six  instances  was  this  inheritance  denied  by  the 
friends.  In  twelve  cases  the  histories  were  incomplete,  and  it  was 
unknown  whether  these  persons  received  a neurotic  inheritance  or 


PUERPERAL  INSANITY. 


959 


not.  It  is  probable  that  many  of  these  last-mentioned  patients  did 
possess  a neurotic  taint,  and  consequently  such  a family  tendency 
probably  existed  in  our  cases  more  frequently  than  shown  by  our 
figures. 

In  three  cases  a previous  attack  acted  as  the  remote  cause.  An- 
aemia was  asserted  to  have  been  the  cause  in  three  cases.  Getting 
up  too  soon  after  labor  was  assigned  in  three  instances.  Illegiti- 
macy was  alleged  to  have  produced  two  cases,  and  in  nine  cases  no 
remote  cause  could  be  assigned  by  the  friends.  The  exciting  or 
producing  cause  in  five  cases  was  overwork ; five  others  were  caused 
by  excitement  too  soon  after  labor ; worry  is  chargeable  with  seven 
cases;  procidentia,  too  rapid  maternity,  exhaustion,  and  puerperal 
fever,  are  each  held  accountable  for  one  case.  The  cause  in  thirteen 
cases  is,  unfortunately,  unknown. 

Late  maternity  has  been  said  to  be  a factor  in  the  causation  of 
this  disease.  While  a fair  proportion  displayed  an  age  beyond  that 
at  which  most  women  bear  their  first  child,  yet  none  were  very  far 
advanced  in  the  child-bearing  period.  One  was  less  than  twenty 
years  old;  fourteen  were  between  twenty-one  and  twenty-five;  ten 
were  between  twenty-six  and  thirty,  and  fourteen  were  between 
thirty-one  and  forty.  Of  the  primiparse  one  was  less  than  twenty, 
twelve  were  between  twenty-one  and  twenty-five,  two  were  between 
twenty-six  and  thirty,  and  five  between  thirty-one  and  forty.  We 
find,  among  the  multiparse,  only  two  patients  were  under  twenty-five, 
eight  were  between  twenty-six  and  thirty,  and  nine  were  between 
thirty-one  and  forty. 

It  is  claimed  by  Dr.  Duncan  that  the  height  of  fecundity  is 
reached  at  twenty-five.  Measured  by  this  standard,  eighteen  of  our 
thirty-nine  cases  had  passed  the  zenith  of  the  child-bearing  period 
before  they  had  had  their  first  attack  of  insanity. 

Scotch  authorities  lay  especial  stress  upon  illegitimacy  as  a cause. 
In  our  experience  this  is  one  of  the  most  infrequent  causes.  Only 
two  of  our  patients  appear  as  having  fatherless  children.  These 
women  both  belonged  to  the  lower  stratum  of  society  and  were  not 
worried  particularly  by  this  evidence  of  their  lapse  from  virtue,  and 
both  of  them  possessed  a neurotic  inheritance. 

In  seventeen  cases,  or  43  per  cent.,  the  disease  developed  on  or 
before  the  fifth  day  after  labor,  as  follows : five  on  the  first  day,  two 
on  the  second  day,  three  on  the  third  day,  one  on  the  fourth  day, 


960 


world’s  homoeopathic  congress. 


and  five  on  the  fifth  day.  One  patient  showed  the  first  symptoms 
on  the  sixth  day,  and  ten  on  the  seventh  day.  It  will  thus  be  ob- 
served that  twenty-eight  cases,  or  more  than  71  per  cent.,  developed 
the  disease  during  the  first  week  after  labor.  Eight  cases  displayed 
the  symptoms  first  on  the  tenth  day,  one  on  the  eleventh  day,  and 
two  on  the  fourteenth  day.  The  most  dangerous  days,  therefore, 
seem  to  be  the  first,  third,  fifth,  and  seventh.  In  regard  to  sex  of 
child  our  experience  is  in  accord  with  the  accepted  impression — 
that  the  disease  more  frequently  follows  the  birth  of  male  children 
than  female.  The  thirty-nine  mothers  bore  forty  children.  Of  this 
number  twenty-seven,  or  69  per  cent.,  are  recorded  as  male,  and 
thirteen,  or  over  30  per  cent.,  were  female  children. 

In  fifteen  cases,  or  38  per  cent.,  of  the  thirty-nine,  the  labor  was 
said  to  be  either  severe,  protracted,  or  instrumental.  In  seven  cases 
the  labors  were  natural.  In  the  large  number  of  seventeen  patients, 
or  41  per  cent,  of  the  cases,  the  character  of  the  labor  was  unascer- 
tainable.  The  proportion  displaying  some  complication  in  the  labor 
is  larger  than  usually  obtained  in  labors  not  followed  by  insanity. 
It  is,  therefore,  a fair  assumption  that  the  character  of  the  labor 
exerts  some  influence  in  the  causation  of  the  disease. 

The  attack  was  said  to  have  been  the  first  in  thirty-two  cases,  or 
82  percent.,  the  second  in  six  cases,  and  the  third  in  one  case.  From 
this  one  would  judge  that  one  attack  does  not  predispose  to  others. 
Only  four  cases  had  puerperal  mania  previously,  and  the  other 
three  women  had  attacks  of  insanity  previous  to  their  marriage. 
In  recent  years  there  has  been  a disposition  to  ascribe  sepsis  as  a 
cause  of  nearly  all  forms  of  disease,  and  puerperal  insanity  has  not 
escaped  the  charge.  In  the  thirty-nine  cares  referred  to,  only  two 
were  preceded  by  any  symptoms  of  septic  poisoning,  and  there  is  a 
doubt  in  the  writer’s  mind  whether  in  either  of  these  cases  there 
existed  the  relation  of  cause  and  effect.  One  patient  had,  ac- 
cording to  the  history,  a mild  run  of  puerperal  fever,  and  the  other 
had  eclampsia  during  labor.  A few  years  ago  it  was  the  writer’s 
privilege  to  see  over  forty  cases  of  puerperal  fever,  in  an  obstetric 
hospital,  and,  as  far  as  his  knowledge  goes,  not  one  of  these  cases 
subsequently  became  insane. 

The  prognosis  in  this  disease  is,  as  a rule,  favorable.  The  general 
physical  state  of  the  patient  at  the  time  the  disease  comes  on  has  a 
marked  influence  over  the  result.  Twenty-seven  of  our  cases  recov- 


PUERPERAL  INSANITY. 


961 


ered,  about  70  per  cent,  of  the  number  treated.  One  patient  came 
in  moribund,  and  died  a few  days  afterward.  Three  patients  were 
discharged  improved.  Two  were  discharged  unimproved,  and  six 
were  still  under  treatment  when  the  statistics  were  gathered. 

The  treatment  of  puerperal  mania  or  melancholia  consists  of 
isolating  the  patient  from  relatives  and  solicitous  friends,  whose 
presence,  as  a rule,  has  the  undesirable  effect  of  increasing  the 
patient’s  excitement,  and  thus  aggravating  the  case,  carefully 
selected  diet  and  the  proper  remedy. 

If  the  case  must  be  treated  at  home,  two  thoroughly  efficient, 
trained  nurses  are  necessary;  one  for  day  duty,  and  the  other  for 
night.  Whenever  restraint  can  be  dispensed  with,  it  should  be 
done,  of  course;  but  in  the  majority  of  the  maniacal  cases,  some 
kind  of  restraint  is  absolutely  necessary.  Never  permit  a patient 
to  be  tied  down  to  the  bed  by  sheets,  but  obtain  from  an  instrument- 
maker  a good,  strong  apparatus,  which  will  hold  the  patient,  and  in 
which  she  will  be  entirely  comfortable.  The  writer  does  not  wish 
to  be  understood  as  advocating  mechanical  restraint  to  the  insane ; 
on  the  contrary,  he  is  a strong  partisan,  favoring  the  non-restraint 
system,  and  has  frequently  employed  his  pen  and  voice  in  uphold- 
ing the  abolition  of  restraint.  In  insane  hospitals  there  are  very  few 
cases  in  which  restraint  is  excusable,  but  in  private  practice  we  do 
have  recourse  to  the  protection-sheet  to  prevent  the  patient  from 
hurting  herself  or  some  one  else.  Diet  is  of  the  utmost  importance 
in  the  treatment  of  these  cases.  Hot  milk  is  our  sheet  anchor ; it 
should  be  given  often,  and  it  is  well  to  add  a teaspoonful  of  bovin- 
ine  or  Murdock’s  food  to  every  cupful.  Other  prepared  foods,  such 
as  Mellen’s  and  Horlick’s,  are  of  value.  In  some  cases,  Cibil’s  and 
Armour’s  beef  are  needed.  Some  food  should  be  given  every  three 
hours,  and  during  the  violent  stages  it  may  be  necessary  to  give  it. 
at  two  hours  intervals.  It  must  be  borne  in  mind  that  one  of  the 
principal  symptoms  to  combat  is  exhaustion. 

The  patient’s  chance  of  recovery  largely  depends  upon  whether 
she  has  the  strength  to  weather  the  maniacal  cyclone,  so  that  food 
must  be  pushed  as  far  as  her  stomach  will  stand  it. 

The  drug  treatment  is  largely  confined  to  those  remedies  which 
are  most  useful  to  combat  feverish  conditions  and  the  opposite  state 
of  exhaustion.  As  especial  remedies,  we  find  Aeon.,  Ars.,  Bapt.,. 
Bell.,  Cimicif.,  Canth.,  Gels.,  Hyos.,  Stram.,  and  Verat.  vir.  Some- 
times, Ign.,  Nux  vom.,  Platina,  and  Verat.  alb.,  are  useful. 

61 


962 


world’s  homoeopathic  congress. 


When  there  is  great  incoherency,  restlessness,  flushed  face,  a ten- 
dency toward  violence  with  an  evident  strong  desire  to  strike  and 
bite  those  standing  near  from  anger,  accompanied  by  hallucinations 
of  sight,  we  have  found  Bell,  especially  useful.  When  the  patient 
is  noisy,  singing,  laughing,  and  very  talkative,  using  obscene  and 
profane  language,  violent  towards  everybody,  but  good-natured,  or  a 
condition  of  mental  confusion,  with  suspiciousness  and  changeable 
conduct,  Hyosc.  has  been  used  with  good  effect. 

When  hallucinations  of  hearing  are  the  particularly  marked  symp- 
toms, with  a desire  for  company,  and  a fairly  good-natured  condi- 
tion, but  quite  changeable,  the  temperature  about  normal,  Stram.  is 
a most  excellent  remedy. 

Yerat.  vir.  has  helped  very  many  cases  when  the  patients  are  very 
suspicious  and  imagine  they  are  to  be  poisoned,  with  great  restless- 
ness, flushed  face,  high  temperature  and  rapid  pulse. 

I will  not  take  up  your  time  by  mentioning  the  indications  for 
any  more  remedies. 

In  our  experience  we  have  rarely  been  obliged  to  go  beyond  Bell., 
Hyosc..  Stram.,  or  Verat.  vir.,  in  maniacal  cases,  and  Aeon.,  Cimi- 
eif.,  Gels.,  Ign.,  or  Yerat  alb.  in  cases  of  melancholia. 

The  earlier  the  treatment  is  begun  the  better.  The  chance  for 
speedy  recovery  is  better  in  a hospital  than  at  home.  Select  your 
remedy  with  great  care,  and  stick  to  it.  Give  easily-digested  food, 
and  give  it  often.  Avoid  hypnotics  and  narcotics  as  you  would 
death,  and  a large  proportion  of  your  puerperal  insanity  cases  will 


recover. 


THE  CAUSES  OF  INCREASE  IN  MELANCHOLIA. 


963 


THE  CAUSES  OF  AN  INCREASE  IN  MELANCHOLIA. 

By  William  Morris  Butler,  M.D.,  Brooklyn,  N.  Y. 


“ No  creature  so  miserable  as  man,”  saith  an  ancient  writer;  “so 
generally  molested,  in  miseries  of  body,  in  miseries  of  mind,  miser- 
ies of  heart;  in  miseries  asleep,  in  miseries  awake,  in  miseries  where- 
soever he  turns.”  “All  his  days  are  sorrow  and  his  travels,  griefs  ; 
his  heart  also  taketh  not  rest  in  the  night.”  “ All  that  is  in  it  is 
sorrow  and  vexation  of  spirit.” 

Th  is  wail  of  despair,  borne  to  us  from  the  earliest  pages  of  the 
world’s  history,  is  re-echoed  to-day  in  the  cry  of  every  melancho- 
liac. This  cry  has  swept  through  the  centuries.  However  much 
brightness  and  sunshine,  joy  and  gladness,  there  may  be  in  the 
world,  there  are  always  thousands  who,  living  continually  in  the 
shadows,  respond  only  to  the  minor  keys  of  the  diapason  of  the 
universe.  Many  are  born  pessimists.  They  behold  everything 
through  darkened  glasses.  Mentally  astigmatic,  they  are  inca- 
pable of  obtaining  a correct  view  of  any  subject.  Never  upon  the 
heights  of  intense  joy,  any  reverse  of  fortune  or  severe  bodily  ail- 
ment plunges  them  into  the  abyss  of  despair,  from  which  no  exit  is 
discernible  except  through  the  portals  of  suicide.  Year  by  year 
this  multitude  swells;  day  by  day  these  grovellers  in  this  labyrinth 
of  mental  darkness  rush,  in  ever-increasing  throngs,  to  our  sanita- 
riums and  hospitals  for  the  insane.  The  question,  therefore,  natu- 
rally arises,  What  is  the  cause  of  this  increase  of  mental  sufferers? 
Are  there  any  conditions  prevalent  in  these  latter  days  which  may 
be  considered  responsible  for  this  result?  Are  there  any  agencies 
at  work  particularly  devitalizing  to  the  nervous  system  ? 

One  agent,  certainly  unknown  until  within  the  past  three  years, 
can  be  assigned  to  this  category,  viz.,  “la  grippe.” 

What  particular  atmospheric  or  telluric  condition  has  made  pos- 
sible our  annual  visitation  by  this  previously  unknown  scourge 
medical  science  has  thus  far  failed  to  demonstrate.  Whatever  may 
prove  to  be  the  correct  theory  of  its  origin  and  continuance,  the 


964 


world’s  homoeopathic  congress. 


brood  of  human  ills  which  have  followed  in  its  train  has  been  in- 
numerable, its  injury  to  the  race  incalculable.  A veritable  “ Pan- 
dora’s casket,”  with  each  recurrence  it  has  produced  an  ever-increas- 
ing dread  and  apprehension.  Peculiarly  debilitating  and  prostrating 
in  its  effect  upon  all  the  vital  organs,  its  disastrous  influence  upon 
the  nervous  system  has  been  particularly  marked  and  striking.  A 
glance  at  the  recent  reports  of  any  hospital  for  the  insane  will  de- 
monstrate that  not  the  least  of  its  ravages  have  been  those  which  it 
has  made  upon  the  brains  of  its  victims.  Without  exception,  in  each 
of  the  reports  for  the  past  two  years  of  twelve  prominent  institutions 
which  we  have  consulted  we  find  this  dread  visitor  figuring  as  an 
influential  causative  agency,  in  numbers  of  the  cases  which  have 
been  admitted.  Nor  can  we  limit  its  effect  merely  to  those  mental 
diseases  directly  traceable  to  its  influence.  The  intense  prostration 
and  debility  always  accompanying  its  invasion,  by  profoundly  low- 
ering the  general  nervous  system,  must  in  many  instances  pave  the 
way  for  the  injurious  results  produced  by  other  influences  to  which 
the  mental  symptoms  may  be  directly  traced.  Frequently  we  see 
that  influenza,  even  when  its  course  may  have  been  of  comparatively 
short  duration,  sows  the  seeds  which,  months  afterwards,  bring  forth 
evil  fruits.  When  we  consider  that  the  underlying  foundation  of 
melancholia,  whatever  may  be  the  immediate  exciting  cause,  is 
always  a weakened  and  impoverished  state  of  the  system,  it  is 
almost  impossible  to  estimate  the  influence  which  this  disease  must 
exert  in  its  production.  Surely  one  cause  of  the  recent  increase  of 
melancholia  can  positively  be  asserted  to  be  “ la  grippe.” 

Another  powerful  factor  may  be  found  in  the  increased  use  of 
large  quantities  of  depressing  drugs. 

Before  the  advent  and  great  popularity  of  Antifebrine,  Phenace- 
tine,  and  numerous  other  marked  heart  depressants,  we  seldom  heard 
of  the  now  trite  cause  of  death,  heart-failure.  No  reflecting  mind 
can  fail  to  believe  that  the  effect  of  reducing  the  temperature  several 
degrees,  and  the  heart’s  pulsations  twenty  to  forty  beats,  in  a few 
hours  must  be  injurious.  Nor  is  the  use  of  these  drugs  confined  to 
the  prescriptions  made,  in  suitable  cases,  by  competent,  legally  quali- 
fied physicians.  Scores  of  individuals,  accustomed  to  find  relief 
from  severe  neuralgia  in  antifebrine,  frequently  take  it  upon  their 
own  responsibility.  So  common  has  this  custom  become  that  hun- 
dreds daily  receive  it  over  the  counters  of  soda-water  fountains,  in 


THE  CAUSES  OF  INCREASE  IN  MELANCHOLIA. 


965 


the  drug  stores  of  every  large  city.  How  much  damage  is  done  by 
the  self  assumed  medical  role  of  multitudes  of  drug  clerks,  incapa- 
ble of  acting  in  this  capacity,  no  one  can  estimate.  That  much 
injury  has  been  done  by  these  drugs,  is  apparent  from  the  change  of 
attitude  which  the  Allopathic  fraternity  now  holds  regarding  them. 
The  Old-School  journals  are  now  constantly  filled  with  warnings 
against  their  injudicious  and  indiscriminate  use.  While  it  is  impos- 
sible, directly,  to  trace  to  their  employment  all  the  injurious  effects 
which  they  have  produced,  it  is  positive  that  they  have  done  much 
harm,  and,  without  doubt,  their  depressant  effect  has  been  the  indi- 
rect cause  of  plunging  many  into  the  depths  of  melancholia. 

The  universal  prescribing  of  enormous  doses  of  Quinine,  by  Allo- 
pathic physicians,  and  its  extensive  use  as  a household  remedy,  not 
requiring  the  advice  of  a physician,  can  also  be  credited  with  much 
injury  in  this  direction.  Knowing,  as  we  do,  from  personal  obser- 
vation, that  Quinine  is  capable  of  causing  insanity  in  many  persons 
especially  susceptible  to  its  effects,  we  cannot  doubt  that  many  cases 
of  melancholia  are  directly  traceable  to  its  influence.  For  proof  of 
the  alarming  increase  in  the  use  of  this  drug  since  the  advent  of 
influenza,  we  need  but  consider  the  amount  now  sold  by  druggists  in 
comparison  with  former  times.  That  Quinine  is  far  from  being  the 
harmless  drug  it  is  supposed  by  the  general  public  to  be,  any  one 
acquainted  with  its  physiological  action  can  testify.  When  one 
reflects  upon  its  depressing  and  disastrous  effects  upon  the  brain, 
when  given  in  large  doses,  it  need  cause  no  surprise  that  its  continu- 
ous use  should  in  many  cases  give  rise  to  melancholia.  Creating,  as 
it  often  has,  temporary  hallucinations  of  sight  and  hearing,  and 
marked  delusions,  the  step  is  but  slight  to  the  establishment  of  a 
condition  of  positive  insanity.  For  a corroboration  of  this  state- 
ment we  need  but  refer  you  to  the  history  presented  by  us,  and 
published  in  vol.  xxv.  of  the  Transactions  of  the  Homoeopathic 
Medical  Society  of  the  State  of  New  York.  In  this  case  we  had  an 
opportunity  of  tracing  the  effects  of  an  Allopath’s  drugging  with 
Quinine  until  the  patient,  finally  crazed  by  its  action  upon  his  sen- 
sitive brain,  jumped  out  of  the  second  story  window  of  his  house. 
How  many  more  remaining  under  Allopathic  treatment,  with  their 
disease  shrouded  under  another  name  for  the  protection  of  the  physi- 
cian in  charge,  have  suffered  in  a like  manner  must  remain 
unwritten  history. 


966 


world’s  homoeopathic  congress. 


The  ever-increasing  worry  of  modern  life  and  business  troubles 
is  another  powerful  agent  to  which  we  must  look  for  an  explanation 
of  the  present  lamentable  condition  of  affairs. 

When  we  consider  the  gigantic  enterprises  conceived  and  executed 
by  the  men  of  modern  times,  and  the  tremendous  financial  burdens 
continually  borne  by  them,  it  is  not  to  be  wondered  at  that  hun- 
dreds fall  beneath  its  weight.  Nor  is  the  result  of  these  disasters 
limited  to  the  individuals  themselves.  Wives  and  children  and  the 
entire  families  are  involved,  and,  in  too  many  instances,  their  men- 
tal strength  not  proving  sufficient  to  stem  the  tide  of  misfortune, 
they  are  swept  into  the  vortex  of  despair. 

Another  factor,  each  year  more  and  more  potent  in  its  injurious 
effects,  is  the  excessive  forcing  process  of  our  present  school  system. 
Weak  and  strong  alike,  regardless  of  individual  idiosyncrasy,  are 
subjected  to  the  same  pressure.  Healthy,  natural  brain  growth  and 
development  is  impossible.  Hours  that  should  be  given  to  sleep  or 
out-door  recreation  must  be  devoted  to  the  preparation  of  lessons 
for  the  succeeding  day  uutil,  when  sleep  is  sought,  the  brain  is 
unable  to  cease  its  excessive  activity,  and  all  night  long  fractions 
and  decimals,  straits  and  rivers,  verbs  and  adjectives  are  mingled  in 
the  distressed  dreams  of  the  over-wearied  sleeper.  Is  it  any  wonder 
that  such  a preparation  for  life’s  work  and  duties  proves  so  often  a 
preparation  for  a living  death  ? With  brain  force  weakened  or  turned 
into  false  channels,  how  many,  as  a result  of  this  mistaken  system, 
pass  years  of  hopeless  misery  in  the  unfathomable  darkness  of  in- 
curable melancholia.  To  prove  that  this  is  no  fancy  sketch,  we  need 
but  glance  at  the  case-book  of  any  nervous-disease  specialist,  or  the 
records  of  any  hospital  for  the  insane.  Nor  are  the  numbers  of 
future  victims  from  this  cause  likely  to  diminish  until  a radical 
change  shall  be  made  in  the  present  system  of  education  by  our 
boards  of  education  and  our  educational  institutions  in  general. 

Another  pernicious  evil  apparently  upon  the  increase  is  the  fre- 
quent production  of  miscarriages  by  women  of  every  class.  The 
name  American  has  become  synonymous  with  greed  for  gain.  The 
accumulation  and  transmission  of  colossal  fortunes  is  regarded  as 
the  acme  of  human  ambition.  With  no  law  of  primogeniture  in 
force,  this  is  impossible  if  wealth,  although  great,  must  be  divided 
among  many  children.  This  desire,  together  with  the  demands  of 
fashionable  society  so  entirely  conflicting  with  the  duties  of  mother- 


THE  CAUSES  OF  INCREASE  IN  MELANCHOLIA. 


967 


hood,  render  child-bearing  among  the  rich  unpopular  and  intoler- 
able. With  the  poor,  scanty  comforts,  divided  among  increasing 
numbers,  become  positive  want  and  give  rise  to  the  same  desire. 
With  such  ideas  permeating  all  classes  of  society,  it  is  no  wonder 
that  our  newspapers  are  continually  filled  with  cases  of  unfortunates 
who  have  lost  their  lives  through  trusting  themselves  to  professional 
abortionists.  The  cases  published,  however,  are  but  the  smallest 
fraction  of  those  who  live  through  similar  operations.  Yet,  while 
escaping  immediate  death,  multitudes  have  their  constitutions  un- 
dermined, and  sow  the  seed  of  future  mental  disease.  The  general 
shock  to  the  nervous  system  is  often  too  great  to  be  rallied  from, 
and  after  years  of  suffering  they  at  last  sink  into  hopeless  melan- 
cholia. Nature’s  laws  are  inexorable,  and  this  is  but  one  of  numer- 
ous instances  where  the  offender  finds  that  the  punishment  is  severe 
and  unavoidable. 

Another  cause,  less  universally  effective,  is  the  increasing  preva- 
lence of  cigarette  smoking  among  children.  Of  the  evil  effects  of 
this  habit  upon  all  classes,  there  can  be  no  doubt,  but  when  it  is 
formed  and  indulged  in  by  children  ranging  from  toddlers  of  four  to 
youths  of  fifteen,  the  injury  must  be  tenfold  increased.  The  poison 
of  nicotine  is  especially  powerful  in  its  effects  upon  the  developing 
nervous  system,  as  is  proven  by  the  pinched  faces  and  dwarfed  forms 
of  the  numerous  street  arabs  of  all  large  cities,  who  almost  from 
babyhood  are  devotees  to  this  habit.  That  the  depression  of  this 
poison  plunges  many  into  insanity  is  proven  by  hospital  reports; 
that  the  numbers  here  recorded,  however,  do  not  anywhere  near  rep- 
resent all  the  cases  so  produced  is  also  without  doubt,  as  in  many  the 
disease  is  assigned  to  some  other  direct  cause,  while  in  reality  the 
first  seeds  might  be  traced  to  this  habit.  The  laws  enacted  for  the 
lessening  of  this  evil  are  most  needed,  and  every  physician  should 
do  his  utmost  to  enforce  them,  else  the  mental  wrecks  from  this  cause 
must  yearly  increase. 

Disappointed  ambition,  the  dissipations  of  fashionable  life,  with 
too  little  sleep,  too  little  exercise,  and  too  constant  confinement  within 
doors,  irregularity  in  eating  and  drinking ; in  fact,  an  almost  incal- 
culable number  of  agencies  might  be  named  which,  while  slight  in 
their  individual  effect,  in  the  aggregate  produce  a most  powerful  de- 
pressing influence  upon  the  general  system,  rendering  it  hyper- 
sensitive to  any  direct  exciting  cause,  and  tending  to  overthrow  the 


968 


WORLD  S HOMCEOPATHIC  CONGRESS. 


reason,  dry  up  the  sparkling  fountains  of  joy  and  hope,  and  substi- 
tute the  waters  of  bitterness  and  despair. 

How  is  this  increasing  tide  of  evil  influences  to  be  stemmed? 
Can  nothing  be  done  to  shield  the  masses  from  these  pernicious  in- 
fluences ? Must  multitudes  of  melancholiacs  continue  to  daily  swarm 
into  our  hospitals  and  sanitariums  or  seek  rest  in  suicide?  Are  we 
simply  to  stand  still  and  hopelessly  look  on?  Certainly,  the  general 
medical  profession  need  not  be  powerless  in  the  face  of  these  appall- 
ing facts.  A successful  crusade  could  be  waged  if  the  profession 
were  once  aroused  to  its  duty.  The  ignorance  and  thoughtlessness 
of  the  people  is  one  great  cause  of  so  many  offences  against  nature’s 
laws.  Our  mission  must  be  educational  as  well  as  curative.  Let 
the  community,  through  the  high  school  and  college,  be  taught  re- 
garding hygiene  and  the  general  laws  of  health.  Impress  upon  the 
masses,  wealthy  and  poor,  educated  and  ignorant  alike,  that  nature 
is  merciless  in  her  punishment  of  transgressors  of  her  laws.  Teach 
men  that  attacks  of  hopelessness  and  despair  which  so  often  cloud 
the  mental  horizon  are  but  the  reflex  of  disordered  natural  functions 
and  nature’s  warnings  against  violations  of  her  laws.  Teach  men 
how  to  live  when  in  health,  and  each  year  melancholia  will  become 
less  and  less  common,  and  soon  suicide  will  be  unknown. 


SOME  STATISTICAL  FACTS  CONCERNING  INSANITY.  969 


SOME  STATISTICAL  FACTS  CONCERNING  INSANITY . 

(Being  a Resume  of  the  Statistical  Reports  of  the  Middletown  State  Homoeopathic 
Hospital,  from  1874  to  1892,  inclusive.) 

By  George  Allen,  M.D.,  Middletown,  N.  Y. 


Believing  that,  as  Homoeopath ists,  we  are  all  interested  in  the 
work  done  by  our  public  institutions,  I have  brought  together,  in 
the  following  paper,  certain  statistical  facts  concerning  one  of  the 
most  prominent  Homoeopathic  institutions  in  the  State  of  New  York 
— the  Middletown  State  Homoeopathic  Hospital. 

Your  attention  is  invited  to  the  results,  along  certain  lines,  of  in- 
sanity under  Homoeopathic  treatment,  as  seen  at  the  above-named 
hospital  during  the  last  nineteen  years. 

The  Middletown  State  Homoeopathic  Hospital  was  the  first  insti- 
tution of  its  kind  in  the  world,  and  though  several  other  States  now 
have  Homoeopathic  hospitals  for  the  insane,  it  still  remains  the  most 
extensive  Homoeopathic  institution  of  its  kind. 

This  hospital  was  opened  for  patients  in  April,  1874,  the  first  pa- 
tient being  received  May  7,  1874.  During  the  balance  of  that 
hospital  year,  there  were  treated  a total  of  69  patients.  During  the 
last  hospital  year,  ending  September  30,  1892,  there  were  treated 
1104  patients.  The  average  number  under  treatment  during  the 
last  nineteen  years  has  been  323.  To  care  for  these  patients,  the 
daily  census  at  present  being  about  1000,  requires  large  buildings, 
valued  at  over  $1,000,00  ; a medical  superintendent  and  staff  of  six 
physicians — five  men  and  one  woman  ; about  150  male  and  female 
nurses,  and  other  employees  enough  to  swell  the  number  to  200 ; 
making  the  total  number  resident  at  the  hospital,  including  patients 
and  employees,  about  1200. 

This  establishment  was  maintained  last  year  at  a cost  for  current 
expenses  of  $168,292,  the  income  for  this  purpose  being  derived 
from  amounts  paid  by  counties  and  private  individuals  for  the  care 
of  patients. 


970 


world’s  homoeopathic  congress. 


Witnessing  the  growth  of  this,  and  other  great  State  and  muni- 
cipal hospitals  for  the  insane  throughout  the  land,  we  are  led  to  in- 
quire if  insanity  is  not  rapidly  increasing? 

The  last  census  of  the  United  States  discloses  an  increase  during 
nine  years  previous  to  1890  of  41,330  insane  persons  in  public  and 
private  asylums,  being  an  increase  of  73.53  per  cent,  over  that  of  the 
previous  census.  Concerning  this  fact,  however,  the  superintendent 
of  the  census  says  : “ The  percentage  of  increase,  when  compared 
with  the  percentage  of  increase  of  population  in  the  last  decade — 
namely,  24.86  per  cent. — does  not  indicate  an  increase  in  the  pro- 
portion of  insane  persons  to  the  population,  but  rather  a great  in- 
crease in  the  amount  of  asylum  accommodation  provided,  and  a wil- 
lingness on  the  part  of  the  public  to  make  a full  use  of  all  the  facili- 
ties thus  provided.”* 

Just  here  we  digress  to  remark  upon  the  misleading  nature  of 
statistics  when  not  properly  interpreted.  Most  of  us  would  have 
inferred  that  an  increase  of  41,330,  or  73.53  per  cent.,  in  the  asylum 
population  during  nine  years  might  be  construed  into  a warrant  for 
the  belief  that  insanity  was  increasing ; but  the  kind-hearted  super- 
intendent of  the  census  allays  our  fears,  and  assures  us  that  this 
means  simply  that  the  people  have  built  more  asylums,  and  are  wil- 
lingly patronizing  them.  Thus  early  we  learn  the  lesson  that  it  is 
unsafe  to  roam  in  statistical  fields  without  a guide. 

The  whole  number  of  patients  admitted  to  the  Middletown. State 
Homoeopathic  Hospital  during  nineteen  years  was  3629,  of  whom 
2775  were  discharged — 1352  having  recovered.  Analyzing  these 
recoveries,  we  find  one  very  important  fact — a fact  well  worth  re- 
membering, one  in  which  all  alienists  are  agreed,  and  which,  after  all 
allowances  have  been  made,  statistics  seem  to  confirm — namely,  that 
a majority  of  recoveries  among  the  insane  come  from  among  those 
patients  who  are  put  under  hospital  treatment  and  regimen  early. 
Of  those  who  came  under  treatment  during  the  first  six  months  of 
disease,  over  53  per  cent,  recovered  ; while  still  earlier  hospital  treat- 
ment gives  still  better  results.  On  the  contrary,  the  longer  treatment 
is  delayed,  the  smaller  does  the  percentage  of  cures  become.  So  that, 
it  may  be  considered  as  true,  that  recovery  from  insanity  is  in  an 
inverse  ratio  to  the  duration  of  the  disease.  Still  further  analysis 


* Robert  P.  Porter,  Census  Bulletin , May  9, 1891,  p.  1. 


SOME  STATISTICAL  FACTS  CONCERNING  INSANITY.  971 


shows  that  76  percent,  or  more  than  three-fourths  of  those  who  re- 
c >vered  did  so  in  less  than  one  year ; while  48  (per  cent.?)  of  the  num- 
ber recovered  in  less  than  six  months,  which  would  seem  to  show 
very  clearly  that  the  chances  of  recovery  diminish  quite  rapidly  after 
the  expiration  of  the  first  year  of  the  disease. 

Of  the  different  forms  of  insanity,  acute  melancholia  has  been  the 
most  numerous,  there  having  been  907  cases,  with  a recovery  rate 
of  56  per  cent.  Cases  of  acute  mania,  while  not  quite  so  numerous, 
have  given  a larger  number  of  recoveries,  namely,  69  per  cent. 
There  have  been  treated  449  cases  of  subacute  mania,  of  whom  201, 
or  45  per  cent.,  recovered.  Under  the  head  of  subacute  mania  are 
included  cases  of  paranoia.  Of  acute  delirious  mania,  or  typho- 
mania — the  delire  aigu  of  the  French — we  have  had  25  cases. 
Three  only  have  recovered,  a percentage  of  12  ; while  20,  or  80 
per  cent.,  have  died,  thus  demonstrating  the  severity  and  extreme 
fatality  of  this  form  of  insanity.  Of  337  cases  of  chronic  mania,  12, 
or  3.5  per  cent.,  have  recovered.  Recovery  from  chronic  mania  is 
very  rare,  but  does  sometimes  occur,  and  may  do  so  after  long 
periods.  And  yet  these  patients,  even  though  capable  of  perform- 
ing with  propriety  the  duties  belonging  to  their  social  or  civil  posi- 
tion, are  likely  upon  minute  examination  to  disclose  traces  of  mental 
weakness  or  mental  disorder.  Our  statistics  show  that  recurrent 
mania,  which  includes  circular  mania,  is  practically  incurable, 
although  the  periods  of  remission  in  this  form  of  insanity  are  un- 
doubtedly oftentimes  of  such  great  length  that  cases  have  frequently 
been  reported  as  recoveries  by  careful  and  conscientious  observers, 
being  classified,  of  course,  under  some  other  designation. 

Alcoholic  insanity  shows  a recovery  rate  of  89  per  cent.,  there 
having  been  51  recoveries  from  85  cases.  These  cases,  however, 
furnish  a large  number  of  recurrent  cases,  because  the  patient 
quickly  returns  to  his  unfortunate  habits  on  being  released  from 
the  hospital.  Of  insanity  from  masturbation,  23  per  cent,  of  our 
cases  have  recovered.  Epileptic  insanity  has  furnished  115  cases, 
with  but  two  recoveries;  while  general  paresis,  though  present  to 
the  number  of  186  cases,  has  thus  far  defied  all  efforts  at  cure,  and 
we  are  unable  to  report  a single  recovery  from  this  protean  disease. 
By  careful  hospital  treatment,  however,  the  duration  of  life  of  the 
paretic  has  been  lengthened,  so  -that  now  it  is  not  uncommon  for 


972 


world's  homoeopathic  congress. 


these  patients  to  live  eight  or  nine  years,  whereas  formerly  two  or 
three  years  was  considered  the  limit  of  their  lives.  Acute  primary 
dementia,  though  a rare  disease,  has  a large  recovery  rate.  Of  37 
cases,  33  recovered — a ratio  of  nearly  90  per  cent.  (89.2).  Terminal 
dementia  furnishes  527  cases,  with  no  recoveries  but  with  102 
deaths,  being  a death-rate  of  about  20  per  cent. 

Concerning  these  recoveries,  it  should  be  stated  that  the  rate  is 
fully  as  high  as  the  results  obtained  at  any  of  the  Old-School  hos- 
pitals, and  they  have  all  been  obtained  Under  purely  Homoeopathic 
treatment — a fact  which,  if  it  proves  nothing  else,  seems  clearly  to 
demonstrate  that  the  hypnotics,  opiates  and  neurotics,  and  multi- 
tudinous drug-preparations  of  our  Old-School  brethren  are,  to  say 
the  least,  unnecessary  in  the  treatment  of  insanity. 

Concerning  the  causes  of  insanity,  it  cannot  be  claimed  that  sta- 
tistics add  much  to  our  knowledge.  Under  this  head  an  attempt 
has  been  made  to  give  the  assigned  causes  only,  and  in  obtaining 
these  the  authorities  have  been  guided  largely  by  the  statements  of 
the  relative  or  friend  who  happened  to  accompany  the  patient  to 
the  hospital.  Such  persons  are  frequently  entirely  ignorant,  while 
some  are  guided  in  their  statements  by  personal  theories  and  opin- 
ions, and  fail  to  make  a scientifically  accurate  statement.  Thus  a 
person  who  had  at  one  time  in  his  life  been  intemperate,  and  at 
another  time  very  religious,  would  be  likely  to  have  his  insanity 
attributed  either  to  intemperance  or  excessive  religious  zeal,  accord- 
ing as  the  person  giving  the  information  happened  to  be  a “ temper- 
ance fanatic”  or  an  anti-religionist;  whereas  the  real  facts  might  be 
that  the  intemperance,  the  religious  excess,  and  the  insanity  were 
all  due  to  an  inherited  or  acquired  neurotic  condition  predisposing 
to  these  peculiar  manifestations. 

The  Middletown  tables  show  that  of  the  remote  causes  heredity 
plays  an  important  part;  while  predisposition  due  to  the  long- 
continued  action  of  vicious  habits,  exhausting  diseases,  or  neurotic 
tendencies  of  various  kinds,  swells  the  list. 

Among  the  exciting  causes,  worry,  intemperance,  masturbation, 
overwork,  and  domestic  troubles  contribute  the  largest  numbers  in 
the  order  named. 

The  relation  of  marriage  to  insanity,  if  it  has  any,  is  shown  by 
the  following  table : 


SOME  STATISTICAL  FACTS  CONCERNING  INSANITY.  973 


Males. 

Females. 

Total. 

Single 

47.3 

35.6 

41.6 

Married 

46. 

50. 

48.4 

Widowed ^ 

5.4 

12.8 

9-  , 

Showing  that  among  the  admissions  at  Middletown,  the  percent- 
age of  single  men  has  been  larger  than  that  of  single  women;  while 
among  the  married,  the  percentage  of  women  has  been  larger  than 
that  of  men. 

During  nineteen  years,  the  number  of  admissions  shows  that  the 
sexes  have  been  very  equally  represented,  the  total  for  the  entire 
period  showing  an  excess  of  only  sixty-five  males. 

Concerning  the  nativity  of  the  patients,  the  following  is  true: 

Two  thousand  seven  hundred  and  fifty- two,  or  75  per  cent.,  are 
native  born  ; while  875,  or  about  25  per  cent.,  are  foreign  born.  Of 
the  foreign  born,  Ireland  furnished  the  largest  number,  viz.,  334, 
being  38  per  cent. ; Germany  coming  next  with  206,  or  23  per  cent, 
of  the  foreign  born.  Thirty  different  countries  have  been  represented 
among  the  patients  at  Middletown.  Patients  have  been  received 
from  fifty-four  of  the  sixty  counties,  comprising  the  State  of  New 
York.  The  largest  number  of  patients  have  been  residents  of 
Orange,  the  county  in  which  the  hospital  is  located  ; while  New 
York,  Ulster,  Suffolk,  Sullivan,  Kings  and  Queens  counties,  have 
contributed  in  large  numbers,  and  stand  numerically  in  the  order 
named. 

The  average  annual  mortality  rate  during  the  entire  period  has 
been  4.99  per  cent,  upon  the  whole  number  treated;  while  the  mor- 
tality rate,  computed  upon  the  whole  number  of  admissions,  has 
been  about  11  per  cent.  These  facts  are  not  particularly  valuable 
as  demonstrating  the  mortality  of  insanity,  per  se , because  a large 
number  of  the  deaths  arose  from  causes  having  little  or  no  connec- 
tion with  insanity. 

Of  the  deaths,  it  appears  that  28  per  cent,  occurred  between  the 
ages  of  forty  and  fifty  years,  19  per  cent,  between  thirty  and  forty 
years,  and  18  per  cent,  between  fifty  and  sixty  years  of  age. 

If  we  examine  the  admissions  with  respect  to  the  ages,  we  find 


974 


world’s  homoeopathic  congress. 


946  patients,  or  above  25  per  cent,  were  between  the  ages  of  thirty 
and  forty  years  when  admitted  ; 819  or  22  per  cent,  between  twenty 
and  thirty  years  of  age;  718  or  21  per  cent,  were  between  forty  and 
fifty  years  old  ; while  574  or  15  per  cent,  admitted  were  between 
the  ages  of  fifty  and  sixty  years.  The  years  of  greatest  mental  and 
physical  activity  are,  therefore,  as  we  should  expect,  the  years  which 
contribute  the  largest  quota  to  the  numbers  of  the  insane. 

The  statistics  showing  the  relation  between  age  and  recovery  are 
somewhat  imperfect,  but  so  far  as  kept  they  tend  to  show  that  the 
greater  number  of  recoveries  are  from  among  the  young,  and  that 
age  is  an  important  factor  in  the  prognosis  of  insanity,  for,  other 
things  being  equal,  the  younger  person  has  the  best  chance  of  re- 
covery. 

In  the  matter  of  education,  about  3.5  per  cent,  of  those  admitted 
have  received  a collegiate  education;  14  per  cent,  have  received 
academic  education  ; 63  per  cent,  have  been  educated  in  the  com- 
mon schools.  Less  than  6 per  cent,  are  reported  as  absolutely  illit- 
erate, having  no  education  whatever. 

These  tables  have  not  been  carried  further  so  as  to  ascertain  the 
relative  recovery-  and  death-rates  among  those  possessing  different 
degrees  of  education,  but  a report  upon  that  subject  from  a series  of 
observations  by  Dr.  Hugh  G.  Stewart,  of  the  Crichton  Loyal  Insti- 
tution, Dumfries,  gives  a smaller  recovery-rate  and  a higher  death- 
rate  among  those  patients  who  have  enjoyed  the  highest  degree  of 
mental  culture,  and  the  same  seems  to  be  true  of  brain  workers  gen- 
erally in  comparison  with  artisans. 

Of  the  patients  admitted,  it  appears  that  about  75  per  cent,  were 
suffering  from  their  first  attack  of  insanity;  12.5  per  cent,  from  their 
second  attack ; about  4.5  per  cent,  from  their  third  attack ; while  3 
per  cent,  had  four  or  more  attacks  of  insanity  at  the  time  of  admis- 
sion. 

For  the  four  years  ending  September  30,  1892,  ninety-nine  cases, 
or  about  8.5  per  cent,  of  those  admitted,  have  previously  been  dis- 
charged recovered,  from  one  to  four  times.  These  figures  show  the 
marked  tendency  to  recurrence  of  the  disorder,  as  well  as  the  possi- 
bility of  recovery,  even  after  several  attacks. 

Concerning  1232  cases  admitted  since  1888,  we  find  the  following 
facts  can  be  gleaned : 10 J per  cent,  of  the  women  admitted  are  said 
to  have  inherited  insanity  from  the  paternal  branch  of  their  ances- 


SOME  STATISTICAL  FACTS  CONCERNING  INSANITY.  975 


try,  and  12J  per  cent,  from  the  maternal  branch.  Of  the  males,  10 
per  cent,  inherited  from  the  father,  and  11  per  cent,  from  the  mother. 
Less  than  2 per  cent,  inherited  from  both  ancestors,  and  8 per  cent, 
from  collateral  branches.  No  hereditary  tendencies  existed  in  57 
per  cent.,  and  in  10  per  cent,  of  the  cases  no  information  could  be 
gained. 

In  the  matter  of  occupation,  it  does  not  appear  from  the  Middle- 
town  statistics  that  any  particular  occupation  predisposes  to  insanity. 
To  be  sure,  a large  number  of  the  women  patients  are  put  down  as 
“ housekeepers/’  and  men  as  “ laborers/’  But  we  know  that  in 
every  community  these  occupations  make  up  the  majority  of  the 
population.  We  receive  a good  many  farmers  and  farmer’s  wives, 
but  not  a number  out  of  proportion  to  the  numbers  represented  by 
these  callings,  and  it  is  probable  that  overwork  and  scanty  fare, 
combined  with  worry,  would  contribute  an  equal  number  of  insane 
people  from  any  other  calling  that  made  up  so  large  a part  of  the 
population. 

The  average  period  of  residence  for  each  individual,  if  the  calcu- 
lations cover  the  entire  period  of  the  hospital’s  history,  is  1.69  years ; 
while  the  average  period  of  residence  of  those  remaining  in  the 
hospital  September  30,  1892,  is  four  years  and  one  month. 

The  foregoing  statistics  are  not  comparative.  They  show  simply 
the  results  obtained  in  certain  directions  at  the  Middletown  State 
Homoeopathic  Hospital.  And  while  the  results  obtained  are  highly 
satisfactory  from  a medical  standpoint,  a glance  at  the  financial 
management  will  show  a like  satisfactory  condition  of  things. 
Without  going  into  details,  it  will  suffice  for  any  business  man  to 
know  that  the  institution  has  been  practically  self-supporting.  The 
managers  keep  within  the  income,  and  do  not  ask  for  appropriations 
for  deficiencies  in  maintenance.  This  is  very  gratifying  to  us  as 
Homoeopathists,for  it  demonstrates  the  possibility  of  conducting  great 
State  and  municipal  hospitals  under  Homoeopathic  management  in 
a manner  satisfactory  to  the  patients,  their  friends,  and  the  public  at 
large. 

The  charter  of  the  Middletown  State  Homoeopathic  Hospital  was 
granted  by  the  Legislature  of  the  State  of  New  York,  because  the 
Homoeopathists  of  that  State  wanted  such  an  institution  for  their 
own  use,  and  they  demonstrated  to  the  Legislature  the  fact  that  their 
numbers,  wealth,  and  influence  were  such  as  to  entitle  them  to  what 


976 


♦ 


world’s  homceopathic  congress. 


they  asked.  That  was  true  nineteen  years  ago,  and  the  result  has 
demonstrated  the  wisdom  of  the  Legislature  in  acceding  to  this  re- 
quest of  the  Homoeopathists,  and  establishing  the  institution  they 
desired.  Moreover,  the  example  of  the  State  of  New  York,  and 
the  result  of  the  experiment  at  Middletown,  has  inspired  similar 
action  in  other  States,  and  it  is  to  be  hoped  that  still  others  will  soon 
follow, New  York,  Massachusetts,  Minnesota,  and  California  in  their 
demand  upon  their  respective  Legislatures  for  State  hospitals  for  the 
Homoeopathic  treatment  of  the  insane  of  the  Homoeopathic  faith. 
And  here  let  me  suggest  that  the  thing  to  ask  for  is,  not  the  privi- 
lege of  having  a Homoeopathic  physician  or  physicians  allowed  to 
practice  in  one  of  several  State  hospitals,  but  rather  a hospital  set 
apart  and  dedicated  to  the  use  of  that  portion  of  the  citizens  of  the 
State  who  are  Homoeopathists.  An  institution  for  Homoeopathists, 
in  the  interests  of  Homoeopathists,  managed  and  superintended  by 
Homoeopathists.  Let  the  demand  be  made,  and  the  appeal  reiterated 
in  unmistakable  terms,  backed  by  the  combined  Homoeopathic  influ- 
ence of  the  entire  State,  brought  to  bear  in  the  most  available  way, 
whether  by  political,  social,  or  personal  agency,  and  sooner  or  later 
the  desired  result  will  be  attained.  It  will  be  better  to  wait  and 
renew  the  appeal  for  exactly  what,  as  Homoeopathists,  you  want  than 
to  accept  any  compromise  which  fails  in  securing  medical  liberty  and 
full  justice  to  Homoeopathy. 


REPORT 


OF  THE 

SECTION  IN  RHINOLOGY  AND 
LARYNGOLOGY. 


Chicago,  III.,  June  3,  1893. 

The  Section  in  Rhinology  and  Laryngology  of  the  World’s  Con- 
gress of  Homoeopathic  Physicians  and  Surgeons  assembled  in  the 
Hall  of  Washington  at  11  o’clock  A.M. 

In  the  absence  of  Horace  F.  Ivins,  M.D.,  of  Philadelphia,  Pa., 
the  Chairman  of  the  Section,  the  meeting  was  presided  over  by  Wes- 
ley A.  Dunn,  M.D.,  of  Chicago,  111.,  who  read  Chairman  Ivins’s 
address  on  “ Recent  Progress  in  Rhinology  and  Laryngology.” 
The  address  was  discussed  by  Drs.  T.  C.  Duncan,  of  Chicago,  and 
W.  E.  Green,  of  Little  Rock,  Ark. 

The  next  paper  read  was  on  “ Kasai  Epithelioma,”  by  Wesley  A. 
Dunn,  M.D.,  of  Chicago.  The  paper  described  a case  of  the  malady 
in  a patient  whom  Dr.  Dunn  exhibited  before  the  Section.  The 
discussion  of  the  subject  was  participated  in  by  Drs.  H.  F.  Ivins,  of 
Philadelphia,  Pa.,  and  W.  R.  King,  of  Washington,  D.  C. 

H.  F.  Fisher,  M.D.,  of  Nashville,  Tenn.,  read  an  essay  on  “ Ma- 
lignant Growths  in  the  Larynx.”  This  paper  was  discussed  by  Dr. 
W.  A.  Dunn,  of  Chicago. 

The  following  papers  were  presented  by  their  titles : 

“ New  Suggestions  in  the  Treatment  of  Constrictions  of  the 
(Esophagus,”  by  D.  G.  Wood  vine,  M.D.,  of  Boston,  Mass.,  with  a 
discussion  by  Dr.  W.  R.  King,  of  Washington,  D.  C. 

“ Massage  in  the  Treatment  of  Nasal  Stenosis,"  by  William  Du- 
lany  Thomas,  M.D.,  of  Baltimore,  Md. 

“The  Treatment  of  Laryngeal  Phthisis,"  by  Charles  E.  Jones, 
M.D.,  of  Albany,  N.  Y. 

62 


v 


978 


world’s  homoeopathic  congress. 


“ The  Treatment  of  Chronic  Rhinitis  by  the  Homoeopath,”  by 
Charles  E.  Teets,  M.D.,  of  New  York,  N.  Y.,  with  a discussion  by 
Dr.  G.  H.  Quay,  of  East  Cleveland,  O. 

“ Nasal  Surgery — Its  Use  and  its  Limitations,”  by  Eugene  L. 
Mann,  M.D.,  St.  Paul,  Minn. 

The  sectional  meeting  then  adjourned. 


RECENT  PROGRESS  IN  RHINOLOGY  AND  LARYNGOLOGY.  979 


RECENT  PROGRESS  IN  RHINOLOGY  AND 
LARYNGOLOGY. 

By  Horace  F.  Ivins,  M.D.,  Philadelphia,  Pa.,  Chairman. 


Mr.  President,  Ladies  and  Gentlemen. — As  Chairman  of  the  Sec- 
tion of  Rhinology  and  Laryngology,  it  is  my  pleasant  duty  to  pass 
in  review  some  of  the  points  marking  the  progress  in  these  special- 
ties within  the  past  year  or  two.  As  it  is,  however,  impossible  to 
consider  all  of  the  advances  made  in  this  line,  I take  the  liberty  of 
indicating  those  which  seem  to  me  to  offer  the  greatest  advantage  to 
us,  in  addition  to  which  I have  revived  some  points  of  sterling 
merit  introduced  years  ago,  but  which  have  practically  fallen  into 
disuse. 

Before  proceeding  with  the  various  subjects,  allow  me  to  express 
my  appreciation  of  the  honor  bestowed  upon  me  in  placing  me  at 
the  head  of  this  Section,  and  to  return  thanks  to  those  who  have 
been  kind  enough  to  respond  to  my  request  for  essays ; at  the  same 
time  regretting  that  more  of  our  foreign  confreres  have  not  re- 
sponded in  a practical  way,  although  a number  of  them  have  been 
invited  to  do  so. 

Considering  our  subjects  in  the  usual  manner,  I shall  first  take 
up  those  which  belong  to  the  nose,  and  proceed  to  the  deeper  tract, 
touching  but  lightly  any  of  the  sections;  leaving  to  you  the  heavier 
task  of  dealing  with  the  details. 

Physiology  of  the  Nose. — The  division  of  the  nasal  cavities 
into  respiratory  and  functional,  so  long  taught,  has  had  a draw- 
back in  the  experiments  of  Kayser  and  Paulsen.  They  used  Osmic 
acid  on  the  heads  of  cadavers,  having  previously  performed  the 
powder-test  upon  them.  The  conclusions  justified  by  these  experi- 
ments are,  that  during  inspiration,  in  a normal  nose,  the  bulk  of 
the  air  passes  along  the  septum,  above  the  inferior  turbinated  body, 
describing  a semicircle  in  its  course  and  extending  upward  nearly  to 
the  roof  of  the  nose.  ( Archives  of  Otology , January  1,  1891.) 


980 


world’s  homoeopathic  congress. 


Epistaxis. — The  origin  of  nasal  haemorrhage  is  now  well  fixed 
in  a large  majority  of  cases.  While  it  was  formerly  believed  thajfc 
the  bleeding- point  might  be  situated  anywhere  in  the  nasal  fossae,  it 
is  at  present  certain  that  few  cases  originate  in  other  than  the  anterior 
region  (the  vestibule),  especially  in  the  triangular  cartilage  at  the 
entrance  to  Jacobson’s  organ.  This  origin  gives  much  greater  cer- 
tainty of  finding  the  bleeding-point  speedily  and  of  promptly  ar- 
resting the  haemorrhage.  The  best  means  which  recent  research  has 
brought  to  light  are  the  application  to  the  bleeding  spot  of  Chromic 
acid  or  the  cherry-red  galvano-cautery  point.  The  former  method 
is  far  preferable,  as  it  is  less  likely  to  be  followed  by  return  at  a sub- 
sequent period.  In  fact,  I have  never  seen  a second  haemorrhage, 
from  the  same  point,  follow  the  careful  application  of  the  acid  in  a 
fresh,  saturated  solution.  On  the  other  hand,  the  cautery  may  de- 
stroy too  much  tissue,  resulting  in  subsequent  secondary  bleeding. 
To  the  general  statement  that  most  haemorrhages  originate  in  the  an- 
terior portion  of  the  nasal  passages,  one  exception  must  be  made, 
viz.,  that  in  atheroma,  especially  in  very  old  persons,  bleeding  more 
frequently  originates  in  the  upper  portion  of  the  canals,  and  is  gen- 
eral, not  being  confined  to  one  or  two  points.  The  remedies  appli- 
cable to  such  cases  are  generally  Carbo  veg.,  Crotalus,  Lachesis,  and 
Hamamelis.  In  younger  persons  I have  found  Bryonia  almost  un- 
failing. I am  pleased  to  note  one  great  advancement  in  the  treat- 
ment of  epistaxis,  namely,  that  few  physicians  now  recommend  the 
use  of  such  styptics  as  Perchloride  of  iron,  for  they  often  do  con- 
siderable harm  to  the  nasal  passages,  at  times  resulting  in  intense  in- 
flammation, abscess  formation,  and  loss  of  the  function  of  smell. 
Another  long  stride  in  the  direction  of  reform  consists  in  the  almost 
uniform  rejection  of  the  cumbersome,  painful,  often  dangerous  pos- 
terior plug,  and  the  substitution  of  the  simpler  and  more  scientific 
measures  proposed  by  Dr.  A.  A.  Philip  ( The  British  Med.  Jour., 
July  18,  1891)  and  by  Dr.  W.  W.  Parker  [Med.  Record , October  4, 
1890).  The  former  uses  what  he  calls  his  “ umbrella  plug.”  A 
piece  of  silk,  thin  cotton,  etc.,  is  pushed  into  the  naso-pharynx  along 
the  lower  meatus  by  means  of  a smooth  stick,  pencil,  or  probe  placed 
against  the  centre  of  the  material  used.  When  introduced,  the  edges 
and  corners  of  the  material  will  project  from  the  nostril.  The  in- 
troducer is  then  withdrawn,  and  by  it  the  top  of  the  umbrella  pouch 
is  well  filled  with  little  pieces  of  cotton  or  lint.  The  introducer  is 


RECENT  PROGRESS  IN  RIIINOLOGY  AND  LARYNGOLOGY.  981 


then  firmly  held  against  the  cotton,  and  the  umbrella  corners  pulled 
upon  until  the  mass  tightly  fills  the  choana.  The  remainder  of  the 
pouch  should  then  be  packed,  and  the  outer  portion  tied,  bag-like, 
with  a string.  When  it  is  desired  to  remove  the  plug,  open  the  bag 
and  pick  out  the  cotton.  Dr.  Parker  takes  fifteen  threads  of  patent 
lint  or  largest  spool  thread,  three  or  four  inches  long,  doubles  them 
upon  themselves,  and  ties  a string  six  or  eight  inches  long  around 
the  middle.  By  the  aid  of  a probe,  the  centre  of  the  threads  is 
pushed  along  the  floor  of  the  canal  to  the  posterior  nares.  The  probe 
is  then  carefully  removed  and  the  nostril  plugged. 

Relation  of  Nasal  Stenosis  to  Ear  Defects, — Although 
this  subject  has  frequently  been  dwelt  upon  during  the  past  few 
years,  it  does  not,  in  general,  receive  the  attention  which  its  im- 
portance deserves;  this  not  so  much  with  reference  to  the  deaf- 
ness as  to  the  tinnitus  aurium,  that  bete  noir  of  the  aural  surgeon. 
Many  aurists  claim  that  at  least  70  per  cent,  of  all  cases  of 
catarrhal  deafness  are  due  to  difficult  nasal  respiration,  and  that 
the  cure  of  the  latter  means  alleviation  of  the  former,  so  far  as  it 
is  possible  to  relieve;  some  even  discard  the  Politzer  bag  and 
Eustachian  catheter  for  other  than  diagnostic  purposes,  claiming 
that  they  do  harm  even  when  used  with  the  greatest  care.  To 
this  I cannot  subscribe,  as  I have  repeatedly  seen  marked  and 
permanent  relief  from  the  use  of  middle-ear  inflation,  without  re- 
lieving the  considerable  nasal  obstruction ; but  when  the  latter  is 
also  accomplished,  the  results  are  vastly  superior  to  those  obtained 
without  it.  Especially  is  this  true  of  tinnitus  aurium,  which,  when 
# dependent  upon  nasal  stenosis  (as  occurs  in  about  50  per  cent,  of 
the  cases  in  young  subjects),  is  speedily  relieved  by  reducing  the 
obstruction. 

Atrophic  Rhinitis. — While  internal  remedies  are  the  most  essen- 
tial features  in  the  cure  of  this  trying  condition,  it  is  possible  to  sup- 
plement their  action  by  judicious  local  measures.  Of  these  none, 
perhaps,  has  gained  more  prominence  or  met  with  better  results  than 
has  Ichthyol.  This  is  generally  used  in  a 5 per  cent,  solution,  in 
fluid  cosmoline  or  albolene,  and  either  applied  directly  to  the  part? 
after  thorough  cleansing,  or  sprayed  into  the  nose  several  times  a 
day.  The  cotton  tampons  introduced  by  Bottstein  some  years  ago 
not  proving  thoroughly  satisfactory,  I made  use  of  glycerine-coated 
cotton  pledgets,  which  answer  a better  purpose  in  that  they  more 


982 


world’s  homoeopathic  congress 


quickly  excite  a flow  of  mucus;  the  consequent  dislodgment  of  the 
hardened  crusts  renders  nasal  respiration  freer,  relieves  the  pressure 
in  the  nasal  region  with  its  resultant  headache,  and  at  the  same  time 
reduces  to  a minimum  the  unpleasant  odor.  More  recently  others 
almost  fill  the  nasal  cavity  with  numerous,  small,  dry,  cotton 
pledgets,  thereby  affecting  the  same  result;  but  in  my  experience, 
acting  more  slowly  and  causing  much  more  annoyance  to  the  patient. 
Another  method  of  treatment  which  has  undoubted  merit  consists 
in  the  application  of  various  powders,  especially  aristol  and  iatrol,  to 
the  lining  membrane.  The  internal  remedy  which  has  recently  been 
brought  into  special  prominence  isTheridion,  so  long  applied  by  Dr. 
A.  Korndoerfer,  of  Philadelphia,  for  the  following  symptoms:  dis- 
charge yellow  or  greenish-yellow,  thick  and  offensive,  but  particu- 
larly if  the  crusts  be  drawn  into  the  throat  and  expectorated.  Dr. 
Korndoerfer’s  chief  symptoms  are  offensive  discharge  (either  thick 
or  thin),  headache,  and  a feeling  of  fulness  or  pressure  at  the  bridge 
of  the  nose.  Hyoscyamus  is  highly  recommended  by  Dr.  Charles 
E.  Teets,  of  New  Yor£,  as  one  of  the  best  remedies  for  the  treat- 
ment of  atrophic  rhinitis. 

Hay  Fever. — I cannot  pass  this  topic  without  saying  one  word 
about  the  fact  that  Naphthalin  is  constantly  adding  to  its  laurels  in 
the  cure  of  Pollen  Catarrh, and  that  Gelsemium  is  gaining  its  proper 
place  among  the  prophylactic  remedies  useful  in  combating  this 
neurosis  (?).  It  is  pleasing  to  know  that  the  wholesale  destruction 
of  sensitive  areas  is  giving  place  to  the  more  conservative  method 
of  reducing  the  actual  obstructions  to  nasal  respiration. 

Nasal  Neuroses, — Of  these,  neuralgia  of  the  face  and  head  and 
reflex  conditions  are  now  receiving  the  attention  that  has  so  long 
been  denied  t hem.  In  many  cases  the  reduction  of  hypertrophies 
or  pressure-tissue  due  to  engorgement,  has  resulted  in  a speedy  and 
complete  cure  of  some  of  the  most  obstinate  neuralgias  of  this 
region.  In  numerous  instances  relief  has  been  obtained  by  the 
insufflation  of  finely  powdered  chloride  of  Sodium.  In  others  it 
has  been  necessary  to  employ  the  galvano-cautery  to  reduce  large, 
turgescent  regions  by  making  a slight  incision  into  the  engorged 
tissue. 

Papillomata  of  the  Nose. — One  word  will  suffice  with  reference 
to  these  infrequent  growths,  which  are  always  found  directly  within 
the  vestibule  upon  the  cartilaginous  septum  or  lower  turbinated  body. 


RECENT  PROGRESS  IN  RHINOLOGY  AND  LARYNGOLOGY.  983 


Some  writers  have,  within  a short  time,  endeavored  to  prove  that 
these  neoplasms  occur  very  frequently  ; but  caution  is  necessary  to 
discriminate  between  the  true  papillomatous  growth  and  a roughened, 
hypertrophic  condition  of  the  membrane,  frequently  found  in  this 
region. 

Local  Anaesthetics. — While  cocaine  still  holds  a large  share  of 
confidence  in  this  capacity,  there  are  cases  in  which  it  is  unsafe  to 
use  it ; therefore,  great  efforts  have  been  made  to  replace  or  augment 
its  action  by  some  drug  which  will  not  be  injurious  to  the  patient. 
Of  these,  Antipyrin,  1 to  3 per  cent,  solution,  has  proven  most  sat- 
isfactory, in  that  it  is  not  only  anaesthetic  but  anti-spasmodic,  and, 
when  used  in  the  nose,  diminishes  reflex  cough  and  asthma  due  to 
nasal  defects  ; above  all,  the  drug  is  highly  antiseptic.  Its  analgesic 
action  lasts  many  hours,  thus  often  making  it  more  satisfactory  than 
Cocaine.  There  seems  to  be  but  one  disadvantage,  viz.,  its  applica- 
tion is  more  irritating  than  that  of  Cocaine. 

Transillumination. — This  important  adjunct  to  the  diagnosis  of 
the  diseases  of  the  antra  and  ethmoidal  sinuses  has  gone  far  to  alle- 
viate a class  of  maladies  which  has  often  rendered  the  surgeon  inop- 
erative in  relieving  obscure  symptoms  of  this  region.  While  trans- 
illumination does  not  clear  up  each  case,  it  must  be  admitted  that 
it  has  done  much  for  this  branch  of  rhinology  ; and  Garel  calls  at- 
tention to  a new  sign — absence  of  luminous  perception  on  one  side 
by  the  patient  himself.  With  a lamp  in  the  mouth  of  a healthy 
subject,  whose  eyes  are  closed,  a luminous  impression  is  produced 
upon  the  lower  part  of  the  retina.  In  four  cases  of  unilateral  empy- 
ema of  the  antrum,  Garel  observed  that  this  luminous  perception 
was  suppressed  on  the  side  containing  pus.  ( Annales  des  Maladies 
du  Larynx , etc.,  February,  1893). 

Fibroid  Tumors  of  the  Naso-Pharynx. — It  is  more  than  pleas- 
ing to  note  the  yearly  change  which  has  taken  place  in  the  treatment 
of  these  growths  of  the  naso-pharynx.  The  more  conservative 
methods  of  electrolysis  and  galvano-cautery  puncture  have  almost 
superseded  the  less  rational,  capital  operations,  such  as  those  of 
Rouge  and  others,  from  which  loss  of  life  has  been  noted.  Few 
cases  now  fail  to  respond  to  the  more  rational  measures,  thus  giving 
a far  better  prognosis  than  was  formerly  possible.  The  cautery-loop 
has  long  been  used,  but  occasional  fatal  results  follow. 

Physiology  of  the  Tonsils. — Hodenpyl  (“  Alumni  Prize  Essay/7 


984 


world’s  HOMCEOPATH1C  CONGRESS. 


College  of  Physicians  and  Surgeons,  ]Sr.  Y.,  May,  1890),  formulates 
the  following  conclusions: 

“1.  The  tonsils  are  lymphoid  structures  closely  resembling  Pey- 
er’s  patches  of  the  small  intestine,  consisting  in  general  of  a congeries 
of  lymph  nodules  separated  from  one  another  by  diffuse  lymphoid 
tissue  which  is  arranged  about  several  of  the  hollow  depressions  of 
the  epithelial  lining  of  the  glands. 

“2.  None  of  the  theories  thus  far  advanced  to  explain  the  func- 
tions of  the  tonsils  are  conclusive. 

“3.  The  tonsils  produce  no  physiological  secretion. 

“ 4.  The  tonsils  are  not  absorbing  organs.  They  neither  absorb 
fluid  nor  solid  particles  from  the  mouth  under  ordinary  conditions, 
nor  do  they  take  up  foreign  materials  from  the  tissues  in  their  imme- 
diate neighborhood. 

“5.  Tubercular  tonsillitis  is  an  uncommon  affection. 

“ 6.  There  is  no  evidence  to  show  that  pulmonary  tuberculosis 
ever  results  from  absorption  of  tubercle  bacilli  from  the  mouth 
through  the  tonsils. 

“ 7.  Rarefaction  of  the  epithelium  of  the  tonsils  offers  a ready 
explanation  of  the  way  in  which  the  contagium  of  diphtheria  may 
gain  entrance  to  the  general  circulation  in  this  disease.” 

This  valuable  thesis,  therefore,  sets  aside  many  of  the  theories 
which  have  been  prevalent  for  years,  doing  away  with  a source  of 
supposed  contamination,  and  places  once  more  upon  the  broad  field 
of  doubt  the  function  of  these  organs,  the  diseases  of  which  give  rise 
to  such  discomfort  to  the  patient,  and  often  result  in  serious  conse- 
quences to  the  general  health. 

Tonsillitis. — Of  late  this  subject  has  given  rise  to  considerable 
discussion,  and  has  even  formed  the  title  of  a large  monograph  by 
Allard  (“  Les  Amygdalites  Aigues”),  who  believes  that  the  causes 
of  this  disorder  are  microbiological,  and  that  the  hypotheses  which 
regard  tonsillitis  as  a general  infectious  disorder,  the  fever  of  which 
the  angina  is  only  a manifestation,  are  the  most  rational  and  the 
most  in  keeping  with  the  majority  of  the  facts,  and  it  is  now  almost 
generally  admitted  that  tonsillitis  is  often  infectious,  with  resultant 
nephritis,  orchitis,  endocarditis,  and  arthritis.  Cases  of  papular 
erythema  and  purpura  complicating  tonsillitis  have  been  reported 
recently.  In  some  cases,  even  a trace  of  albumin  has  been  discov- 
ered in  the  urine,  but  as  this  is  a condition  which  might  possibly  be 


RECENT  PROGRESS  IN  RHINOLOGY  AND  LARYNGOLOGY.  985 

complicated  by  other  and  antecedent  disorders,  it.  can  scarcely  be 
looked  upon  as  an  actual  symptom  or  sequel  of  amygdalitis.  In  the 
last  few  years,  much  attention  has  been  drawn  to  the  resemblance 
between  follicular  tonsillitis  and  diphtheria;  many  authors,  in  fact, 
failing  to  find  a differential  diagnosis  ; some  even  claiming  that  the 
usually  milder  affection  is  but  a forerunner  or  even  a modified  form 
of  the  latter. 

Hypertrophied  Tonsils. — In  passing,  I wish  to  suggest  one 
remedy  for  enlargement  of  the  tonsils,  which  has  not,  so  far,  been 
spoken  of  by  others,  and  which  has  proved,  clinically,  the  most  use- 
ful remedy  tried  ; namely,  Ignatia,  30x,  with  nodulated,  slightly 
inflamed  tonsils,  especially  in  nervous  persons,  when  the  right  tonsil 
is  the  worse,  and  with  associated  enlargement  of  the  right  anterior 
cervical  glands. 

Cancer  of  the  Tonsils  and  Pharynx. — Although  Arsenic,  Hy- 
drastis can.,  and  Phytol.  still  hold  high  positions  as  therapeutic 
measures  in  the  treatment  of  this  fatal  affliction,  the  recent  employ- 
ment of  Calendula  in  a 20  per  cent,  solution,  together  with  its 
internal  administration  in  the  2x  or  3x,  has  given  a decided  impetus 
to  the  internal  administration  of  drugs  in  pharyngeal  cancer,  and 
Dr.  H.  C.  French  ( Pacific  Coast  Jour,  of  Horn.,  January,  1893) 
writes  very  flatteringly  of  the  action  of  “ a paste  of  red  clover  (Tri- 
folium Americano)  applied  to  an  ulcer  [epithelioma  of  the  eyelid], 
and  the  same  remedy  taken  internally,  in  doses  of  from  two  to  five 
drops  of  the  fluid  administered  three  times  daily,  has,  in  the  hands 
of  the  writer,  proven  both  prophylactic  and  curative.  The  strength 
of  the  paste  must  be  graded  to  the  susceptibility  of  the  patient  by 
the  addition  of  slippery  elm  powder.  Under  this  treatment  we  have 
seen  an  ichorous  discharge  become  bland  or  cease  entirely,  the  rough 
edges  become  smooth,  and  the  hard  base  softened.”  We  welcome 
this  new  remedy  for  such  a serious  malady,  and  will  place  it  along- 
side of  the  preceding  drugs. 

Guaiacum. — Dr.  Wm.  C.  Goodno,  of  Philadelphia,  says  that, 
“in  the  ordinary  form  of  pharyngitis,  such  as  is  so  frequently  devel- 
oped after  cold,  it  is  nearly  a specific  remedy,  much  superior  to 
Belladonna  and  other  remedies  which  are  generally  administered.” 
Acting  upon  this  suggestion  contained  in  The  Hahnemannian  Monthly , 
February,  1891,  I have  used  the  remedy  very  extensively  in  both 
acute  and  subacute  pharyngitis,  and  am  heartily  in  accord  with  the 


986 


world’s  homoeopathic  congress. 

doctor.  The  indications  upon  which  I prescribe  are  partly  empirical, 
but  often,  recently,  certain  appearances  guide  me  in  its  administra- 
tion, namely,  the  congestion,  which  is  less  bright  than  the  Bella- 
donna, and  is  on  either  side  of  the  throat;  the  pharynx,  at  times,  is 
slightly  glazed,  at  others,  infiltrated  ; much  follicular  involvement; 
and  the  patient  complains  of  a smarting,  especially  burning,  liken- 
ing it  to  the  effect  of  pepper.  When  given  early  and  repeatedly, 
using  the  2 x or  the  3x,  it  acts  promptly,  and  in  a large  number  of 
cases  has  cut  short  acute  pharyngitis  in  patients  who  are  accustomed 
to  have  long  sieges  from  similar  beginnings. 

Diphtheria.— Some  authors  have  disclaimed  any  marked  conta- 
giousness of  diphtheria,  unless  the  bacilli  be  of  unusual  virulence,  a 
few  writers  even  claiming  absolute  non-contagiousness  of  this  malady. 
This  seems  like  very  bad  teaching,  especially  should  the  laity  be  apt 
scholars.  Dr.  Bourges  (La  Diphtherie)  studies  the  subject  from 
the  following  standpoint : Diphtheria  is  a contagious  disease  due  to 
the  bacillus  described  by  Klebs  and  later  by  Loeffler.  He  claims 
that  the  diagnosis  between  the  false  diphtheria  of  scarlatina  and  true 
diphtheria  is  always  difficult,  and  often  even  impossible.  In  order 
to  prevent  the  spread  of  diphtheria  when  there  is  a vesicular  erup- 
tion (containing  the  diphtheria  bacilli)  on  the  udder  of  newly-calved 
milch  cows,  extreme  measures  should  be  instituted  to  prevent  its 
spread  by  appointing  dairy  inspectors.  When  the  condition  is  dis- 
covered, the  sale  of  the  milk  should  be  prohibited,  the  udders 
thoroughly  disinfected,  aud  the  wet,  unsanitary  condition  of  the  cow- 
sheds speedily  remedied.  In  the  local  treatment  of  diphtheria  there 
seems  to  be  a growing  tendency  to  discard  the  harsher  measures, 
substituting  those  which  are  less  objectionable  to  the  patient,  and 
which  can  be  applied  without  giving  rise  to  so  much  resistance.  Of 
the  internal  remedies,  perhaps  none  has  recently  created  so  much 
discussion  as  Permanganate  of  potassium,  introduced  by  Dr.  I.  W. 
Heysinger,  of  Philadelphia,  about  fifteen  years  ago  ; but  which  had 
practically  been  neglected  until  Dr.  Heysinger’s  paper,  upon  the 
subject,  appeared  in  the  Jour,  of  Oph.y  Otol.  and  Lar .,  January  1892. 
The  doctor  looks  upon  the  remedy,  when  given  in  the  earlier  stages, 
as  an  infallible  specific.  He  uses  about  one  grain  of  the  crystals  in 
three  ounces  of  pure  water,  giving  one  teaspoonful,  together  with 
mother  tincture  of  Bell.,  every  hour  or  so.  He  further  employs 
the  Permanganate  as  a prophylactic.  Acting  upon  his  sugges- 


RECENT  PROGRESS  IN  RHINOLOGY  AND  LARYNGOLOGY.  987 


tions,  a number  of  physicians  have  used  it  with  very  gratifying 
results. 

Benign  Ulceration  of  the  Pharynx.— Besides  establishing  the 
identity  of  this  condition,  first  described  by  Heryng,  Masucci  ( Revue 
de  Laryngologie , d’Otologie  et  de  Rhinologie,  October  15,  1891)  has 
proved  the  existence  of  special  bacteria,  the  streptococcus  mono- 
phormus  and  variegatus,  described  by  Heryng  and  Ludwig,  demon- 
strating the  benignity  of  the  affection.  The  lesion  is  usually 
unilateral  and  single,  oblong  in  shape,  and  apt  to  appear  upon  the 
soft  palate.  The  ulcer  is  covered  with  a grayish  membrane,  which 
disappears  in  a few  hours,  leaving  no  trace.  This  form  of  ulcera- 
tion has  been  too  slightly  dealt  with  by- writers  in  general,  and  most 
practitioners  look  upon  it  as  if  of  syphilitic  or  phthisical  origin.  It 
is,  therefore,  well  to  call  especial  attention  to  this  transient,  benign, 
and  simple  ulceration,  that  patients  may  not  be  relegated  to  either 
of  the  classes  above-named. 

Pyriform  Sinuses  and  the  New  Tonsil. — Dobrowolski,  of 
Warsaw  [Jour,  of  Lar.,  Rlxi.  and  Otol .)  has  presented  a very  im- 
portant thesis  bearing  upon  this  subject,  in  which  he  states  that  in 
general  the  papillae  and  mucous  glands  are  not  numerous  in  the 
sinuses.  As  to  the  follicles,  the  author  regards  the  pyriform  sinus 
in  his  cases  (60)  under  four  categories.  In  the  first,  and  most 
numerous,  (almost  one-half)  cases,  there  were  no  folliculi,  only  a 
circumscribed  infiltration  under  the  epithelium.  In  the  second  (less 
numerous),  the  adenoid  tissue  under  the  epithelium  contained  nodu- 
lar agglomerations,  similar  to  the  tonsils.  In  the  third  class,  the 
adenoid  tissue  was  in  the  form  of  single  sacciform  glands,  identical 
with  those  of  the  base  of  the  tongue.  Finally,  in  the  last  class 
(8  cases)  these  glands  were  agglomerated  in  the  shape  of  the  tonsils  ; 
thus  leading  him  to  the  classification  of  a new  (pyriform)  tonsil,  or 
as  named  by  Dobrowolski,  “ tonsilla  laryngea  saccus — sinus  pyri- 
form saccus — fifth  tonsil.”  This  latter  was  present  in  six  cases  on 
both  sides  (generally  at  the  bottom  of  the  pyriform  sinus)  and  was 
more  or  less  of  the  size  of  a bean.  The  tonsil  was  composed  of 
from  4 to  15  sacciform  glands.  The  author  regards  the  laryn- 
geal tonsil  as  a normal,  though  not  constant,  organ  similar  to  the 
lingual,  pharyngeal,  and  faucial  tonsils. 

The  Epiglottis. — Recently  the  theory  that  the  epiglottis  de- 
scended in  such  a way  as  to  cover  the  upper  portion  of  the  larynx 


988 


world’s  homceopathic  congress. 


(luring  deglutition,  has  met  with  temporary  rebuff  in  the  new 
theory  that  it  remains  upright  during  the  act  of  swallowing;  clos- 
ure of  the  sphincter  serving  to  prevent  the  entrance  of  food.  Ac- 
cording to  Michelson,  this  cartilage  has  a taste  function  on  its  pos- 
terior face,  which,  although  long  known,  has  not  been  proven  ex- 
perimentally until  quite  recently. 

Functional  Aphonia. — The  chief  advancement  of  recent  years 
with  reference  to  the  treatment  of  this  neurosis,  consists  in  the  cure 
by  hypnotic  suggestion.  This  method  has  been  found  very  effica- 
cious in  numerous  instances  in  which  other,  and  approved,  measures 
have  been  used  in  vain. 

Contraction  of  the  Transverse  Arytenoid  Muscle  and  Bi- 
lateral Paralysis  of  the  Posterior  Crico-Arytenoid  Muscles. — 
Ruault  and  others  have  endeavored  to  clear  up  many  cases  of  di- 
agnosis of  posterior  crico-arytenoid  paralysis  by  substituting  that  of 
contraction  of  the  transverse  arytenoid  muscle.  These  two  con- 
ditions are  claimed,  by  various  writers,  to  be  one  and  the  same,  and 
Krishaber  looked  upon  them  as  a unilateral  spasm  of  the  arytenoid 
muscle.  Mackenzie,  Seymour,  and  others  admit,  besides  paralysis 
of  the  abductors,  secondary  contraction  of  the  adductors  ; but  there 
is  a growing  tendency  to  look  upon  the  condition  in  many  cases  as 
u a primary  contraction  of  the  adductors  with,  in  certain  cases,  a 
secondary  myopathic  paralysis  of  the  abductors  and  atrophy  of 
these  muscles  consecutive  to  their  functional  inertia.”  (Jour,  of 
Lar.,  Rliin , and  Otol.,  August  1892.)  Ruault  (Maladies  du  Nez  et 
du  Larynx ),  in  discussing  abductor  paralysis  and  adductor  spasm, 
arrives  at  the  conclusion  that  it  is  most  probable  that  irritation  of 
one  recurrent  nerve,  such  as  is  produced  by  slight  compression,  in- 
duces spasm,  convulsions,  or  intermittent  tonic  contraction  of  the 
band,  lasting  for  a short  time,  rarely  more  than  a week ; that  these 
actions  may  disappear  with  their  cause  and  recur  and  disappear,  but 
if  the  pressure  continue,  it  very  rapidly  determines  a paralysis, 
limited  at  first  to  the  dilator  muscle ; and  if  the  pressure  be  from 
the  first  sufficiently  severe,  it  determines  sudden  paralysis,  either 
limited  at  first  to  the  dilator  or  immediately  generalized. 

Laryngeal  Phthisis. — While  cocaine  was  far  in  advance  of  the 
older  application,  morphine,  in  relieving  pain  and  enabling  the 
patient  to  swallow  comfortably,  where  this  act  was  exceedingly  pain- 
ful, that  which  will,  to  a great  extent,  supersede  both  of  the  pre- 


RECENT  PROGRESS  IN  RHINOLOGY  AND  LARYNGOLOGY.  989 


ceding,  at  the  same  time  proving  more  or  less  curative,  is  the  local 
use  of  Calendula  as  advised  by  Dr.  A.  C.  Peterson,  of  San  Fran- 
cisco. He  sprays  into  the  larynx  a watery  solution  of  1 to  20,  or 
weaker,  with  the  addition  of  two  or  three  drops  of  carbolic  acid  to 
the  ounce;  but  I have  had  better  results  from  a Petroleum  solu- 
tion (calenduaol)  as  manufactured  by  Clapp  and  by  Buffington. 

Cysts  of  the  Larynx. — Until  very  recently,  cystic  tumors  of 
this  organ  were  looked  upon  as  exceedingly  rare,  but  of  late  many 
cases  have  been  reported.  The  causes  of  these  cystic  formations  are 
various,  viz.,  retention  (Kantack),  atrophy,  excitation,  and  haemor- 
rhages. Schrotter  believes  that  they  are  of  the  same  origin  as  mili- 
ary vesicles,  and  many  cases  originate  from  neoplastic  growths.  It 
has  long  been  taught  that  cystic  tumors  of  the  larynx,  when  once 
ruptured  rarely  refilled;  but  it  is  now  well  known  that  the  contents 
may  reaccumulate  many  times  before  complete  destruction,  thus 
leading  to  the  treatment  by  cauterization  or  by  evulsion  of  a large 
portion  of  the  sac. 

Intubation. — Although  O’Dwyer’s  original  idea  seems  to  have 
been  to  use  intubation  for  the  purpose  of  relieving  acute  laryngeal 
stenosis,  especially  if  caused  by  membranous  deposits,  the  method 
has  been  carried  much  further,  making  it  valuable  not  only  to  such 
cases,  where  it  has  a reputation  equal  to  that  of  tracheotomy,  to  which 
it  is  vastly  superior  in  many  forms  of  chronic  stenosis,  especially 
when  of  a syphilitic  character,  or  when  complicated  bv  the  presence  of 
benign  growths.  One  of  the  objections  to  intubation  has  been  a diffi- 
culty in  introducing  the  tube,  owing  to  its  entrance  into  one  of  the  ven- 
tricles of  the  larynx,  thus  preventing  its  passage  through  the  glottis. 
To  the  inexperienced  this  has  sometimes  proved  an  insurmountable 
obstacle,  but  it  can  usually  be  overcome  by  rotation  of  the  introducing 
handle  from  right  to  left,  or  vice  versa , and  the  tilting  of  the  tip  of 
the  instrument  toward  the  opposite  side  of  the  larynx.  O’Dwyer,  in 
the  Annual  of  the  Universal  Medical  Sciences  for  1892  (to  which  pub- 
lication I am  indebted  for  many  valuable  suggestions  in  the  prep- 
aration of  this  review),  says : “ While  I have  often  had  the  progress 
of  the  tube  arrested  by  entering  one  of  the  ventricles,  I never  found 
any  great  difficulty  in  disengaging  it  by  rotating  the  introducer,  or 
otherwise  changing  the  direction,  until  a few  months  ago,  when  I was 
called  to  the  N.  Y.  Foundling  Asylum  to  intubate  an  infant  five 
months  old,  in  which  the  resident  physician  had  failed  after  many 


990 


world’s  homoeopathic  congress. 


trials.  After  four  careful  and  prolonged  attempts,  I was  about  to 
give  it  up  as  useless,  when  it  occurred  to  me  that  if  the  long  diameter 
of  the  tube  could  be  brought  across  the  long  diameter  of  the  chink, 
either  transversely  or  obliquely,  the  increased  size  in  this  direction 
would  prevent  it  from  engaging  in  the  ventricle.  This  was  accom- 
plished by  swinging  the  handle  of  the  introducer  well  around  in  the 
left  angle  of  the  mouth,  when  the  tube  slipped  in  without  difficulty. 
This  impediment  to  intubation  results  from  the  entering  portion,  of 
the  tube  being  too  small  instead  of  too  large,  and  the  remedy  consists 
in  increasing  the  size  of  the  distal  extremity  by  making  it  cylindrical 
instead  of  oval,  as  at  present  constructed.” 

This  manoeuvre  I have  sometimes  found  necessary  in  intubating, 
and  I believe  that  O’Dwyer’s  notice  of  it  will  not  only  render  the  op- 
eration easier  but  go  far  toward  making  possible  the  introduction  of 
the  tube  in  all  cases.  One  word  of  warning  is  here  necessary;  if 
much  force  be  exerted  when  the  tube  is  in  the  ventricle,  perforation 
will  occur,  and  the  tube  be  forced  down  between  the  cartilaginous 
and  soft  structures,  not  only  thwarting  the  object  of  the  intubation, 
but  occasioning  a greater  amount  of  dyspnoea,  even  after  the  tube 
has  been  withdrawn.  Maydl,  of  Vienna,  has  employed  intubation 
as  a means  of  obviating  the  entrance  of  fluid  into  the  respiratory 
organs  during  operations.  The  tube  is  connected  with  a drain,  to 
which  is  attached  a funnel.  The  pharynx  is  then  tamponed  with 
iodoform  gauze.  Through  the  funnel  the  patient  respires,  and  can 
be  narcotized.  He  says  that  in  this  manner  it  is  possible,  in  opera- 
tions upon  the  mouth  and  pharynx,  to  prevent  aspiration  of  blood 
and  wound  secretions,  and  even  glottic  spasms,  without  performing 
tracheotomy.  The  doctor  has  tried  his  method  in  several  cases  with 
good  results,  and  it  was  further  found  that  the  apparatus  could  re- 
main in  position  at  least  twenty  hours  without  harm. 

Phonetic  Roll  of  the  Trachea. — The  causes  of  the  great  va- 
riety in  the  pitch  of  various  voices,  especially  in  singing,  has  been 
the  occasion  of  many  theories ; some  basing  the  difference  upon  the 
length  of  the  trachea  or  the  vocal  bands,  and  the  various  resonant 
cavities  of  the  throat,  nose,  and  head,  including  the  accessory  sinuses. 
Dr.  Moura,  of  Paris  (Jour.  Lav .,  Bhin.,and  Otol. , April,  1893),  who 
made  a series  of  experiments,  claims  that  much  depends  upon  the 
relative  length  of  the  trachea  and  vocal  bands,  and  the  relative  di- 
ameter of  the  cricoid  cartilage  and  trachea,  together  with  the  con- 


RECENT  PROGRESS  IN  RHINOLOGY  AND  LARYNGOLOGY.  991 


stant  change  which  the  latter  undergoes  during  vocalization,  in  that 
its  diameter  is  altered  according  to  the  pitch  of  the  tone.  “ The  par- 
allelism of  anatomical  development  between  the  length  of  the  liga- 
mentary glottis  and  the  diameter  of  the  trachea,  and  the  diameter 
of  the  cricoid  is  very  often  defective.”  Thus,  in  two  similar  sub- 
jects, whose  vocal  ligaments  measured  9 mm.,  the  diameter  of  the 
trachea  was,  in  one  8 mm.,  and  in  the  other  14  mm.  The  voice  of 
the  first  cannot  have  the  same  tone  as  the  latter.  In  one,  the  voice 
must  be  heightened,  and  in  the  other  lowered.  The  inverse  of  this 
is  seen  in  the  vocal  ligament  of  2,  3,  and  4 mm.  longer  than  the 
calibre  of  the  trachea ; the  influence  of  the  tracheal  wave  is  to  raise 
the  glottic  tone. 

Foreign  Bodies  in  the  (Esophagus. — B.  Polikier,  of  Warsaw 
(Revue  Mensuele  des  Maladies  de  I’Enfance , January,  1891),  gives 
a very  simple  method  for  the  extraction  of  some  foreign  bodies 
from  the  oesophagus.  In  two  cases  where  the  body  could  not  be 
discovered,  either  by  laryngoscopy  or  by  the  ordinary  methods,  by 
placing  one  finger  in  the  space  between  the  trachea  and  sterno- 
cleido- mastoid  muscle  on  the  right  side,  and  pushing  upward,  he 
was  able  to  find  a little  elevation  below  the  cricoid  cartilage.  While 
with  one  hand  he  tickled  the  child’s  throat,  he  made  an  effort  of 
massage  with  the  other  by  pushing  the  body  upward  and  backward, 
when  in  a few  seconds  the  child,  in  each  instance,  vomited  a coin. 
The  conclusions  which  may  be  drawn  are  that,  notwithstanding  the 
deep  position  of  the  oesophagus,  it  is  often  possible  to  find  a foreign 
body  by  external  manipulation,  thus  making  this  simple  method 
worthy  of  trial,  rather  than,  as  is  usually  done,  force  the  body 
downward  into  the  stomach,  where  it  may  occasion  annoyance  or 
even  do  considerable  harm. 

Discussion. 

T.  C.  Duncan,  M.D. : The  subject  of  chronic  enlargement  of 
the  tonsils  is  one  that  gives  those  who  pay  special  attention  to  dis- 
eases of  children  a great  deal  of  trouble.  I have  had  the  best  of 
success.  If  we  have  an  acute  attack  of  tonsillitis,  the  recovery  or 
subsidence  of  the  chronic  enlargement  is  very  rapid. 

In  reference  to  hay  fever:  Some  years  ago  I gathered  all  the 
literature  of  all  the  cases  I possibly  could  upon  this  one  disease. 
I think  it  is  due  to  spinal  irritation.  The  remedy  that  has  been 
most  successful  in  warding  off  the  annual  attack  with  me  has  been 


992 


world’s  homoeopathic  congress. 


Iodide  of  arsenic,  beginning  early  in  the  summer  and  giving  it 
once  a day  for  two  or  three  days  and  then  skipping  and  com- 
mencing again.  In  these  cases  of  development  of  hay  fever  it  takes 
about  five  years  until  you  get  a fully  developed  attack  with  the 
nasal  and  asthmatic  symptoms  in  full.  I think  it  runs  about  fif- 
teen years,  and  then  the  patient  seems  to  get  to  that  condition  when 
it  becomes  less  and  less  distressing  every  year.  The  greatest  and 
best  remedy,  however,  is  a change  of  climate  for  these  people  who 
are  run  down  and  worn  out.  They  are  men  engaged  in  active 
business  and  they  need  a rest,  and  the  best  place  I know  of  to  send 
them  to  is  Lake  Superior  or  Ashland  or  to  points  about  there.  The 
relief  is  almost  immediate,  and  I think  it  is  due  to  the  uniform  tem- 
perature that  they  meet  with  in  that  region. 

In  our  Congress  of  Medical  Climatology  we  had  a report  of  a 
gentleman  who  was  cured  of  nasal  catarrh  by  a visit  to  old  Mexico. 
I believe  from  the  symptoms  of  his  case  that  his  trouble  was  at  the 
nerve  centers.  The  first  thing  he  did  when  he  got  there  was  to  take 
a bath,  and  then,  up  in  that  high  altitude  of  8000  feet,  he  was  above 
all  irritation,  and  the  disease  was  arrested.  Since  his  return  he  has 
not  had  a recurrence  of  the  trouble. 

W.  E.  Green,  M.D. : I have  cured  a good  many  cases  of  hay 
fever  by  treating  them  for  hypertrophy  of  the  turbinated  bones. 
The  hay  fever  will  disappear  rapidly  when  you  treat  it  thus.  The 
application  of  the  electro-cautery  to  the  mucous  membrane  will 
destroy  the  high  sensitive  condition  of  the  parts  and  cure  your 
cases.  My  experience  is  that  a large  number  of  cases  of  hay  fever 
are  curable  by  simply  removing  the  catarrhal  condition  that  exists 
here.  I find  that  almost  every  patient  who  is  subject  to  acute  at- 
tacks of  cold  in  the  head  that  gradually  passes  down  into  the  lungs 
are  relieved  in  that  way.  The  disposition  to  take  cold  is  removed 
by  curing  these  catarrhal  conditions  that  exist  in  a very  large  per- 
centage of  human  beings. 


NASAL  EPITHELIOMA. 


993 


NASAL  EPITHELIOMA. 

By  Wesley  A.  Dunn,  M.D.,  Chicago,  III. 


The  advances  made  in  nasal  studies  since  the  invention  of  the 
modern  instruments  of  examination  has  made  possible  the  diagnosis 
and  successful  treatment  of  many  serious  diseases  that  were  formerly 
considered  incurable.  This  is  especially  true  of  the  malignant  dis- 
eases of  the  nasal  cavities,  on  the  early  diagnosis  of  which  depends 
the  treatment  and  prognosis. 

The  consideration  and  symptoms  surrounding  a case  of  epithe- 
lioma of  the  nasal  cavity  is  not  materially  different  from  the  same 
disease  in  other  cavities  if  the  early  symptoms  be  not  obscured  by 
some  acute  trouble,  as  was  the  history  of  one  of  the  cases  I wish 
to  report. 

Mrs.  Mary  J.  appeared  at  my  clinic  in  April,  1892,  and  gave 
the  following  history  : She  was  50  years  of  age,  colored,  of  strong 
physique,  and  had  always  been  in  good  general  health  until  March, 
1891,  when  she  suffered  from  an  attack  of  la  grippe,  attended  by 
symptoms  of  cold  in  the  head  and  nasal  stenosis  and  codgh.  This 
attack  kept  her  in  bed  six  weeks,  and  was  followed  by  dropsy  of  the 
lower  limbs  for  three  months.  During  this  time  she  suffered  from 
great  pains  in  the  front  part  of  the  nose  and  head  from  time  to  time. 
In  February,  1892,  she  observed  a wart-like  growth  on  the  lower 
part  of  the  right  side  of  the  nasal  septum,  with  pain  in  and  about 
the  growth,  extending  into  the  side  of  her  head.  The  growth  in- 
creased rapidly,  and  caused  a copious  but  not  offensive  discharge. 
The  neighboring  lymphatic  glands  were  not  involved.  This  growth 
was  removed  by  some  solution  applied  by  her  attending  physician, 
but  in  a short  time  she  observed  a similar  growth  on  the  left  side  of 
the  septum.  This  was  treated  by  a snare  and  forceps,  but  without 
apparent  success. 

The  disease  rapidly  increased,  and  about  the  first  of  April  she  ap- 
plied at  my  clinic  for  treatment.  For  a month  past  the  discharge 

63 


994 


world’s  homoeopathic  congress. 


had  been  bloody  and  foetid,  with  extreme  pain  in  the  nose,  extending 
into  the  face  and  head. 

Her  general  health  was  somewhat  depressed,  yet  did  not  show  an 
extreme  degree  of  exhaustion.  The  appetite  and  digestion  were 
good.  No  history  of  cancer  or  tuberculosis  could  be  found,  and  no 
injury  to  the  nose  that  she  could  remember.  She  said  that  a few 
weeks  before,  about  the  time  the  discharge  became  foetid,  she  had 
pulled  away  a good-sized  mass  of  tissue  from  the  inside  of  her  nose, 
which  she  described  as  looking  like  flesh.  From  that  time  the  dis- 
charge was  excoriating,  bloody,  and  offensive.  An  examination 
showed  the  septum  to  be  a mass  of  ulceration  and  decomposition. 
The  mucous  membrane  of  the  septum  was  destroyed  as  far  back  as 
could  be  observed  by  anterior  inspection.  The  cartilage  had  become 
destroyed  and  was  crumbling  away.  The  tissues  of  the  turbinated 
bodies  were  swollen  but  not  ulcerated.  The  ulceration  did  not  in- 
clude the  fibro-cartilaginous  band  at  the  cutaneous  surface  of  the 
septum,  but  extended  high  into  the  nasal  cavities,  and  very  far  toward 
the  posterior  border  of  the  septum. 

A section  of  the  diseased  tissue  was  removed  and  referred  to  Prof. 
Howard  N.  Lyon,  who  submitted  it  to  microscopical  examination 
and  pronounced  it  a typical  epithelioma. 

As  treatment  promised  negative  results,  a radical  operation  was 
decided  upon  for  the  complete  extirpation,  if  possible,  of  the  malig- 
nant tissue. 

The  operation  was  performed  April  19, 1892,  by  following  Rouge’s 
method  of  dissecting  the  lip  and  infra-nasal  tissue  from  the  maxil- 
lary bone,  and  drawing  the  face  upward  until  the  whole  of  the  nasal 
cavity  was  exposed. 

The  growth  did  not  involve  the  cutaneous  rim  of  the  septum  ; 
therefore,  the  cartilage  and  mucous  membrane  was  removed  from 
this  portion  of  the  skin,  leaving  an  external  septum  dividing  the 
opening.  All  the  tissues  of  the  nose  were  removed  as  far  as  the 
posterior  nares,  the  septum,  the  middle  and  inferior  turbinated  bones, 
the  maxillary  crest,  etc.,  until  we  felt  perfectly  satisfied  that  every 
vestige  of  the  growth  was  removed. 

The  haemorrhage  was  controlled  by  hot  water  and  pressure  from 
time  to  time,  and  was  not  extreme,  yet  considerable  blood  was  lost. 
The  face  was  restored  to  its  normal  position  and  sutured  with  catgut 
to  the  maxillary  tissues.  The  cavity  was  packed  with  long  strips 


NASAL  EPITHELIOMA. 


995 


of  gauze  through  the  normal  nasal  openings.  The  patient  reacted 
well,  and  no  unfortunate  symptoms  appeared.  The  temperature  was 
at  no  time  above  100°,  and  she  suffered  but  little  pain. 

The  dressing  was  removed  every  second  day,  and  the  wound  thor- 
oughly disinfected.  There  was  considerable  depression  of  the  ex- 
ternal nose  from  want  of  support,  and  marked  tendency  to  close  up 
the  external  nasal  openings  by  a granulation,  which  was  avoided  by 
inserting  a small  canula. 

She  was  discharged  May  4th,  but  still  appears  at  the  clinic  from 
time  to  time  to  show  us  that  she  is  in  perfect  health. 

This  case  illustrates  the  possibility  of  sometimes  saving  the  life  of 
a patient  in  this  serious  disease  by  radical  measures  when  the  usual 
treatment  would  be  of  no  avail. 

I will  refer  to  a second  case  equally  as  fortunate: 

Mr.  S.  C.  S.,  Iowa,  applied  to  me  for  treatment  in  June,  1891,  for 
an  ulceration  of  the  eutano-mucus  margin  of  the  septum.  For  a 
number  of  months  past  an  ulceration  had  been  gradually  destroying 
the  lower  portion  of  the  nasal  septum,  and  had  at  this  time  involved 
about  three-fourths  of  an  inch  of  the  anterior  margin,  extending  into 
the  upper  lip  and  involving  the  tip  of  the  nose.  The  end  of  the  sep- 
tum was  wholly  destroyed  and  broken  away,  being  apparently  worse 
on  the  left  side. 

The  general  health  had  been  rapidly  depressed  to  such  a degree  of 
exhaustion  that  the  patient  was  overcome  by  the  slightest  exertion, 
fainting  away  from  a slight  examination,  or  from  a short  walk  or 
effort  of  any  kind.  He  had  been  formerly  in  good,  robust  health, 
having  been  a man  of  fine  physique. 

He  said,  that  while  he  had  never  suffered  an  injury  to  the  nose, 
that  about  six  years  before,  an  ulceration  had  occurred  at  this  part 
of  the  septum,  but  which  had  healed  after  a few  months,  and  that 
in  April,  1890,  he  had  observed  a Moody  discharge  from  the  nose 
attended  by  scabs,  but  without  odor.  The  scabs  were  quickly  re- 
formed after  being  exfoliated. 

In  January,  1891,  he  first  observed  actual  ulceration  to  have  taken 
place,  which  increased  rapidly,  and  spread  downward,  until  the 
middle  of  the  outside  of  the  nose  was  reached,  attended  by  ex- 
tremely excoriating  and  foetid  discharge,  which  grew  more  intense 
until  he  applied  for  treatment. 

The  pain  was  not  severe,  but  the  physical  weakness  and  cachexia 


996 


world’s  homoeopathic  congress. 


were  very  marked.  No  glandular  enlargement  was  found.  There 
was  no  history  of  tuberculosis  or  other  constitutional  diseases,  except 
in  the  grandmother  on  the  father’s  side,  who  had  died  of  cancer. 

A specimen  of  the  diseased  tissue  was  examined  microscopically 
by  Professor  Lyon,  who  pronounced  it  an  epithelioma. 

Believing  that  slighter  deformity  would  follow  treatment  in 
this  case  by  paste  than  by  surgical  means,  I decided  to  remove  it  by 
the  so-called  paste  treatment  in  preference  to  the  knife,  therefore  I 
applied  : 

R.  Zincum  chloridum,  gr.  xx. 

Hydrastis,  can.,  pulv.,  .......  gr.  xx. 

Albumen  (white  of  egg)  q.s., S. 

M’. — To  make  paste. 

This  paste  was  applied  twice  daily  for  about  a week,  being  held 
in  place  by  adhesive  plaster.  At  the  end  of  this  time,  elm  poultice 
was  applied  until  the  destroyed  tissue  came  away. 

Being  impressed  that  the  growth  was  not  entirely  removed,  the 
paste  was  again  applied  for  a-  few  days,  and  afterward  treated  by 
poultice.  When  the  tissue  had  all  been  removed,  application  of 
Mayer’s  ointment  caused  rapid  healing  of  the  wounded  surface. 

The  advantage  gained  by  this  method  of  cure  in  this  peculiar 
location  was  the  great  amount  of  tissue  restored  by  granulation  dur- 
ing the  healing  process;  much  more,  I am  sure,  than  would  have 
followed  an  operation  by  the  knife.  The  lip  was  completely  re- 
stored ; the  end  of  the  nose  filled  in  until  only  a small  notch  was 
left  at  the  tip  of  the  nose*  and  the  lower  end  of  the  septum. 

A photograph  taken  a few  months  ago  shows  but  a moderate 
amount  of  deformity  remaining.  A recent  letter  informs  me  that  for 
a year  or  so  the  nose  was  very  tender,  especially  to  cold  air,  but  now 
it  is  quite  hardy  and  of  natural  color.  His  general  health  has  been 
perfect  since  the  operation. 

The  treatment  of  epithelioma  of  the  nose  has  not  been  very  satis- 
factory, and  but  few  cases  have  been  reported  as  cured,  and  while  I 
am  not  positive  that  these  cases  will  not  yet  have  recurrence,  I do 
feel  that  the  results  already  obtained  have  justified  the  operation.  I 
believe  it  to  be  unwise  to  attempt  anything  other  than  radical  treat- 
ment in  such  cases.  I believe  it  is  useless  to  attempt  operation  on 
malignant  growths  within  the  nose  without  opening  the  nasal  cavity 


NASAL  EPITHELIOMA. 


997 


and  I believe  that  the  method  pursued  in  the  first  operation  is  the 
most  practical  and  complete.  It  gives  free  and  roomy  space  in  the 
nasal  cavity  without  danger  of  marring  the  contour  of  the  face  or  of 
disfiguring  the  surface,  and  is  practically  devoid  of  danger. 

I do  not  believe  it  possible  to  remove  such  growths  with  a snare 
or  forceps  with  a degree  of  certainty  necessary  in  such  cases.  The 
electro-cautery  I believe  to  be  insufficient  and  harmful  in  such  cases, 
as  so  little  tissue  can  be  destroyed  at  a single  sitting,  and  the  appli- 
cation repeated  so  seldom,  and  the  treatment  followed  by  so  much 
inflammation  and  proliferation  of  new  tissue,  that  the  treatment  is 
dangerous  and  uncertain. 

The  treatment  by  paste,  where  it  can  be  properly  applied,  is  very 
satisfactory,  because  it  is  not  so  excessive  as  to  produce  violent  in- 
flammation, and  is  continuous  in  its  action  until  the  growth  is  re- 
moved. It  is  not  applicable,  however,  to  the  majority  of  cases  in  the 
nose,  because  of  their  deep  origin  in  the  nasal  cavities. 

While  I have  been  informed  of  many  successful  cases  of  malig- 
nant diseases  cured  by  properly  selected  remedies,  I have  not  had 
the  courage  to  try  medical  treatment  in  such  cases,  knowing  that 
such  a short  time  would  carry  the  case  beyond  the  limit  of  operative 
interference,  and  fearing  the  power  of  remedies  to  restore  the  parts 
in  so  short  a time  and  eliminate  such  destructive  cell  formation  from 
the  nose,  I have  resorted  at  once  to  the  surgical  treatment,  and  fol- 
lowed it  by  such  constitutional  remedies  as  seem  indicated  by  the 
circumstances  of  the  case. 


Discussion. 

H.  F.  Ivins,  M.D. : Dr.  Dunn  is  to  be  congratulated  upon  such 
happy  results  in  the  two  cases  reported,  since  nearly  always  little 
more  than  temporary  relief  is  obtained,  and  not  infrequently  the 
fatal  termination  is  apparently  accelerated  by  radical  measures. 

In  the  first  case,  the  progress  of  the  disease  was  so  extensive  as  to 
make  it  appear  impossible  to  relieve  by  other  than  such  treatment; 
yet  it  must  not  be  forgotten  that  internal  remedies  have  done  nobly 
in  many  instances,  and  local  treatment  frequently  deserves  credit. 
The  internal  remedy  which  would  seem  most  clearly  indicated  in 
the  first  case  is  Hydrastis  can.,  although  Ars.  might  have  controlled 
most  of  the  symptoms.  As  the  doctor  aptly  remarks,  however, 
delay  was  dangerous,  and  the  results  in  the  case  up  to  the  time  of 
reporting  could  scarcely  have  been  better  from  any  mode  of  treat- 
ment. 


/ 


998  world’s  homoeopathic  congress. 

My  thoughts  naturally  turn  to  the  internal  and  local  use  of 
Calendula  in  this  form  of  cancer,  as  I have  seen  it  act  almost  mar- 
vellously in  some  instances. 

In  this  case  it  seems  very  evident  that  the  snare  and  galvano-cautery 
were  entirely  out  of  place,  and  even  the  curette  scarcely  offered  hope 
of  more  than  temporary  alleviation. 

In  the  second  case,  I should  have  been  led  to  a trial  of  Chininum 
ars.  in  2x  or  3x  trituration.  The  unusually  great  amount  of  granu- 
lation tissue  following  the  use  of  the  paste,  with  the  resultant  slight 
deformity  must  have  been  gratifying  alike  to  the  operator  and  to  the 
patient. 

I would  suggest  that  at  a future  time,  viz.,  at  the  expiration  of 
the  three  years’  grace  usually  allowed  for  cancerous  growths,  the  doc- 
tor make  a final  report  of  these  cases. 

W.  R.  King,  M.D. : I don’t  know  why  I was  selected  to  discuss 
this  paper  unless  it  was  because  I have  seen  so  few  cases.  In  my 
experience  of  twelve  years  I have  seen  but  two  cases  of  undoubted 
epithelioma  of  the  nasal  passage.  One  of  these  remained  under  mv 
control  for  but  a limited  time,  and  I cannot  say  anything  with 
reference  to  it.  Dr.  Dunn’s  paper  has  in  it  very  little  to  discuss. 
It  is  a description  of  his  method  of  treatment  in  two  cases  of  epi- 
thelioma, but  the  description  of  his  first  case  was  very  interesting 
to  me.  In  that  case,  where  the  development  of  the  growth  was  so 
great  that  it  had  penetrated  to  the  deeper  structures  of  the  nasal 
cavities,  it  was  evident  that  there  was  nothing  else  to  be  done  to 
save  the  patient’s  life  but  the  operation  he  performed.  That  the 
disease  may  return,  is  possible,  of  course;  but  that  the  woman’s  life 
has  been  prolonged,  is  a decided  advance.  The  second  case  treated 
by  myself  was  by  the  paste  method.  As  I understand  Dr.  Dunn’s 
case,  the  disease  had  not  reached  the  deeper  structures  of  the  nasal 
cavity ; so  of  course  we  would  have  less  deformity  and  a better  ex- 
ternal nose. 

I most  heartily  approve  of  the  galvano-cautery.  I believe  it 
will  be  absolutely  harmful  in  cases  of  malignant  epithelioma  of  the 
nasal  passages.  The  proliferation  of  tissue  that  follows  the  appli- 
cation, where  it  is  done  sufficiently  frequently  and  thoroughly  to 
remove  the  diseased  mass,  is  a dangerous  elemeut,  and  you  are  apt 
to  produce  more  active  cell  infiltration,  and,  of  course,  constitutional 
development  with  it.  The  possibility  of  curetting  has  been  spoken 
of  by  the  doctor.  In  the  early  stages  of  the  disease  we  are  not 
always  looking  for  epithelioma  where  we  have  an  inflammatory 
process  in  the  internal  passages;  and  it  is  often  not  until  the  later 
stages,  and  after  the  foetid  nature  of  the  discharge  becomes  marked 
and  the  cachexia  becomes  apparent,  that  the  diagnosis  is  made  by 
tneans  of  the  microscope,  when  it  is  usually  too  late,  I think,  to 
apply  the  curette  or  snare. 


MALIGNANT  GROWTHS  IN  THE  LARYNX. 


999 


MALIGNANT  GROWTHS  IN  THE  LARYNX. 

By  H.  F.  Fisher,  M.D.,  Nashville,  Tenn. 


These  are  comparatively  rare,  and  the  literature  upon  the  subject 
so  limited,  that  a report  of  every  case  is  justified.  Although  the 
treatment  in  this  case  did  not  prevent  death,  it  proved  palliative,  and 
being  one  of  the  few  cases  treated  with  Homoeopathic  remedies  should 
be  of  interest  to  us.  This,  therefore,  is  the  only  apology  I have  to 
make  for  encroaching  upon  the  time  of  this  body. 

Cancer  of  the  Larynx  was  brought  prominently  before  the  pub- 
lic a few  years  since  by  the  sufferings  and  death  of  General  Grant, 
of  America,  and  Emperor  Frederick  III.,  of  Germany.  These  cases 
received  a great  deal  of  attention  at  the  hands  of  skilled  specialists 
in  all  countries. 

These  malignant  growths  are  divided  into  two  classes : Sarcomata 
and  carcinomata  (epitheliomata  being  classed  with  the  latter),  but  it 
requires  microscopic  examination  to  determine  the  difference ; and  as 
the  methods  of  treatment  are  essentially  the  same,  the  distinction  for 
other  than  pathological  research  is  unnecessary. 

Statistics. — Fauvel  found  7 sarcomata  in  300  cases  of  laryngeal 
growths;  Gurlt  found  1 case  of  laryngeal  sarcomata  in  848  cases  of 
this  morbid  growth  in  the  body.  Bosworth,  on  page  743  of  his  ex- 
cellent work,  states,  “ I find  recorded  in  medical  literature  47  cases 
of  laryngeal  sarcomata/’  and  admits  that  in  his  extensive  practice 
he  has  had  only  1 case.  Gurlt  in  11,131  cases  of  carcinomatous 
growths  found  63  in  the  larynx;  Lebert  found  3 cases  in  9118; 
Baker  found  3 in  500;  and  Winnerwarter  1 in  548  cases.  Mack- 
enzie, London’s  famous  specialist,  saw  53  cases  of  carcinoma  of  the 
larynx;  hence,  it  is  readily  seen  that  carcinoma  is  nearly  six  times 
as  frequent  as  sarcoma. 

I present  herewith  a report  of  the  case  which  came  under  my 
treatment  for  your  consideration. 

Case. — Rev.  C , set.  52,  presiding  elder  : Light  hair  and  com- 


1000 


world’s  homceopathic  congress. 


plexion,  blue  eyes,  5 feet  5 inches  in  height,  weight  normally  130 
now  122  pounds,  consulted  me  September  18,  1890,  for  throat 
trouble,  stating  that  he  feared  he  would  be  compelled  to  leave  the 
ministry  on  account  of  his  voice  failing.  He  had  been  examined  by 
prominent  specialists,  in  St.  Louis,  Fort  Worth,  and  Waxahachie — 
two  diagnosing  laryngeal  tuberculosis,  and  one  chronic  catarrhal 
laryngitis. 

History. — My  throat  has  been  troubling  me  for  nine  mouths,  at 
which  time  I found  it  difficult  to  preach  my  usual  time,  and  after 
exertion,  difficulty  in  breathing.  Seven  months  ago,  had  La  Grippe , 
since  which  the  trouble  has  developed  more  rapidly  ; now,  get  out 
of  breath  easily ; have  to  exert  myself  a great  deal  to  preach  ; have 
a burning,  sticking  pain,  as  if  caused  by  a splinter,  extending  from 
the  throat  to  the  right  ear,  when  swallowing;  hoarseness,  voice  fails 
me  when  preaching;  cold  air  in  the  throat  or  on  the  neck  produces 
cough;  swallowing  difficult;  liquids  especially  go  the  wrong  way 
and  regurgitate  through  the  nose;  pain  when  swallowing  like  rub- 
bing two  rough  surfaces  together ; at  times,  a little  itching;  hurting 
pain  in  throat  ushers  in  a spell  of  coughing,  terminating  in  vomit- 
ing which  produces  intense  pain  ; voice  rough  and  hoarse;  cough  a 
great  deal,  raising  a frothy  white  or  clear-starch  like  mucus;  expec- 
toration profuse;  occasionally,  quite  nervous;  when  talking  of  deli- 
cate subjects,  become  almost  uncontrollable;  five  years  ago  had  a 
nervous  attack  in  the  pulpit,  from  which  I am  entirely  recovered. 
General  health  ahvays  excellent;  weight  has  diminished  some  re- 
cently in  spite  of  good  appetite;  bowels  regular,  stool  and  urine 
normal ; no  particular  thirst,  nor  desire  for  special  articles  of  food  ; 
skin  normal  ; cheerful  temperament.  Smoke  three  to  five  cigars 
a day ; never  use  a pipe  nor  chew ; do  not  use  liquors  or  narcotics ; 
am  afraid  it  is,  or  will  result  in,  cancer.  No  history  of  tuberculosis, 
syphilis,  or  cancer  obtainable. 

Examination  of  the  nose  reveals  a chronic  catarrhal  condition  ; 
both  inferior  and  middle  turbinates  hypertrophied,  especially  in  the 
left  nostril;  slightly  parted  lips,  indicating  some  mouth-breathing: 
tongue  slightly  coated  white  anteriorly,  but  heavily  posteriorly ; 
breath  not  offensive;  gums  normal;  teeth  in  good  condition;  uvula 
elongated,  pointed,  and  flat  anteriorly;  much  congestion  of  a violet- 
red  color  in  the  pharynx  and  naso-larynx;  pharynx  very  sensitive; 
laryngoscopic  and  rhinoscopic  examination,  completed  uuder  cocaine, 


MALIGNANT  GROWTHS  IN  THE  LARYNX 


1001 


but  even  then,  the  gagging  continued  so  that  examination  was  not 
satisfactory  ; the  following  conditions,  however,  were  noted  : Larynx 
congested  ; vocal  cords,  especially  the  right,  hypersemic  and  soggy  ; 
glottis  and  epiglottis  less  mobile  than  normal ; right  ventricle  con- 
gested, and  apparently  on  a higher  plane  than  the  left;  this  conges- 
tion extending  up  the  glottis  and  epiglottis;  pain  intense  when 
gagging ; vocal  cords  straight  and  smooth,  having  no  gnawed  ap- 
pearance as  in  tuberculosis;  temperature  normal;  pulse  76.  The 
appearance  of  the  pharynx,  nasopharynx,  and  larynx,  resembled  an 
acute  exacerbation  of  chronic  catarrhal  laryngitis,  and  having  re- 
cently been  exposed,  in  damp,  cool  weather,  sleeping  in  strange  beds 
with  inadequate  covering,  it  was  rather  difficult  to  make  a clear 
diagnosis.  Bosworth,  page  753,  says:  “ There  is  nothing  in  the 
gross  appearances  of  carcinoma,  in  its  earlier  stages,  which  renders 
it  possible  to  make  an  absolute  definite  diagnosis. 

It  is  to  be  borne  in  mind,  that  the  disease  consists  essentially  in 
cell  infiltration,  which  burrows  into  surrounding  parts.”  Expecto- 
ration of  a clear-starch,  lumpy  character,  which  was  raised  with  little 
effort,  some  ptyalism  of  a stringy,  tenacious  character.  The  burn- 
ing sticking  pain,  extending  into  the  ear  was  the  most  persistent 
symptom;  no  thirst  nor  restlessness;  “sleep  as  calmly  and  peace- 
fully as  an  infant.”  Face  very  slightly  flushed,  eyes  bright,  and 
pupils  dilated  slightly. 

Treatment . — With  this  picture  of  the  case  before  me,  the  first 
recipe  was  Belladonna  and  Kali  bichr.,  two  hours  apart;  cleansed  the 
nasal  cavities,  pharynx,  and  larynx  with  spray  solution. 

R.  Sulpho-carbolate  of  soda,  drachm  i. 

Aqua, quart  i. 

M.  Sig. — Use  two  ounces  as  spray  for  cleansing. 

After  using  this  solution,  applied  oil ; spray. 


R.  Eucalvptol  (Sanders), gtts.  x. 

Terebene,  .........  gtts.  x. 

Menthol, grains  viii. 

Albolene, ounce  ii. 


M.  Sig.— Use  after  aqueous  solution,  q.s.,  to  protect  the  parts. 

Next  day,  against  my  earnest  protest,  he  attended  a camp-meeting, 
and  got  thoroughly  chilled  and  wet  while  there.  In  spite  of  this  he 


1002 


world’s  homoeopathic  congress. 


reported  better  on  the  next  visit,  five  days  later.  The  burning,  stick- 
ing pain  was  still  troublesome,  and  the  throat  remaining  decidedly 
congested,  continued  Belladonna  and  substituted  Merc,  biniodide 
3x  for  Kali  bichr. ; used  same  sprays  as  before.  Two  days  later  he 
went  to  fill  another  appointment,  and  on  September  27th  I sent  per 
mail  Belladonna  and  Argentum  met.  4x,  the  latter  for  the  voice, 
which  cracked  easily.  Eight  days  later  he  wrote  for  more  medi- 
cine, complaining  that  the  burning  pain  resembled  that  produced  by 
red  pepper.  • ^ 

3^.  Belladonna  and  Capsicum;  but  on  October  10th,  on  exami- 
nation of  the  throat,  again  prescribed  Belladonna  and  Argentum 
met.,  using  spray  as  before.  He  stated  : “ Those  little  pills”  (Bella- 
donna) “give  me  more  relief  than  anything  else  so  far.”  On  Octo- 
ber 14th,  having  been  exposed  in  cold,  wet  weather,  and  complaining 
of  cold  and  rheumatism,  gave  Rhus  tox.  3x,  continuing  this  remedy 
until  November  5th,  with  the  addition  of  Kali  bichromic.  the  first 
week  for  the  expectoration  and  Argentum  nitric,  for  the  pain  the 
remainder  of  the  time.  On  this  last  date  discontinued  everything 
but  Argentum  nitric,  and  the  sprays,  he  having  reported  that  the 
cold  and  rheumatism  had  disappeared,  and  the  burning,  .sticking 
pain  was  much  relieved.  November  22d  he  again  reported  improve- 
ment in  the  pain;  said  the  expectoration  had  again  become  lumpy, 
clear-starch  like,  tenacious,  irritating,  and  difficult  to  raise;  no  blood 
nor  pus  streaks  in  sputa ; voice  weaker.  1^.  Naphthalin  and  Ar- 
gentum met. 

November  26th  reports  the  cough  no  better;  more  hoarseness; 
great  difficulty  in  talking;  scraping  in  the  throat,  with  the  burning, 
sticking  pain  more  prominent.  I^.  Merc.  jod.  cum  Kali  jod.  and 
Argentum  nit.  December  11th  reports  better,  except  the  pain  and 
general  weakness.  Up  to  this  date  he  had  lost  thirteen  pounds, 
although  the  appetite  was  good  ; continued  Argentum  nitric.  He 
left  next  day  for  Corpus  Christi  to  try  change  of  climate,  all  the 
while  using  the  Argentum  nitricum  four  times  daily.  While  in 
Corpus  Christi  he  “ lived  on  oysters,  fish,  and  the  best  obtainable,” 
gained  three  pounds  the  first  two  weeks,  but  lost  four  the  remainder  of 
his  stay,  returning  home  February  11,  1891.  From  this  date  I 
visited  him  at  his  residence  almost  daily  until  the  middle  of  April. 
He  looks  fatigued,  wearied,  disheartened,  and  has  abandoned  all 
hope  of  recovery,  refusing  absolutely  any  operative  interference.  Is 


MALIGNANT  GROWTHS  IN  THE  LARYNX. 


1003 


very  weak ; voice  almost  lost ; some  dyspnoea  upon  exertion  ; 
drowsy;  rests  well  and  appetite  good,  but  afraid  to  eat  on  account 
of  the  intense  pain  when  swallowing;  pharynx  and  larynx  congested 
and  angry  looking;  right  side  of  epiglottis  and  glottis,  right  ven- 
tricle, and  vocal  cord  congested,  swollen,  nodular,  and  nearly  immo* 
bile;  the  point  on  the  glottis  beginning  to  ulcerate  freely;  the  left 
side  of  the  epiglottis  and  glottis  infiltrated,  smooth,  bright  red,  the 
infiltration  resembling  oedema;  no  tendency  to  dyspnoea,  except 
when  exerting  himself ; cervical  glands  enlarged;  larynx  extremely 
sensitive  to  external  pressure;  profuse  expectoration  of  greenish- 
yellow,  pus-streaked  saliva,  with  a foetid,  sweetish  odor,  difficult  to 
raise.  1^.  Stannum  met.,  and  Phosphorus,  and 

R.  Sodium  biboratis  (borax), drachm  i. 

Aqua,  ....  ......  quart  i. 

M.  Sig. — Spray  larynx  to  cleanse  thoroughly. 

Then  apply  : 

R.  Cocaine, 

Aqua, 

M.  Sig. — Apply  to  larynx  before  eating. 

This  gave  great  comfort.  Zinc  sulphate,  grs.  ii. ; Argen.  nitric., 
grs.  iv. ; Carbolic  acid,  gtts.  iii. ; Sodium  chloride,  grs.  v. ; et  aqua, 
oz.  i.,  were  more  irritating  than  the  above  recipe  for  spraying  ; hence, 
continued  its  use.  Continued  Stannum  and  Phosphorus  one  week, 
then,  on  account  of  the  livid  color  of  the  throat  and  slight  nasal 
haemorrhage,  with  constant  picking  at  the  nose,  gave  Arum  triphil, 
one  day.  February  20th  the  recipe  was  Hepar  sulphur  and  Kreo- 
sotum  for  the  entire  condition.  February  23d,  began  local  applica- 
tions of  Iodoform,  after  spraying  first  in  Ether,  which  caused  much 
irritation,  and  subsequently  applying  the  powder  with  the  brush 
directly  to  the  parts.  Afterwards  used  charcoal  and  sulphur  tritu- 
rated together,  which  seemed  less  irritating  and  more  effective. 
These  applications  were  continued  ’until  death  relieved  him.  March 
12th  the  recipe  was  Alumina,  for  very  obstinate  constipation,  and 
Nitric  acid  for  the  pain.  The  latter  seemed  to  aggravate.  Argen- 
tum nitric,  was  substituted  on  the  14th,  and  continued  until  April 
29th,  he  having  gone  from  the  city  to  attend  to  important  business. 
April  29th,  1^.  Hepar  sulphur.  He  was  now  very  weak ; unable 


. grains  x. 
. ounce  ii. 


1004 


world’s  homceopathic  congress. 


to  leave  the  bed ; bowels  loose,  but  controllable ; voice  lost ; cancer- 
ous, cachectic  look ; skin  dry,  hot,  harsh ; face  haggard ; aged  per- 
ceptibly and  demise  predicted  early.  Gave  Aconite  for  fever,  Na- 
trum  mur.  for  chilly  sensation  about  10.30  a.m.,  and  Arseni- 
cum. On  May  18th,  1^.  Digitalis  and  Ammonium  for  weakened 
heart  action. 

Result. — Death  from  exhaustion,  May  21st,  at  2.30  p.m. 

Remarks. — My  records  do  not  show  that  Arsenicum  was  given 
before  May  13th,  but  I am  firmly  under  the  impression  that  it  was 
tried  early  and  no  record  made.  My  impression  is  that  it  aggravated 
and  was  discontinued.  However,  if  Arsenicum  was  not  used,  it 
should  have  been  given  a trial. 

About  February  15th  he  coughed  up  a piece  of  cotton-wood  tooth- 
pick about  three-sixteenths  of  an  inch  long.  He  and  the  family 
assert  that  he  had  not  been  using  that  kind  of  a toothpick  for  over 
a year,  and  he  firmly  believed  it  had  something  to  do  with  his 
malady. 

I do  not  ascribe  the  trouble  to  this  cause,  for  upon  microscopic 
examination  the  wood  did  not  show  any  signs  of  having  been  im- 
bedded in  tissue,  which  would  have  been  the  case  had  it  re- 
mained there  for  over  a month.  In  March  he  had  the  sputa  ex- 
amined microscopically  for  tuberculosis,  desiring  to  test  the  Koch 
treatment  if  tubercular  bacilli  were  present.  Careful  examination 
by  a competent  microscopist  gave  negative  results.  This  same  gen- 
tleman was  requested  to  examine  a second  time  for  carcinoma  or 
sarcoma,  but,  being  called  away,  failed  to  do  so. 

Owing  to  the  unintentional  oversight  of  a son,  I failed  to  receive 
a message  from  my  patient,  stating  that  I could  have  his  larynx  after 
his  death  for  examination  ; the  message  was  delivered  after  corpse 
was  dressed  for  burial,  and  in  deference  to  the  family  gave  up  my 
fond  hope  of  an  examination  of  it  post-mortem. 

Diet. — Milk,  buttermilk,  cream,  ice-cream,  custards  without  sugar, 
raw  eggs,  oysters,  broths,  and  easily  digested  foods  were  taken  with 
relish  ; these  articles  were  more  easily  swallowed  if  very  cold ; 
cracked  ice  was  used  to  quench  thirst. 

Indications  for  the  Remedies. 

Aconite. — Face  flushes  up  when  rising  from  incumbent  position  ; 
dryness  in  the  mouth  ; thirst;  burning,  constriction  in  the  larynx  ; 


MALIGNANT  GROWTHS  IN  THE  LARYNX. 


1005 


soft  palate,  uvula,  fauces  and  pharynx  dark-red;  weak  voice;  skin 
hot,  dry ; face  hot  and  flushed  ; feverish  ; pulse  quick  and  hard. 
(Given  only  a few  days  before  death). 

Alumina. — Rectum  inactive ; soft  stool  requires  much  straining  ; 
stools  hard,  like  sheep’s  dung  : scanty  ; larynx  more  troublesome 
'when  constipated.  (Relief  after  a few  doses). 

Ammonium  Curb. — Accumulation  of  mucus  in  the  larynx;  great 
oppression  in  breathing;  palpitation  of  the  heart;  feels  as  if  dying  ; 
pulse  small  and  quick.  (Given  with  Digitalis  to  relieve  the  dysp- 
noea and  stimulate  the  heart’s  action). 

Argentum  Met. — Neck  stiff*,  swallowing  difficult;  sticky,  tough 
saliva  ; viscid,  gray,  jelly-like  mucus  easily  hawked  up  ; throat  feels 
raw  and  sore  when  coughing ; hoarseness  of  professional  speakers ; 
a dull  cutting,  which  becomes  a stitch,  causing  fits  of  coughing; 
easy  expectoration  of  white,  thick  mucus  like  boiled  starch.  (Used 
this  remedy  in  the  beginning  and  subsequently,  but  seemed  to  get 
no  results). 

Argentum  Nitric. — Sickly  appearance;  white  tongue;  pytalism ; 
tenacious  mucus  in  the  throat,  causing  hawking;  soreness;  sensation 
as  if  a splinter  were  lodged  in  the  throat  when  swallowing  or  moving 
the  neck  ; uvula  and  fauces  dark-red  ; burning  in  the  throat.  (This 
remedy  seemed  to  give  most  relief  of  the  burning,  sticking  pain  in 
the  larynx). 

Arsenicum. — Great  emaciation ; restlessness  and  anxiety;  weak- 
ness and  prostration. 

Arum  Triphil. — Congestion;  soreness;  dryness;  burning  pains 
and  ulceration  in  the  throat ; constant  picking  of  the  nose.  (Given 
one  day  only  and  with  relief  of  the  nasal  symptoms). 

Belladonna. — Eyes  sparkling;  pupils  dilated;  swallowing  diffi- 
cult; pain  extending  from  the  throat  into  the  ear;  congestion  of  the 
pharynx  and  larynx  ; pain  in  the  throat  comes  and  goes  suddenly ; 
great  inclination  to  sleep  ; aggravation  from  draft  of  air  and  in 
changeable  weather.  (For  a time  gave  considerable  relief  to  the 
pain  and  other  symptoms). 

Capsicum. — Burning  in  the  throat  as  if  from  red  pepper. 

Digitalis. — Heart’s  action  feeble;  irregular;  pulse  very  slow. 

Hepar  Sulphur. — Sticking  in  the  throat  extending  to  the  ear, 
worse  on  swallowing;  sensation  as  if  a splinter  was  in  the  throat; 
suppuration  in  the  larynx;  weakness  of  the  larynx,  cannot  speak 


1006 


world’s  homoeopathic  congress. 


aloud ; cough  caused  by  cold  air  in  the  throat.  (This  remedy,  with 
Kreosotum,  gave  considerable  relief  to  the  pain  and  seemed  to  con- 
trol suppuration  to  some  extent). 

Kali  Bichromic. — Hoarseness;  accumulation  of  tough,  stringy 
mucus  in  the  larynx;  expectoration  stringy;  tissues  in  the  throat 
dark-red  and  livid.  (Loosens  the  mucus  and  assists  expectoration). 

Kreosotum. — Paleface;  tongue  coated  white;  putrid  odor  from 
the  mouth  ; roughness  of  the  throat ; hoarseness  ; shortness  of  breath ; 
sticking  in  the  larynx.  (Seemed  to  work  in  conjunction  with  Hepar 
to  control  pain  and  suppuration). 

Mercurius  Binoid. — Much  phlegm  in  the  throat;  congestion  of 
the  tissues  in  the  throat.  (Always  given  in  conjunction  with  Bella- 
donna). 

Mercurius  Jod.  Cum.  Kali  Jod. — For  the  cough  that  would  not 
yield  to  Argentum  met.  (A  failure). 

Naphthalin. — For  the  clear,  starch-like  mucus  difficult  to  raise. 
(This  remedy  acted  well  in  freeing  the  mucus). 

Nitric  Acid. — Suspecting  specific  taint  and  for  the  burning,  stick- 
ing pain  ; sallow  complexion  ; purulent  expectoration.  (Aggrava- 
tion caused  by  the  3x  in  water). 

Phosphorus. — Expectoration  of  yellowish-white  mucus,  difficult 
to  detach.  Cough  causing  much  pain;  non-assimilation  increased; 
salty  saliva. 

Rhus  Tox. — Cold  taken  in  damp,  cold  weather;  rheumatism  worse 
left  side,  “ can  predict  storm  several  days  ahead  of  time;”  worse  in 
bad  weather. 

Stannum  Met. — Efforts  to  expel  mucus  in  throat  causes  vomiting; 
hoarseness;  ulceration  in  right  side  of  throat ; roughness  in  larynx  ; 
scraping  cough  with  greenish-yellow  expectoration  ; extreme  weak- 
ness and  prostration  ; must  sit  or  lie  down  continually. 

Discussion. 

W.  A.  Dunn,  M.D. : I have  not  treated  a case  of  cancer  of  the 
larynx  proper,  but  I had  a case  of  epithelioma  of  the  laryngo-pha- 
rynx  situated  on  the  posterior  wall  of  the  pharynx  immediately  be- 
hind the  larynx.  It  was  about  the  size  of  my  thumb  or  larger,  and 
oblong,  perhaps  an  inch  and  a half.  It  extended  from  the  base  of 
the  tongue  when  depressed  to  below  the  junction  of  the  larynx  with 
the  oesophagus.  The  patient  was  an  old  lady  and  quite  reduced.  I 
undertook  to  remove  the  growth  by  the  electro-cautery  snare,  and 


TREATMENT  OF  CONSTRICTION  OF  (ESOPHAGUS.  1007 


removed  it  very  successfully,  apparently.  The  surface  was  perfectly 
smooth,  and  I sent  her  home.  She  came  back  in  about  two  weeks, 
with  the  growth  as  big  as  ever,  and  I removed  it  again.  It  re- 
turned very  slowly  that  time.  I kept  her  in  the  hospital,  and  con- 
tinued the  cauterization  every  two  or  three  days  from  time  to  time, 
usually  twice  a week,  and  succeeded  in  removing  most  of  it.  I do 
not  remember  the  number  of  operations,  but  I thought  once  she 
would  bleed  to  death.  She  had  a haemorrhage  in  the  night,  coming 
on  about  six  hours  after  the  cauterization.  She  rallied  from  it,  how- 
ever, and  got  along  very  well,  but  finally  took  la  grippe  very  badly, 
and  died.  The  results,  as  far  as  I went,  were  satisfactory,  but  what 
they  would  have  been  eventually  I do  not  know. 

A tailor  in  this  city,  a good  friend  of  mine,  was  taking  treatment 
by  cautery.  He  suffered  from  a very  profuse  discharge,  and  had 
had  nasal  polypi  and  irritation  in  the  nose  for  many  years.  I had 
removed  the  polypi  and  the  hypertrophied  tissue  at  the  posterior  end 
of  the  nasal  passage,  but  the  discharge  continued.  He  had  enlarged 
lingual  tonsils.  I operated  on  the  left  side  with  the  electro-cautery, 
and  it  healed  up  nicely.  Then  I operated  on  the  right  side,  hoping 
to  relieve  this  continual  irritation  which  gave  him  so  much  annoy- 
ance in  his  throat  and  nose.  The  right  side  did  not  heal  up  kindly. 
Afterwards  a little  projection,  the  size  of  a dime,  that  caught  my 
eye,  looked  suspicious.  His  tongue  had  never  shown  any  symptoms 
of  malignant  disease  before.  When  he  came  in  again  I took  a piece 
for  the  microscope,  and  had  it  examined  by  Prof.  Lyon,  and  he  at 
once  pronounced  it  epithelioma.  I consulted  with  Dr.  George  A. 
Hall,  who  was  then  alive,  in  regard  to  it,  and  he  was  of  the  same 
opinion.  We  immediately  operated  on  him,  Dr.  Hall  assisting  me, 
and  we  removed  the  whole  base  of  the  tongue  by  an  elliptical  inci- 
sion. We  first  performed  tracheotomy,  and  with  a pair  of  little 
curved  uterine  Emmett’s  knives,  which  curve  in  different  directions, 
we  were  able  to  dissect,  with  the  aid  of  that  and  my  finger  and  the 
head  mirror.  We  dissected  out  a mass  about  an  inch  and  a half 
transversely  and  as  far  forward  as  the  anterior  third  of  the  tongue. 
We  were  not  able  to  see  the  growth  with  the  mouth  open  and  the 
tongue  depressed,  as  it  was  so  low  on  the  tongue,  but  you  could  see 
it  with  the  throat  mirror.  We  did  not  operate  with  the  laryngeal 
mirror,  but  by  the  sense  of  touch.  When  we  pulled  the  tongue 
well  out,  under  the  influence  of  chloroform,  we  could  get  at  it  fairly 
well.  With  a curved  needle  we  sewed  the  tongue  with  catgut  and 
brought  it  together.  It  healed  very  kindly,  and  the  man  is  very 
well  and  happy  to-day,  and  comes  in  often  to  let  me  see  it  is  not 
springing  up.  The  operation  was  very  difficult;  for  the  tongue, 
you  know,  is  very  bad  tissue  for  an  epithelioma.  He  got  into  a 
controversy  afterwards,  in  regard  to  his  case,  with  one  of  the  leading 
physicians  in  the  city.  He  was  the  only  member  of  his  family  that 


1008 


world’s  homoeopath rc  congress. 


was  especially  a friend  of  mine.  The  others  worked  upon  him  until 
they  got  him  to  consult  this  famous  surgeon,  who,  in  his  brusque 
way,  said,  “ You  must  have  the  tongue  out.”  It  scared  the  man 
nearly  to  death.  He  told  me  about  it,  and,  of  course,  I didn’t  want 
to  take  the  whole  responsibility  of  the  man’s  life,  and  we  went  to 
see  I)r.  Hall  again,  but  he  was  just  as  positive  that  we  were  right. 

About  two  months  after  that  case  I had  another  from  the  country, 
but  he  was  too  far  gone;  the  whole  tongue  was  involved.  You 
could  see  it  when  the  mouth  was  open,  and  see  that  it  extended  into 
the  sides  of  the  throat.  I didn’t  want  to  undertake  the  operation 
because  it  had  involved  too  much  tissue.  Another  specialist  ad- 
vised the  same  way;  so  he  went  home  and  died  a month  afterward. 
It  matters  very  little  whether  the  growth  be  in  the  nose  or  larynx 
or  tongue,  it  is  always  bad  enough  ; but  the  result  of  these  three 
successful  cases  convinces  me  that  by  careful  and  radical  means  we 
could  save  many  cases  that  uow  die. 

It  has  been  a question  in  my  mind  whether  the  cauterization  of 
that  man’s  tongue  did  not  produce  the  proliferation  of  epithelioma. 
I was  afraid  it  did  ; so  I have  not  cauterized  a tongue  since.  There 
had  been  no  such  symptoms  before  this  operation.  I am  afraid  that 
the  irritation  of  the  cautery  was  the  primary  irritation  that  pro- 
duced the  proliferation  of  the  epithelial  cells;  so  that  I want  to 
caution  you,  and  ask  the  advice  of  others  in  regard  to  this  particu- 
lar matter.  I think  we  should  investigate  the  matter,  and  report  all 
such  cases. 


TREATMENT  OF  CONSTRICTION  OF  CESOPHAGUS.  1009 


NEW  SUGGESTIONS  IN  THE  TREATMENT  OF  CON- 
STRICTION OF  THE  (ESOPHAGUS. 


By  D.  G.  Woodvine,  M.D.,  Boston,  Mass. 


I propose  to  speak  of  three  forms  of  constriction  of  the  oesophagus, 
viz.,  spasmodic,  organic,  and  constriction  from  malignant  disease  of 
the  passage. 

The  first  variety  belongs  to  the  nervous,  and  is  found  most  fre- 
quently among  debilitated  women  whose  nervous  systems  have 
been  wrecked  to  a greater  or  less  extent  by  the  habits  and  customs 
of  the  present  generation,  or  by  having  inherited  a constitution  with- 
out any  vital  stamina.  The  general  appearance  of  the  patients  is 
pale,  anaemic,  nervous,  having  a poor  appetite  for  proper  food,  or  a 
capricious  one  for  unnatural  articles.  This  form  of  stricture  is  not 
wholly  confined  to  women,  but  sometimes  occurs  among  men. 
When  it  does  occur  among  females  it  is  more  likely  to  be  near  the 
menopause.  The  constriction  commences  with  a very  slight  diffi- 
culty in  swallowing  solids,  accompanied  with  a sensation  that  some 
thing  has  lodged  in  the  gullet,  and  necessitates  the  use  of  some  kind 
of  liquid  to  remove  it.  The  difficulty  develops  more  or  less  rapidly 
until  there  is  a sense  of  dread  at  the  thought  of  swallowing  anything 
of  a solid  character.  We  have  known  persons  afflicted  with  this 
complaint  to  spend  nearly  two  hours  in  eating  a meal.  The  result 
in  such  cases  could  be  nothing  less  than  extreme  emaciation,  or  in 
other  words,  slow  starvation.  Under  such  circumstances  the  patient 
realizes  that  there  is  a necessity  of  getting  relief  in  some  way  or 
other,  and  most  naturally  applies  to  her  family  physician  to  obtain 
relief.  When,  however,  she  is  informed  what  is  necessary  to  have 
done,  in  order  to  overcome  the  difficulty,  she  naturally  shrinks  from 
the  operation  of  dilatation.  The  patient  concludes  to  postpone  the 
operation,  hoping  that  the  difficulty,  if  nervous,  may  after  a while 
pass  away.  The  expectation  of  the  patient  is  however  hardly  ever 
realized  in  this  regard  ; she  is  obliged  sooner  or  later  to  submit  to 
an  operation.  When  this  is  successfully  done  she  feels  that  she  has 

64 


1010 


world’s  homoeopathic  congress. 


a new  lease  of  life,  until  there  are  signs  of  its  reappearance,  which  is 
most  likely  to  occur.  This  state  of  affairs  fills  the  mind  of  the  pa- 
tient with  fear  of  choking  and  a dread  of  another  operation.  How- 
ever being  familiar  with  the  relief  received  by  the  dilatation  she 
does  not  shrink  from  the  second  as  she  did  from  the  first ; but  has  it 
repeated ; this  is,  however,  not  so  in  all  cases,  for  there  are  those  that 
put  it  off  until  starvation  stares  them  in  the  face,  before  they  will 
submit. 

The  cause  of  this  form  of  constriction,  we  believe  to  be  a deficiency 
in  the  nerve  supply  to  the  muscle  of  the  oesophagus  at  a particular 
point,  which  suggests  some  diseased  condition  of  the  base  of  the 
brain.  The  extent  of  this  diseased  condition  determining  whether 
it  is  a spasmodic  or  a permanent  constriction. 

The  extent  of  time  covering  a spasmodic  constriction  according 
to  recent  authorities  may  be  from  a few  moments  to  several  hundred 
days. 

The  treatment  of  spasmodic  stricture  of  the  oesophagus  requires 
the  use  of  the  cone  or  olive-shaped  bougie.  It  is  well  always  to 
begin  the  dilatation  with  the  smallest  size,  and  not  to  hurry  the 
operation,  when  there  is  a decided  resistance.  We  are  well  satisfied 
from  experience  that  the  presence  of  the  bougie  will  sometimes  occa- 
sion a decided  spasm,  either  of  the  constricted  parts  or  those  in  close 
proximity,  which  may  continue  for  an  indefinite  period.  The  evidence 
of  this  possibility  being  in  the  fact,  that  the  bougie  may  pass  down 
comparatively  easy ; when  the  attempt  to  withdraw  it  is  made,  it  can 
only  be  accomplished  with  great  difficulty.  In  such  cases  patience 
is  of  the  greatest  importance  in  making  a success  of  passing  the 
bougie.  It  should  be  covered  with  some  oleaginous  substance  like 
cosmoline  or  sweet  oil.  It  is  important  that  the  operator  shall  have 
acquired  such  a sense  of  touch  in  the  use  of  the  probe  that  he  may 
be  able  to  recognize  the  condition  of  the  parts  as  to  readily  determine 
the  difference  between  the  constriction  and  a pocket  of  mucous  mem- 
brane. When  the  point  of  constriction  is  reached  by  the  bougie  and 
the  resistance  is  decided,  the  pressure  should  be  gentle  at  first,  but 
increasingly  firm,  but  not  harsh,  accompanied  by  a rotary  movement 
of  the  bougie  in  the  hands  of  the  operator;  and  if  the  parts  do  not 
yield  to  a proper  amount  of  pressure,  the  instrument  should  be  re- 
moved, and  the  patient  allowed  to  rest,  and  then  after  thoroughly 
anointing  the  bougie  it  may  be  again  introduced  and  the  pressure 


TREATMENT  OF  CONSTRICTION  OF  (ESOPHAGUS.  1011 


applied  as  before.  This  operation  may  be  repeated  several  times,  or 
until  the  stricture  is  overcome,  provided  the  condition  of  the  patient 
will  allow.  Strictures  of  this  class  are  not  as  difficult  to  overcome 
by  means  of  bougies  as  those  where  the  muscular  tissues  have  become 
more  permanently  thickened,  called  organic. 

The  following  remedies  used  internally,  we  have  found  useful  in 
the  treatment  of  spasmodic  stricture  of  the  oesophagus : 

Belladonna  is  indicated  by  pressing  pain,  like  contraction  and  a 
feeling  as  though  a foreign  body  had  lodged  fast  in  the  oesophagus; 
a feeling  during  deglutition  that  the  throat  is  too  narrow  or  drawn 
together  too  tightly  for  food  to  pass  properly. 

Gelsemium  semp.  has  afforded  relief  in  some  cases  of  spasmodic 
constr'ction,  where  there  seems  to  be  great  prostration  of  the 
nervous  and  muscular  systems. 

Hyoseyamus  nig.  is  called  for  in  that  class  of  cases  where  the 
patient  has  a great  deal  of  twitching  of  the  muscles;  spasmodic  con- 
striction of  the  oesophagus  from  a variety  of  causes  ; solid  and  warm 
food  can  be  swallowed  best;  liquids  cause  spasms  in  the  oesophagus, 
stop  respiration  and  talking. 

Hydrophobium  is  spoken  of  by  some  authorities  as  being  indi- 
cated in  periodical  spasms  of  the  oesophagus,  with  painfnl  urging 
to  swallow,  but  impossibility  of  doing  it;  abhorrence  of  fluids,  es- 
pecially water. 

Phosphorus,  stricture  of  the  oesophagus,  regurgitation  of  all  food  ; 
food  reaches  the  cardia  and  is  immediately  rejected. 

Veratrum  alb.  is  useful  in  spasmodic  constriction  of  the  oeso- 
phagus, resulting  in  paralysis  of  the  tube. 

The  organic  form  of  stricture  is  the  more  difficult  to  treat  by 
means  off  the  bougie  or  internal  medication.  The  deposit  of  fibrinous 
material  into  the  submucous  and  muscular  tissues,  followed  by 
thickening  and  contraction  of  the  muscular  tissue  gives  rise  to  a con- 
dition of  muscular  resistance  which  sometimes  is  most  difficult  suc- 
cessfully to  overcome.  This  the  result  of  various  causes  which  are 
not  alvvays  understood,  stare  one  in  the  face  with  a sort  of  defiance 
which  is  certainly  very  discouraging.  It  is  a fact,  however,  that  we 
have  strictures  occurring  from  mechanical  causes,  such  as  drinking 
hot  water  and  corrosive  substances.  The  treatment  of  what  is  de- 
nominated organic  stricture  of  the  oesophagus  may  be  divided  into 
general  and  local,  or  systemic  and  local.  We  find  the  general  sys- 


1012 


world’s  homceopathic  congress. 


tem  much  depressed  from  want  of  food.  The  patient  has  become 
much  emaciated,  very  much  discouraged  and  hardly  cares  to  make 
any  further  effort  to  live;  in  facta  release  many  times  would  be 
welcomed.  The  importance  of  getting  nutrition  into  the  system  in 
such  a manner  as  to  give  the  patient  strength  as  soon  as  possible 
cannot  be  over-estimated.  If  the  patient  is  much  reduced  physi- 
cally, injections  of  beef  tea  by  the  rectum  should  be  given  until  she 
is  sufficiently  strong  to  bear  the  operation  of  dilatation  with  the 
hard  rubber  or  ivory  bougie.  This  operation,  as  before  suggested  in 
the  treatment  of  spasmodic  stricture,  should  be  practiced  in  this  case 
with  even  more  care  if  possible  than  the  other.  We  have  found 
that  it  requires  much  patience  and  care  to  work  the  bougie  through 
this  form  of  stricture ; but  when  it  is  accomplished  there  should  be 
two  or  three  larger  sizes  passed  through  at  one  sitting.  In  some 
cases  of  bad  stricture  there  will  be  more  or  less  of  hemorrhage  from 
slight  laceration  of  the  tissues.  When  this  is  the  case,  the  dilata- 
tion should  not  be  pushed  too  far  at  one  sitting.  If  any  haem- 
orrhage occurs  a Hamamelin  suppository  of  appropriate  size  should 
be  carried  down  into  the  partially  dilated  stricture  and  left  there, 
which  will  soon  melt  and  operate  on  the  lacerated  part  as  a local 
styptic.  If  the  lacerated  tissue  does  not  give  rise  to  haemorrhage, 
there  should  be  a Calendula  suppository  applied  which  will  have  a 
most  beneficial  effect.  There  can  be  no  doubt  that  this  new  method 
of  applying  remedial  agents  directly  to  the  diseased  part  where 
dilatation  is  necessary  may  prove  of  great  value  in  the  treatment  of 
constriction  of  the  oesophagus.  After  one,  two  or  three  days  as  the 
case  may  require,  the  operation  of  dilatation  may  be  repeated,  be- 
ginning again  with  the  smallest  size  bougie  and  increasing  the 
number  and  size  until  finally  the  passage  is  fully  dilated,  following 
each  time  of  dilatation  with  the  local  application  of  medicine  by 
means  of  the  medicated  suppositories  as  the  case  may  require.  In 
fact  any  remedy  which  the  operator  may  desire  may  be  applied 
locally  in  the  form  of  a suppository. 

The  internal  administration  of  remedial  agents  may  be  practiced 
as  they  may  be  indicated  by  the  totality  of  the  symptoms. 

The  malignant  form  of  constriction  is  of  the  most  serious  charac- 
ter and  the  one  in  wdiich  we  have  ’less  hope  of  doing  anything  to 
permanently  relieve  the  patient.  The  treatment  must  necessarily  be 
palliative.  The  dilatation  must  be  cautiously  carried  on  to  a greater 


TREATMENT  OF  CONSTRICTION  OF  (ESOPHAGUS. 


1013 


or  less  extent,  depending  upon  the  progress  that  the  disease  has 
made  upon  the  passage.  In  the  primary  stage  of  the  development 
of  cancer  of  the  oesophagus  it  will  be  difficult  to  recognize  the  dif- 
ference between  it  and  organic  stricture  by  the  touch  or  by  the 
amount  of  pressure  of  the  bougie  necessary  to  open  the  passage. 
In  such  a case  we  depend  upon  the  character  of  the  touch  and  the 
general  appearance  of  the  patient  to  decide.  In  such  cases  our  suc- 
cess will  depend  much  upon  the  judicious  use  of  the  bougie  and 
the  proper  treatment  immediately  following,  whether  or  not  we  give 
relief  to  the  patient,  prolong  his  existence,  or  by  injury  or  perfora- 
tion hasten  a fatal  termination.  We  suggest  that  immediately  after 
the  dilatation  has  been  accomplished  that  a suppository  of  Hydrastis 
canadensis  should  be  carried  into  the  dilated  stricture,  and  left  to 
melt  and  flow  down  over  the  diseased  part.  Any  other  remedy 
that  the  physician  may  desire  can  be  applied  in  the  same  manner. 
We  believe  that  these  local  applications  following  so  soon  the  use  of 
the  bougie  will  be  likely  to  have  a healing  effect  and  thus  prevent 
as  rapid  a degeneration  of  the  tissues  as  would  otherwise  occur  with- 
out their  use.  It  will  also  leave  the  passage  in  a better  condition 
for  a subsequent  dilatation.  If  the  disease  has  progressed  so  far  that 
the  tissues  have  begun  to  soften  and  break  down,  the  appropriate- 
ness of  the  local  treatment  will  only  appear  the  more  reasonable. 

As  we  have  before  stated,  we  do  not  undertake  the  treatment  of 
these  cases  with  any  hope  of  permanent  relief,  but  with  the  hope  of 
making  the  patient  more  comfortable.  The  following  remedies  may 
aid  us  in  thus  doing: 

Arsenicum  album  will  be  called  for  by  the  totality  of  the  symp- 
toms more  than  almost  any  other  remedy  during  the  progress  of  the 
disease.  The  characteristic  symptoms  which  call  for  its  use  are  ex- 
cessive pains  in  the  cardiac  region  of  the  stomach,  extending  up  into 
the  oesophagus,  of  a burning  character,  causing  nausea.  Great  thirst 
for  cold  water  and  acidulated  drinks,  a small  quantity  of  which 
satisfies.  Vomiting  of  food  soon  after  eating. 

Hydrastis  canadensis  is  indicated  when  there  is  a sense  of  great 
prostration  and  sinking  at  the  epigastric  region,  with  palpitation  of 
the  heart.  Empty,  gone  feeling  in  the  stomach.  Acute,  distressing 
pain  in  the  region  of  the  pit  of  the  stomach. 

Kreosotum  for  nausea  and  vomiting,  with  a painful  sensation  of 
tightness  at  the  pit  of  the  stomach.  Painful,  hard  place  in  the 
region  of  the  stomach. 


1014 


world’s  homceopathic  congress. 


Lycopodium,  painful  pressure  in  the  pit  of  the  stomach  and  lower 
part  of  the  chest.  Contraction  and  spasm  of  the  stomach  when 
breathing. 

Phosphorus;  the  region  of  the  stomach  is  painful  to  the  touch. 
Painful  ness  of  the  stomach  when  walking.  Violent  pain  in  the 
stomach.  Burning  of  the  stomach,  extending  up  into  the  throat. 

A word  in  regard  to  the  feeding  of  patients  comes  within  the 
scope  of  this  paper.  We  do  not  propose  to  refer  to  old  methods  of 
feeding,  but  to  suggest  a new  one.  Neither  does  the  author  propose 
to  ignore  any  other  method.  We  suggest  that  good  tender  beef  or 
mutton  be  finely  minced  and  slightly  moistened,  salted  and  frozen 
in  appropriate  moulds,  with  hollow  centres,  of  proper  size  and  form, 
and  carried  down  by  the  same  instrument  that  carries  the  supposi- 
tory through  the  dilated  stricture  to  the  stomach,  and  there  be 
dropped  and  the  introducer  removed.  By  this  means  something 
more  than  a liquid  diet  could  be  given  until  the  patient  would  be 
able  to  swallow  solid  food  himself.  It  might  be  well,  after  the  dila- 
tation is  made,  to  carry  a few  beef-balls  into  the  stomach  before  car- 
rying down  the  medicated  suppository  to  remain  in  the  constricted 
portion.  Of  course  this  same  method  of  introducing  solid  food  into 
the  stomach  in  other  forms  of  stricture  when  necessary  is  equally  as 
feasible. 

The  instrument  above  referred  to,  called  the  introducer,  is  a very 
simple  invention  of  the  author.  It  consists  of  a slightly  tapering, 
left-hand  screw,  with  a hollow  shank,  with  a thread  cut  in  it  to 
correspond  to  the  screw-thread  on  the  whale-bone  rod,  upon  which 
the  bougies  are  introduced  for  the  purpose  of  dilatation.  When  the 
dilatation  is  accomplished,  the  bougie  is  removed  from  the  whale- 
bone rod,  and  the  introducer  screwed  in  its  place. 

The  size  of  the  introducer  is  as  follows : whole  length  one  inch 
and  a half,  length  of  shank  half  an  inch,  breadth  of  same  one- 
quarter  of  an  inch ; length  of  coarse,  left-handed  screw  one  inch, 
and  size  of  same  one-eighth  of  an  inch,  and  slightly  tapering.  It 
is  made  of  metal  and  silver-plated. 

The  suppository  is  another  invention  of  the  author,  and  is  de- 
signed to  go  with  the  introducer.  It  is  nothing  more  or  less  than 
a rectal  suppository  made  with  a hollow  centre  of  appropriate  size 
to  receive  the  screw,  which  is  screwed  into  each  one  before  the  sup- 
pository is  cold,  and  before  it  is  removed  from  the  mould.  These 
are  kept  in  a cold  place  until  needed  for  use. 


TREATMENT  OF  CONSTRICTION  OF  (ESOPHAGUS.  1015 


When  medicated  ice  could  be  in  any  way  serviceable  in  the  treat- 
ment of  disease  of  the  oesophagus,  medicated  water  might  be  put 
into  the  suppository-moulds  and  frozen,  with  the  hollow  centre  for 
the  introducer,  and  thus  be  passed  down  and  up  the  gullet  as  many 
times  as  necessary,  or  be  lodged  at  any  point  in  the  cardiac  region 
of  the  stomach. 

The  operation  of  introduction  is  quite  simple.  The  suppository 
is  screwed  on  to  the  introducer,  and  the  introducer  is  screwed  on  to 
the  whale-bone  rod,  and  carried  down  the  oesophagus  to  the  dilated 
portion  near  the  cardiac  orifice  of  the  stomach,  when  t'he  whale-bone 
rod  is  turned  several  turns  to  the  right,  when  the  suppository  will 
be  detached,  and  the  introducer  must  be  removed.  If  the  stricture 
be  located  at  the  upper  portion  of  the  oesophagus,  then  the  supposi- 
tory should  be  carried  down  and  up  several  times  when  a sufficient 
amount  of  the  remedy  will  have  been  applied  to  the  dilated  portion. 

It  is  self  evident  that  a suppository  could  not  be  lodged  very  well 
at  the  upper  portion  of  the  oesophagus,  without  great  inconvenience 
to  the  patient. 

The  writer  has  used  these  suppositories  by  means  of  the  introducer 
herein  described  to  a limited  extent  successfully ; but  the  cases  to 
which  they  are  applicable  occur  so  seldom  in  one’s  practice  that  it 
may  take  some  time  before  the  results  could  be  definitely  known. 
We  therefore  thought  it  best  to  publish  the  facts,  and  thus  give  to 
the  profession  an  opportunity  to  test,  criticise,  or  improve  on  the 
suggestions  for  the  benefit  of  humanity. 

Discussion. 

William  R.  King,  M.D. : I have  seen  not  more  than  eight  cases 
of  oesophageal  constriction  of  any  variety  in  the  past  fifteen  years. 
I have  treated  not  more  than  four  of  these,  and  not  to  any  extent 
whatever,  by  constant  or  continuous  dilatation.  Those  that  have 
been  under  my  care  were  mainly  those  in  the  first  division  of  Dr. 
Wood  vine’s  paper,  viz.,  spasmodic  cases,  and  all  these  cases  were 
women  of  decidedly  nervous  temperament.  One  of  them  I have 
never  treated  continuously,  but  have  been  called  twice  in  consulta- 
tion when  she  was  seemingly  choking  from  a particle  of  solid  food 
tightly  and  spasmodically  constricted  in  the  oesophagus.  In  this 
case,  after  relief  was  obtained  by  inducing  vomiting  through  the  use 
of  hypodermic  injections  of  Apomorphin,  the  case  was  left  in  the 
hands  of  her  family  physician,  from  whom  she  has  received  strictly 
Homoeopathic  treatment — no  local  measures  whatever  except  when 


.1016 


world’s  homoeopathic  congress. 


strangling — and  her  condition  is  improved  decidedly;  the  attacks 
are  much  less  frequent,  and  she  enjoys  more  of  the  freedom  of  the 
table. 

Another  case,  an  elderly  lady,  suffered  continuously  from  inability 
to  swallow  food.  It  would  regurgitate  and  often  stick  fast  in  the 
oesophagus.  She  has  been  much  relieved,  though  not  cured,  by  a 
rather  brief  course  of'  electricity  applied  along  the  oesophagus  from 
above  downwards  and  across  the  tube. 

The  third  case  is  that  of  a lady  just  coming  under  my  observation 
— a less  severe  case  though  quite  annoying  to  her,  she  frequently 
having  to  reject  morsels  of  food  on  account  of  sudden  spasmodic 
constrictions  of  the  oesophagus  just  below  the  upper  orifice.  She  is 
very  nervous  and  fidgety,  with  many  symptoms  of  Zincum  phosph., 
which  remedy  I have  just  placed  her  upon.  What  the  result  will 
be  I cannot,  of  course,  with  accuracy  say. 

The  fourth  case  was  of  organic  stricture  in  a man,  whether  of 
malignant  nature  or  not  I cannot  surely  say,  as  he  passed  out  of  my 
hands  before  I could  with  certainty  determine.  In  his  case  I re- 
sorted to  the  old  form  of  graduated  bougies  for  a time,  with  applica- 
tions of  the  galvanic  current  through  the  gullet  at  the  point  of  con- 
striction, together  with  the  indicated  remedies,  which  included  at 
different  times  Ars.  alb.,  Tabacum,  Phosph.,  Nux  vom.,  etc.  He 
improved  somewhat,  though  so  slowly  that  he  probably  became  dis- 
couraged, as  he  passed  from  sight,  and  I have  seen  or  heard  nothing 
from  him  since. 

After  this  confession  of  the  extremely  small  amount  of  experience 
in  this  class  of  disease  possessed  by  the  subscriber,  I will  proceed 
to  pass  comment  upon  Dr.  Woodvine’s  paper,  with  its  new  ideas  and 
novel  methods. 

The  division  of  the  subject  into  three  classes  of  constriction  is  a 
very  natural  one,  and  simplifies  the  handling  of  the  subject.  In  the 
first  class,  viz.,  spasmodic  constriction,  we  have  almost  invariably  to 
deal  with  a so-called  nervous  individual.  I doubt  whether,  in  many 
cases,  any  organic  cause  for  the  constrictive  spasms  can  be  demon- 
strated ; that  is,  any  actual  disease  at  the  seat  of  the  nerve  centres 
from  whence  co-ordinate  motion  is  controlled.  I am  equally  unable 
to  demonstrate  the  absence  of  such  organic  lesion,  but  I believe  func- 
tional conditions,  as,  for  instance,  nerve  anaemia,  if  I may  call  it  so, 
might  easily  be  a causative  factor,  as  also  might  its  opposite,  viz  , 
congestion  of  the  central  nerve  seat  or  along  its  track.  Except  in 
the  more  aggravated  cases,  where  absolute  starvation  or  at  least  de- 
cided emaciation  is  progressing,  I am  inclined  to  be  content  with  the 
Homoeopathic  remedy  as  I can  find  it  indicated,  abetted,  perhaps, 
by  the  faradic  current  of  electricity  applied  at  intervals.  If  the 
cause  is  central,  or  at  least  away  from  the  actual  seat  of  constriction, 
it  appears  fair  to  suppose  that  remedies  might  prove  more  efficacious 
than  local  dilatation. 


TREATMENT  OF  CONSTRICTION  OF  (ESOPHAGUS.  1017 


In  £he  use  of  the  improved  cones  or  olive-shaped  bougies  described 
by  Dr.  Woodvine,  I should  dread  very  much  the  possibility  of  a 
severe  constriction  occurring  after  its  passage;  and  this  being  then 
above  the  butt  of  the  bougie,  wonld  make  it  extremely  difficult  of 
removal,  perhaps  even  causing  a separation  of  the  whalebone  screw- 
thread,  leaving  our  bougie  to  drop  down  to  the  stomach  beyond 
our  reach.  This  may  be  an  unnecessarily  suspected  bugaboo,  but  it 
would  present  itself  more  in  such  cases  than  where  a fixed  organic 
stricture  occurs.  There,  care  should  be  taken  to  avoid  passing  a 
cone  too  large  to  readily  return.  In  the  spasmodic  case  this 
cannot  be  done,  as  the  extent  of  the  sudden  constriction  cannot  be 
anticipated. 

The  treatment  by  means  of  bougies  is,  of  course,  the  rational 
treatment  for  organic  constriction,  especially  when  nutrition  is 
gravely  interfered  with. 

I contend  that  in  such  cases  none  but  an  experienced  hand  should 
officiate,  especially  in  the  inflammatory  or  malignant  cases,  owing  to 
the  ease  with  which  serious  damage  may  be  done,  aggravating  the 
patient’s  discomfort  and  often  shortening  his  life. 

The  novel  method  of  applying  locally  the  suitable  remedy,  as  well 
as  for  inserting  solid  food  balls  by  means  of  the  so-called  “ intro- 
ducer,” is  quite  interesting,  and  I believe  in  the  suitable  cases  will 
prove  of  great  value.  The  instrument,  from  its  description,  seems 
a very  ingenious  one,  and  well  adapted  for  its  designed  use. 

In  many  cases,  though  I feel  we  can  more  readily  and  with  more 
comfort  to  our  patient  apply  our  local  remedy  in  liquid  form,  though 
of  course  in  small  quantities,  where  the  constriction  is  high  up  in 
the  oesophagus,  I doubt  whether  the  suppository  would  be  any  better 
borne  than  the  liquid  remedy  ; and  when  lower  down  I am  more 
decidedly  inclined  to  doubt  it — of  course  admitting  that  the  supposi- 
tory is  capable  of  holding  the  remedy  in  contact  for  a much  longer 
period,  if  that  should  be  a desideratum. 

The  most  valuable  feature  of  the  instrument,  to  my  mind,  is  the 
possibility,  with  it,  of  depositing  solidified  masses  of  meat,  etc., 
beyond  the  point  of  constriction,  thus  fulfilling  the  requirements  for 
free  nourishment. 

The  author  of  this  paper  admits  that  he  has  used  his  introducer 
for  applying  suppositories,  etc.,  to  a limited  extent  only,  owing  to 
the  fact  that  suitable  cases  occur  but  seldom  in  a single  practice ; 
therefore,  much  may  yet  be  learned  by  trial  and  experimentation 
with  this  new  method  of  treating  this  troublesome  and  distressing 
condition.  To  my  mind,  there  is  much  that  is  practical  and  feasi- 
ble in  the  method  and  instrument  designed,  therefore,  as  described 
in  the  paper. 


1018 


world’s  homoeopathic  congress. 


MASSAGE  IN  THE  TREATMENT  OF  NASAL 
STENOSIS. 

By  William  Dulaney  Thomas,  M.D.,  Baltimore,  Md. 


A due  appreciation  of  the  importance  and  results  of  intra-nasal 
surgery,  and  the  duty  incumbent  upon  us  as  practitioners  of  medi- 
cine to  render  to  our  patients  the  most  efficient  service  in  the  most 
efficient  way,  prompts  me  to  say  a few  words  in  reference  to  the  re- 
duction of  hypertrophied  tissue  in  the  nasal  cavity  and  pharyngeal 
vault.  The  methods  heretofore  employed  have  been  those  of  the 
snare;  actual  cautery,  or  chemical  cauterization;  and  while  useful, 
and  in  many  cases  necessary,  they  do  not  fill  the  requirements  of  all 
cases.  There  are  many  instances  coming  under  our  notice  in  which 
we  realize  the  importance  for  a reduction  of  hypertrophied  tissue, 
but  do  not  think  best  to  operate.  In  this  very  class  of  cases  I have 
found  a treatment,  namely,  massage,  midway,  as  it  were,  between 
operation  and  cauterization  to  be  of  great  advantage. 

As  a result  of  nasal  stenosis,  we  necessarily  have  a turgescence  of 
the  vessels  which  supply  the  mucous  tissue.  Hypersemia  means 
increase  of  nutrition,  loss  of  tonicity  of  the  vascular  walls,  and 
thickerting  of  the  intra-venous  structure,  all  of  which,  sooner  or 
later,  means  true  hypertrophy.  Just  at  this  stage  does  massage  win 
its  greatest  laurels,  although  I believe  it  to  be  available  in  the  later 
stages. 

The  effect  of  massage  is  to  produce  a stimulation  of  the  capilla- 
ries, thus  restoring  in  part  the  normal  condition  of  the  tissues. 
Clinically,  as  a result  of  this  rejuvenation  of  the  tissues,  we  find 
cataracts  disappear,  old  ulcerations  heal,  neuralgia  relieved  or  cured, 
stiffened  joints  made  supple,  and  deposits  and  thickenings  absorbed. 
That  the  effect  of  massage  is  to  produce  absorption,  may  be  proved 
by  the  experiment  of  von  Mosengeil.  Mosengeil,  taking  a number 
of  rabbits,  injected  into  the  knee-joints  of  each  a solution  of  India- 
ink.  At  intervals  massage  was  practiced  upon  the  right  knee, 
while  the  left  remained  untouched.  After  twenty-four  hours  the 
animals  were  killed,  and  the  parts  inspected.  The  left  knee-joints 
were  distended  with  fluid,  while  the  right  side,  which  had  been 


MASSAGE  IN  THE  TREATMENT  OF  NASAL  STENOSIS.  1019 


manipulated,  showed  an  entire  disappearance  of  the  substance  in- 
jected. The  lymphatics  on  the  right  side,  however,  were  filled  with 
particles  of  India-ink,  while  the  corresponding  side  revealed  no  such 
appearance.  The  evident  conclusion  is,  that  massage  produced  ab- 
sorption. 

Gerst,  who  has  given  the  subject  of  massage  considerable  atten- 
tion, reports  a number  of  cases  of  naso-pharyngeal-catarrh,  etc., 
which  have  been  cured,  and  claims  for  the  manipulation  a decrease 
of  redness  and  tumefaction  of  the  mucous  membrane,  a disappear- 
ance of  heat  and  pressure,  and  relief  from  the  embarrassed  respira- 
tions— a most  important  object  to  attain. 

It  is  not  my  purpose  to  prolong  this  paper  by  the  relation  of 
cases  treated  by  me,  and  the  effects  produced;  it  is  sufficient  for 
the  present  to  say  that,  although  my  experience  has  not  been  as  ex- 
tensive as  it  might  have  been  had  I improved  the  opportunities 
presented,  nevertheless  I am  Sufficiently  pleased  to  recommend  it  to 
the  members  of  the  Congress.  At  present  the  instrument  used  by 
me  is  a probe  nine  inches  long,  and  three-sixteenths  of  an  inch  in 
diameter  at  the  handle,  tapering  to  a point  one-sixteenth  of  an  inch 
in  diameter,  which  is  surmounted  by  a bulb.  The  method  of  manip- 
ulation consists  of  a series  of  short,  quick  raps  against  the  mucous 
membrane,  aided  by  a slight  rubbing  movement.  Sneezing  at  once 
occurs,  and  is  to  be  prevented  by  pressure  on  the  upper  lip.  Toler- 
ance is,  however,  effected  usually  by  the  second  or  third  sitting;  One 
of  the  greatest  difficulties  standing  in  the  way  of  the  use  of  massage 
thus  applied  is  the  labor  involved.  The  hand  soon  tires  after  two 
or  three  minutes,  and  the  operator  gives  up  in  disgust.  It  has  oc- 
curred to  me,  as  well  as  to  others,  that  an  attachment  could  be 
readily  made  to  the  Garey  vibrometer,  by  which  these  movements 
would  be  regular  and  graduated,  and  rendered  much  more  effective. 
Such  an  attachment  has  been  recommended  to  the  vibrometer  com- 
pany, and  they  have  seen  fit  to  adopt  it,  with  a promise  of  its  early 
appearance. 

What  I claim  for  massage  of  the  nose  and  throat  is  not  a cure  in 
all  cases,  but  in  that  class  of  cases  in  which  connective-tissue  changes 
have  not  undergone  great  alterations,  but  where,  as  yet,  there  is 
by  perse  mia  of  the  parts,  with  consequent  turgescenee.  I trust  the 
importance  of  the  subject  will  appear  to  you  to  be  sufficient  to  in- 
duce further  inquiry  and  investigation  ; if  so,  I shall  have  accom- 
plished the  purpose  of  this  brief  paper. 


1020 


world’s  homoeopathic  congress. 


THE  TREATMENT  OF  PHTHISIS . 

By  Charles  E.  Jones,  M D.,  Albany,  N.  Y. 


I know  of  no  disease  that  is  attended  with  more  intense,  constant 
and  often  intolerable  suffering  than  the  one,  the  treatment  of  which, 
is  the  subject  of  this  paper.  To  palliate  pain,  to  prevent  a lingering 
death  from  starvation,  and  to  save  life  from  suffocation  are  the 
problems  that  often  require  all  the  surgical  skill  and  medical  acumen 
of  the  physician.  As  statistics  prove  that  laryngeal  phthisis  is 
present  in  the  majority  of  consumptive^,  cases  more  or  less  numerous 
will  come  to  us  all  sooner  or  later.  It  is  therefore  most  important 
that  we  have  at  command  the  means  experience  has  demonstrated  to 
be  of  value  in  the  abatement  of  its  manifestations  or  its  possible 
cure.  Heinze  in  his  classical  work  on  laryngeal  phthisis  published 
in  1879,  in  his  third  and  final  conclusion  says,  “ a cure  of  laryngeal 
consumption  will  most  probably  never  be  made.”  Although  since 
this  was  written  the  progress  of  fourteen  years  has  introduced  new 
methods  and  new  remedies,  but  few  cures  have  been  reported,  and 
some  of  these  must  be  taken  sub  judice  as  sufficient  time  from  the 
apparent  recovery  had  not  been  allowed  to  provide  for  the  occurrence 
of  relapses.  Others  have  undoubtedly  been  merely  cases  of  follicular 
catarrhal  laryngitis  complicating  pulmonary  tuberculosis.  Much 
may  be  done,  however,  in  the  way  of  prevention.  Repeated  laryn- 
geal inflammations  occurring  in  those  of  a strumous  diathesis  impair 
the  vitality  of  the  mucous  membrane  with  consequent  defective 
function.  The  capillary  walls  lose  their  elasticity,  thus  favoring 
stasis  of  the  circulation.  The  products  of  inflammation,  which  in 
those  of  sound  constitution  are  easily  absorbed,  in  the  scrofulous  and 
debilitated  form  a nidus  for  the  development  of  tubercle.  A timely 
recognition  of  this  predisposition  followed  by  prompt  and  suitable 
treatment  will  often  prevent  tuberculosis.  The  progress  of  laryngeal 
phthisis  may  be  divided  into  the  following  stages: 

1.  Stage  of  Anaemia. 


THE  TREATMENT  OF  PHTHISIS. 


1021 


2.  Stage  of  Tumefaction. 

3.  Stage  of  Ulceration. 

4.  Necrosis  or  Caries  of  the  Cartilages. 

The  second  stage,  as  to  form,  may  be  regarded  as  hypertrophic 
or  polypoid.  The  treatment  should  be  both  general  and  local.  The 
constitutional  treatment  is  necessarily  the  same  as  that  of  pulmonary 
consumption.  Especially  in  those  rare  cases  where  the  physical 
signs  of  lung  invasion  are  wanting,  and  where  the  larynx  seems  to 
be  the  focus  of  the  disease,  too  exclusive  reliance  on  topical  medica- 
tion should  be  guarded  against;  for  it  is  in  these  very  cases  that 
hygienic  and  general  medical  measures  should  be  adopted  with  refer- 
ence to  the  predisposing  cause.  If  the  causa  excitans  can  be  traced 
with  a certainty,  as  is  sometimes  possible,  the  pursuance  of  the  causal 
avocation  should  be  interdicted.  Of  the  general  treatment  I have 
bnt  little  to  say,  as  it  is  still  as  varied  and  manifold  as  the  theories 
of  the  aetiology  of  the  disease  were  before  the  discovery  of  Koch. 
Now  while  the  general  treatment,  as  has  already  been  said,  is  refer- 
able to  that  of  consumption  in  its  most  extended  sense,  I would  not 
be  understood  as  limiting  the  therapeutics  of  the  larynx  to  purely 
local  medication ; for  fortunately  we  possess  remedies  whose  specific 
power,  when  administered  internally,  seem  to  be  exerted  upon  the 
larynx.  The  local  treatment  may  be  divided  into  palliative  and 
curative.  The  office  of  the  first  is  to  alleviate  pain,  mitigate  cough, 
diminish  dysphagia,  and  calm  the  laryngeal  dyspnoea.  The  second 
is  employed  in  primary  cases  or  cases  in  which  the  lungs  are  but 
slightly  involved,  and  where  the  disease  has  not  become  so  extensive 
as  to  banish  all  hope  of  success.  The  anaemic  stage  seldom  presents 
itself  for  treatment;  when  it  does  the  laryngeal  membrane  is  livid, 
stained  with  dirty-looking  spots  and  marked  by  the  velvety  projec- 
tions which  presage  coming  ulceration;  I know  of  no  better  topical 
application  than  ten  drops  Liquqr  sodae  arsenitis  to  the  ounce  of 
water  used  as  a spray.  In  a paper  read  by  me  before  the  New  York 
State  Homoeopathic  Medical  Society  in  1879  I advocated  this  treat- 
ment, and  have  had,  as  yet,  no  reason  to  abandon  it.  It  is  in  this 
stage  that  I have  used  the  Perchloride  of  iron  (ten  drops  to  the 
ounce),  especially  if  the  above  named  velvety  projections  are  present, 
as  recommended  by  Sir  Morrel  McKenzie. 

Palliative  Treatment . — One  of  the  first  symptoms  met  with  is  the 
hacking  cough,  which  most  patients  quite  definitely  locate  as  rising 


1022 


world’s  homoeopathic  congress. 


from  the  superior  part  of  the  larynx — what  might  be  called  an  inter- 
arytenoideal  cough.  Laryngoscopic  examination  will  usually  dis- 
close some  tumefaction  of  the  arytenoids,  a swelling  of  the  arytenoi- 
dean  space,  bathed  with  a secretion  more  or  less  rich  in  cellular  ele- 
ments. If  there  is  a disposition  to  excessive  secretion,  a thorough 
cleansing  of  the  part  is  essential.  A simple  spray  of  Carbonate  of 
soda,  five  grains  to  the  ounce,  will  answer  quite  as  well  as  the  Poly- 
pharmic  solution  of  Dobell,  though  if  the  secretion  is  offensive,  then 
the  latter  is  better.  This  solution  consists  of 


Acidi  carbolici,  grains  8. 

Soda  biboraci, grains  2. 

Sodse  bicarb., grains  2. 

Glycerinse, ounce  1. 

Aquse  dest.,  ad.  q.  s., ounces  8. 

M.  et.  ft.  lot. 


A favorite  spray  of  mine,  after  cleansing,  is  Glycerinse,  ounce  one- 
half  ; Aquae  dest.,  ounce  one-half ; Acidi  tannici,  grains  40  ; Acidi 
carbolici,  grains  4;  Tincture  olei  menthe  pip.,  minims  3.  For  home 
use,  Compound  tincture  of  benzoin,  a teaspoonful  to  a pint  of  water 
at  140°,  in  a Martingale  inhaler,  is  of  great  service.  Or  two 
drachms  of  Succus  coinum,  with  a pint  of  water,  when  the  cough 
is  very  aggravating.  Schmidt  recommends  steam  inhalations — to  a 
pint  of  hot  water,  Balsam  of  Peru,  half  an  ounce;  Alcohol,  2 
drachms;  but  I believe  whatever  efficiency  it  may  possess  depends 
upon  a Benzoic  acid  which  the  Balsam  contains.  The  following  is 
advised  by  Dr.  E.  L.  Sherley : Creosote,  1 drachm;  Compound 
tincture  of  benzoin,  4 drachms  ; Tincture  of  luxmlin,  4 drachms — 
one  drachm  of  this  mixture  to  a pint  of  hot  water.  Creosote  alone 
may  be  used  as  a spray.  One  and  a half  ounces  of  Creosote  in  the 
presence  of  one  ounce  of  Glycerine,  add  to  fifteen  ounces  of  water. 
(English  Beech- wood  creosote,  prepared  by  Morsen,  is  the  best  prep- 
aration.) The  atomization  of  Glycerine  by  a Codman  & Shurtleff 
atomizer  will  often  prove  serviceable.  Sacubash  speaks  highly  of 
inhalations  of  Pine-needle  oil,  two  or  three  times  a day,  for  the  irri- 
tating cough.  Oil  made  from  the  fresh  needles  is  preferable.  A 
Davidson’s  oil  atomizer  will  serve  well  the  purpose  of  administra- 
tion. I have  found  a maceration  of  powdered  Hydrastis  root  in 
Alboleme  very  serviceable  in  those  cases  characterized  by  a tough, 
gluey  secretion.  Lefferts  has  found  Terebene,  five  to  forty  minims, 


THE  TREATMENT  OF  PHTHISIS. 


1023 


added  to  an  ounce  of  water,  in  the  presence  of  twenty  grains  of  Mag- 
nesium carbonate,  a teaspoonful  mixed  with  a pint  of  water  and  in- 
haled at  140°  for  ten  minutes  night  and  morning,  very  useful  in 
allaying  the  irritative  cough.  Eucalyptol,  half  a drachm  to  the  ounce 
of  Albolene,  makes  a useful  spray.  Solis-Cohen*  recommends  Ethyl 
iodide,  ten  minims,  dropped  on  the  sponge  of  a Yeo  respirator  and 
inhaled  for  an  hour.  Iodine  has  long  been  used  to  relieve  the  infil- 
tration, but  I have  never  observed  that  it  exerted  the  slightest  influ- 
ence in  checking  the  progress  of  the  disease.  Should  its  application 
be  thought  advisable,  however,  great  care  should  be  taken  not  to 
employ  too  concentrated  solutions,  for  cases  of  oedema  are  on  record 
which  have  been  produced  and  proven  fatal  through  its  indiscreet 
employment. 

With  the  advent  of  ulceration  we  have  much  graver  conditions  to 
meet.  Since  Horace  Green  recommended  Nitrate  of  silver,  of  a 
strength  varying  from  20  to  60  per  cent.,  no  remedy  in  the  entire 
range  of  topical  application  has  excited  more  controversy  than  this 
agent.  Although  it  is  still  used  by  a few  laryngologists,  the  ma- 
jority have  consigned  it  to  its  proper  place  among  “ the  things  that 
were.”  Nitrate  of  silver  does  not  penetrate  sufficiently  deep  into  the 
tissues.  It  has  been  experimentally  proven  that  when  a solid  or 
saturated  solution  is  applied  to  a denuded  mucuous  surface,  it  com- 
bines with  the  albumen  and  protein  of  the  granular  cells,  forming  a 
thin  pellicle.  Its  action  on  the  intact  membrane  is  first  a combina- 
tion of  a portion  of  the  silver  with  the  albumen,  mucine  and  chlorides 
of  the  secretion  ; the  remainder  of  the  silver  penetrates  the  epithelial 
interstices  and  is  deposited  as  granules  of  Oxide  of  silver,  which  act 
as  foreign  bodies,  giving  rise  to  congestion  and  inflammation.  When 
the  ulcerations  are  superficial,  and  especially  on  the  arytenoids,  appli- 
cations of  Iodoform  seem  to  have  a retarding  effect.  But  I think 
our  best  results  from  Iodoform  are  in  those  cases  of  combined  syphi- 
litic and  tuberculous  laryngitis.  Schnitzler’s  excellent  paper,  read 
at  the  International  Congress  of  1890,  has  called  attention  to  the 
comparative  frequency  of  the  coexistence  of  tuberculosis  with  syphi- 
litic ulceration  of  the  larynx.  In  these  cases,  Iodoform  has  an 
almost  magical  effect.  I prefer  the  saturated  ethereal  solution  di- 
luted with  twice  the  quantity  of  Almond  oil  sprayed  through  a Sas 


* N.  Y.  Med. . Jour.,  March  6,  1886. 


1024 


world’s  homoeopathic  congress. 


tube  with  about  thirty  pounds  pressure.  It  is  often  used  in  powder, 
but  my  preference  has  long  been  in  favor  of  the  spray  with  this,  as 
with  other  remedies,  unless  it  be  necessary  to  limit  the  extent  of  the 
medicament.  I then  prefer  cotton  on  a laryngeal  applicator.  The 
insufflation  of  powders  I have  found  badly  borne  by  the  tuberculous 
larynx,  frequently  causing  cough,  and  suffocating  attacks.  On  ac- 
count of  the  objectionable  odor  of  Iodoform  I have  tried  both  Iodol 
and  Aristol,  but  have  been  disappointed  in  the  results.  Tymonsky* 
speaks  well  of  a daily  application  of  an  80  per  cent,  solution  of 
Resorcin.  I have  had  no  experience  with  this  remedy,  but  should 
regard  its  effects  as  similar  to  those  of  Carbolic  acid.  Since  the  in- 
troduction of  Pyoktanin  (Methyl-violet)  as  an  antiseptic,  Masini 
commends  its  use  as  a spray,  fifteen  drachms  to  eight  ounces  of  water 
three  times  a day.  He  claims  to  have  found  it  more  useful  than 
Iodoform  menthol  lactic  acid.  Sheinmanf  and  BresgenJ  apply  it 
directly  to  the  ulcers  by  means  of  heated  probes  dipped  in  the  powder. 
From  the  unsatisfactory  results  obtained  by  myself  with  this  remedy 
in  syphilitic  ulceration  I have  never  been  tempted  to  resort  to  it  in 
tuberculous  ulceration.  Hr.  II.  F.  Ivins§  makes  favorable  mention 
of  a spray  of  a watery  solution  of  Calendula  “one  to  twenty  or 
weaker,”  with  the  addition  of  two  or  three  drops  of  Carbolic  acid  to 
the  ounce,  as  recommended  to  him  by  Hr.  A.  C.  Peterson,  of  San 
Francisco.  I much  prefer  Calenduol,  a preparation  made  by  mace- 
rating under  heat  the  marigold  flowers  in  pure  petroleum  oil.  From 
a very  limited  experience  I think  I may  predicate  good  results  from 
its  employment.  Among  the  more  recently  introduced  drugs  for  the 
local  treatment  of  this  disease,  menthol  and  lactic  acid  stand  pre-emi- 
nent in  the  almost  general  recognition  of  their  value.  Menthol  was 
first  used  by  Rosenberg,  in  1885,  and  since  then  he  has  presented 
several  communications  attesting  its  worth.  He  employed  a 10  to 
20  per  cent,  solution  in  oil,  sprayed  in  the  larynx  once  or  twice  a 
day.  He  claims  that,  in  addition  to  its  analgesic  effect,  it  deterges 
the  ulcers,  which  soon  become  of  a healthy  rose  color,  and  are  cov- 
ered with  healthy  granulations,  and  healing  in  from  four  to  six 
weeks.  The  tumefaction  gradually  diminishes  under  its  influence. 

* Monatschrtft  far  OhrenheilJcunde,  May,  1891,  No.  5,  p.  153. 

f Berlin  Klin.  Wochenschrift,  August  18, 1890,  No.  33. 

J Deutsche  Med.  Wochenschrift , No.  4, 1890. 

$ Diseases  of  the  Nose  and  Throat , p.  432. 


THE  TREATMENT  OF  PHTHISIS. 


1025 


Goughenhein  and  Glover*  propose  the  following  : One  part  of  men- 
thol added  to  five  parts  of  creosote  and  five  parts  of  almond  oil 
(mixed  in  a water-bath)  to  be  painted  on  the  ulcerated  surface.  A. 
B.  Thasherf  finds  a 10  percent,  solution  in  liquid  vaseline  very  use- 
ful in  dysphagia.  Solutions  as  highly  concentrated  as  40  per  cent, 
have  been  used,  but  they  are  certainly  objectionable  on  account  of  the 
intense  irritation  they  cause.  Of  all  the  caustics  employed  in  ulcera- 
tions of  the  larynx,  lactic  acid  gives  the  most  hope  of  successful  re- 
sult. To  Krause,  of  Berlin,  belongs  the  honor  of  using  it  for  the 
first  time.  He  was  induced  to  try  it  through  the  experiments  of 
Mosetig-Morhof  with  it  in  lupus  of  the  skin.  Since  Krause  read 
his  paper  before  the  Laryngological  Subsection  of  the  59th  meeting 
of  German  naturalists  and  physicians,  many  cases  have  been  reported 
confirming  its  value.  He  commenced  with  a 10  per  cent,  solution, 
gradually  increasing  the  strength  to  10,  60,  80,  or  100  per  cent.,  as 
the  patient  becomes  more  tolerant  of  the  acid.  Under  its  influence, 
the  deep-red  tumefied  parts  become  pale  and  shrivelled.  With  the 
stronger  solutions  firmly  adherent  eschars  are  produced,  which,  in 
falling  off,  leave  a healthy-looking  granular  surface  at  the  bottom 
of  the  ulcer.  Krause  has  seen  post-mortem  evidence  of  the  complete 
cicatrization  of  ulcers  in  a case  dying  of  pulmonary  consumption. 
It  acts  more  promptly  on  soft  than  hard  infiltrations.  When  the 
stronger  solutions  are  used,  parts  should  be  ansestheized  with  a 4 per 
cent,  solution  of  cocaine. 

Krause  used  a brush,  but  the  cotton-carrier  is  cleaner.  The  part 
should  be  thoroughly  cleansed  by  an  alkaline  spray,  and  then  it 
should  be  rubbed  in  by  gentle  pressure;  when  the  milder  solutions 
are  employed,  applications  may  be  made  every  day,  or  every  other 
day,  pro  re  nata.  To  prevent  the  spasm  of  the  larynx  which  some- 
times occurs  in  the  use  of  lactic  acid,  cocaine  may  be  applied.  Dr. 
Theodore  Hering,  of  Warsaw,  in  certain  cases,  those  in  which  there 
is  considerable  oedema  with  pronounced  pyriform  swellings  of  the 
arytenoids,  advised  sub-mucous  injections  of  lactic  acid.  They 
would  seem  to  be  especially  indicative  in  hard  infiltrations  and  pseu- 
do-polypoid growths.  Hering  employed  a solution  of  10  to  20  per 
cent.,  five  minims  being  injected  at  each  sitting.  Dr.  G.  W.  MagorJ 

* Jour.  Laryngol.  and  Rhin .,  1890,  p.  365. 

f Cin.  Lancet  and  Clinic,  June  22,  1889. 

1 Canada  Med.  Surg.  Jour.,  December,  1886. 

65 


1026 


world’s  homoeopathic  congress. 


pronounces  strongly  in  favor  of  this  method.  This  treatment  does 
not  preclude  the  intercurrent  use  of  a mild  lactic  acid  spray  or  other 
soothing  measures. 

Perhaps  the  most  distressing  symptom  we  are  called  upon  to  re- 
lieve is  dysphagia.  Before  the  discovery  of  cocaine,  insufflations  of 
morphia  in  starch  powder,  iodoform,  or,  preferably,  gum  acacia,  from 
its  adhesive  qualities,  were  mainly  relied  upon  for  the  relief  of  this 
symptom.  I am  commencing  to  think  that  far  better  results  are 
obtained  from  morphine  in  painful  deglutition  than  its  more  recent 
rival  cocaine.  The  latter  is  too  evanescent  in  its  effects,  and  its  ne- 
cessarily repeated  use  seems  to  diminish  its  ansesthetic  power.  Good- 
hart*  has  reported  a case  where  this  happened.  There  are  other 
objections  to  its  continued  use.  The  primary  action  of  cocaine  on 
the  muscular  fibres  of  vascular  walls  is  spasmodic,  followed  by  pare- 
sis, which,  recovering  very  gradually,  leads  to  diapedesis  from  the 
vessels  and  consequent  increased  catarrhal  inflammation.  Dr.  Beebe, 
in  an  excellent  paper,  calls  attention  to  the  fact  that  cocaine  increases 
the  salivary  as  well  as  the  mucous  secretions.  So,  while  tempora- 
rily relieving  the  odynphagia,  it  subsequently  causes  increased  dis- 
position to  swallow  on  account  of  the  augmented  secretion.  This 
action  of  cocaine  is  confirmed  by  a .proving  made  by  Dr.  Percy 
Wilde,  who  gives  these  two  symptoms  following  its  local  application 
“ intense  salivation  and  spasm  of  the  abductor  muscles.”  I think 
morphine  combined  with  tannic  acid  and  glycerine,  and  applied  with 
the  applicator,  will  give  far  more  satisfactory  and  lasting  results  in 
painful  deglutition  than  cocaine,  whether  used  as  a spray  or  painted 
on  in  oily  solution.  Sainte-Hilaire  recommends  a 30  per  cent,  solu- 
tion of  antipyrine  as  an  ajsthetic.  Its  effects  last  from  one  to  two 
hours.  Milder  solutions  have  no  effect.  It  causes  some  transient 
pain,  however.  Caffeine  has  been  used  as  an  analgesic,  but  it  is  only 
very  slightly  sedative,  and  is  very  uncertain.  The  acetamide  of 
eugenol,  made  from  cloves,  has  recently  been  found  to  possess  anses- 
thetic power.  It  is  an  aesthetic  as  well,  but  is  not  caustic.  It  may 
possibly  have  a future. 

In  laryngeal,  as  well  as  pulmonary  cases,  a suitable  and  sufficient 
diet  is  necessary.  Experience  has  shown  that  food  of  a semi-solid 
consistency  is  swallowed  with  less  pain  than  in  a liquid  or  solid  form. 


* Brit.  Med.  Jour.,  December  6,  1884,  p.  1133. 


THE  THE  ATM  ENT  OF  PHTHISIS. 


1027 


Food  should  be  taken  with  a gulp  and  not  sipped.  Egg  swallowed 
en  bloc,  milk  enriched  with  cream,  and  nutritious  broth  thickened 
with  baked  flour,  rice  flour,  or  oatmeal,  raw  oysters  and  custards, 
form  the  dietary  to  which  the  patient  is  often  restricted.  Dr.  D.  G. 
Woodvine*  found  this  method  very  useful:  “A  small  pitcher  is 
placed  upon  the  floor  at  the  foot  of  a lounge;  the  patient  procures  a 
piece  of  rubber  tubing  eighteen  inches  long ; he  lies  down  with  his 
feet  over  the  arm  of  the  lounge,  his  face  and  head  extending  over  the 
foot,  his  left  cheek  toward  the  floor.  He  then  places  one  end  of  the 
tubing  in  the  pitcher,  the  other  in  his  mouth,  and  by  suction  draws 
the  fluid  into  the  mouth,  letting  it  flow  along  the  inside  of  the  cheek 
and  the  lower  jaw  until  it  reaches  the  oesophagus  and  then  swal- 
lowed.” This  is  a slight  improvement  of  Wolfenden’s  method. f A 
patient  of  Dr.  Woodvine’sJ  discovered  that  the  springing  of  the 
shoulders  simultaneously  with  the  swallowing  would  facilitate  the  act. 
With  the  occurrence  of  aphagia  our  only  course  is  gavage  and  nutrient 
enemata.  Bryson  Delevan§  advised  that  a tube  of  small  calibre, 
about  the  size  of  a large  catheter,  be  introduced  into  the  oesophagus 
just  below  the  inferior  constrictor  of  the  pharynx.  He  devised  a 
special  apparatus  for  thus  introducing  the  food.  Owing  to  the  size 
of  the  tube,  great  care  should  be  exercised  not  to  pass  it  into  the 
larynx.  I prefer  a tube  about  half  an  inch  in  diameter.  There  are 
cases  in  which  the  tube  will  not  be  tolerated ; nutrient  enemata 
must  then  be  given.  The  rectum  should  be  thoroughly  washed  out 
preceding  the  enema.  A few  drops  of  tincture  of  opium  added  will 
often  assist  its  retention.  The  following  recipe  of  Morrel  McKenzie 
makes  a very  nourishing  injection.  Cooked  beef,  mutton  or  chicken 
three  ounces  seven  drachms ; sweet-bread,  one  ounce  seven  drachms ; 
fat,  six  drachms ; brandy,  two  drachms ; water,  two  ounces.  “ These 
ingredients  mixed  well  together  will  make  nine  ounces.  The  meat, 
sweet-bread  and  fat  must  first  be  passed  through  a fine  mincing 
machine  and  then  rubbed  up  with  water  gradually  added  to  make  a 
very  thick  paste.  It  should  be  injected  at  a temperature  of  ninety- 
five  degrees,  and  ought  not  to  be  administered  more  than  twice  in 
twenty-four  hours.”  Feeding  by  rectum,  however,  should  not  be 

* Jour,  of  Opth.,  Oto.  and  Laryngol.,  vol.  ii.,  1890,  p.  303. 

f Jour,  of  Laryngol.  and  Rhin.,  vol.  i.,  p.  317. 

J Trans.  Am.  Med.  Inst.  Horn.,  1885. 

\ Trans.  Am.  Laryngol.  As<so.,  1884,  p.  81. 


1028 


world’s  homoeopathic  congress. 


persisted  in  for  a long  time  on  account  of  the  intolerance  often  pro- 
duced, but  should  be  alternated  by  attempts  per  ora. 

The  surgical  treatment  of  laryngeal  phthisis  commenced  with  the 
introduction  by  Schmidt,  of  Frankfort,  of  puncturing  and  incising. 
To  my  mind  this  procedure  only  furnishes  fresh  foci  for  infection. 
Hering*  observing  that  the  deep  ulcers  were  not  reached  in  every 
part  by  Lactic  acid  advised  curetting  to  be  followed  by  cauterization 
with  the  acid.  Krause  afterward  adopted  the  same  treatment  in 
selected  cases.  But  from  the  reports  I have  read  it  seems  to  me 
that  where  there  were  good  results  they  might  fairly  be  attributed 
to  the  action  of  the  acid,  and  curetting  was  superfluous.  As  to  the 
use  of  the  gal  van  o- cautery  I regard  it  as  productive  of  much  more 
harm  than  good.  When  laryngitis  assumes  a form,  which  in  the 
earlier  part  of  this  paper  has  been  designated  as  polypoid,  that  is,  the 
formation  of  circumscribed  tumors  without  ulceration,  and  in  the 
papillomatous  vegetations  sometimes,  though  rarely,  found  in  the 
tuberculous  larynx,  and  when  sessile,  their  destruction  by  the  gal- 
vano-cautery  is  to  be  preferred  to  their  evulsion  by  the  cutting  for- 
ceps, the  only  objection  to  this  method  being  the  repeated  seances 
which  its  use  requires.  When  pedunclated  the  removal  by  forceps 
is  more  desirable. 

Tracheotomy,  in  my  judgment,  is  only  justifiable  in  threatened 
death  from  suffocation.  Beverly  Robinsonf  advises  it  as  a directly 
curative  measure ! 

“ 1.  because  it  is  certainly  a palliative  procedure  of  much  value. 

“2.  It  may  ultimately  be  found  a direct  curative  means  yielding 
favorable  results.  To  obtain  these  latter  it  seems  indicated  not  to 
delay  the  operation  to  a late  date.”  My  objections  to  the  operation, 
except  in  cases  of  apncea,  are,  that  the  larynx  does  not  receive  the 
necessary  amount  of  air,  and  mucous  more  readily  accumulates. 
The  dry  cool  air  coming  into  almost  immediate  contact  with  the 
pulmonary  surface  is  apt  to  cause  complications.  Again,  the  wound 
may  become  infected.  The  complete  physiological  rest  which  this 
operation  is  supposed  to  give  I do  not  think  is  obtained.  McKenzie j 
says,  “ during  the  last  twenty  years  I have  performed  tracheotomy 
in  a few  cases  of  laryngeal  phthisis  perhaps,  a dozen.  Although  it 

* Deutsche  Med.  Wochenschrift,  Leipsic,  1887,  Bd.  13,  p.  136. 

f Am.  Jour.  Med.  Sciences,  1879,  p.  416. 

% Diseases  of  the  Throat  and  Nose , vol.  i.,  p.  377. 


THE  TREATMENT  OF  PHTHISIS. 


1029 


has  often  relieved  urgent  dyspnoea,  I cannot  recall  a single  instance 
in  which  the  operation  delayed  the  pathological  process.  Far  from 
giving  rest  to  the  larynx,  the  wearing  of  the  canula,  in  my  opinion, 
tends  to  irritate  the  windpipe.”  Resort  has  been  had  to  intubation. 
F.  E.  Hopkins*  reports  a case.  “ The  presence  of  the  tube  excited 
violent  paroxysms  of  coughing,  and  was  later  expelled.  The  dys- 
pnoea was  relieved  and  the  relief  continued.”  This  is  explained  by 
the  force  exerted  in  introducing  the  tube ; it  tore  away  a portion  of 
the  posterior  commissural  thickening,  and  doubtless  the  remainder 
subsided  somewhat  from  contraction  and  relief  to  the  engorgement 
from  bleeding.  Dr.  Masseif  reports  three  cases  relieved  by  this 
operation. 

Therapeutics. — The  dominant  school  of  medicine  place  but  little 
reliance  on  the  internal  administration  of  medicine  with  distinctive 
reference  to  their  special  action  upon  the  air  passage,  but  largely 
limit  their  internal  treatment  to  the  general  dyscrasia,  and  to  local 
applications.  So,  it  is  to  Homoeopathic  literature  that  we  are  obliged 
to  seek  for  this  means  of  encountering  the  pathological  conditions  in 
question. 

Arsenic , as  mentioned  before,  is  indicated  where  the  laryngeal 
membrane  is  anaemic,  stained  with  dirty-looking  spots,  and  marked 
by  the  velvety  projections  which  presage  coming  ulceration.  Cough 
is  absent  or  entirely  out  of  proportion  to  the  progressive  emaciation. 
Accompanying  the  objective  signs  is  a peculiar  sensation  of  burning, 
which  is  referred  to  the  region  of  the  cricoid  and  thyroid  cartilages. 
The  same  remedy  is  also  serviceable  in  a later  stage,  when  extensive 
ulceration  has  taken  place  and  an  indolent  and  acrid  sero-purulent 
discharge  comes  from  the  ulcers.  I formerly  used  Arsenicum  album, 
but  of  late  years  have  preferred  the  second  trituration.  The  late 
Dr.  Niohol  in  a study  of  this  sort  commends  it  highly  in  throat  con- 
sumption. Dr.  Beebe  reports  three  cases  greatly  benefited  by  its 
use. 

Aurum  lodatum  Zx. — Meyerhofer  has  found  it  useful  “ in  torpid 
ulcerations  of  the  larynx.”  , 

Drosera. — Is  nearly  always  useful  for  the  spasmodic  cough  of  the 
early  stages.  I agree  with  Jousset  in  giving  material  doses  of  15  to 
20  drops  of  the  tincture  three  times  a day. 

* N.  Y.  Med.  Jour.,  1892,  p.  234. 
f Jour.  Laryngol.  and  Rhin.  Jour.,  July,  1891,  p.  265. 


1030 


world's  homoeopathic  congress. 


Kali  Bichrom  is  only  useful  in  the  follicular  catarrh  with  muco- 
purulent, stringy  expectoration  which  often  precedes  the  develop- 
ment of  tubercle. 

Hepar  Sulphur. — The  posterior  wall  of  the  larynx  is  abundantly 
supplied  with  racemose  glands,  from  this  fact  suppurating  ulcera- 
tions in  this  portion  of  the  larynx  are  quite  frequent  and  especially 
indicate  the  use  of  this  classical  drug. 

Phosphorus. — Often  indicated  in  irritative  cough  which  seems  to 
arise  from  the  posterior  commissure. 

Seleniate  of  Soda. — In  my  paper  on  “ Laryngeal  Phthisis,”  to  which 
allusion  has  been  made,  favorable  notice  was  given  to  this  salt  of 
Selenium,  but  since  then  I have  not  found  it  at  all  satisfactory.  The 
following  is  an  extract  of  a letter  written  to  Dr.  Ivins*  by  Meyer- 
hofer  in  1889:  “In  my  work  you  will  find  (page  48,  par.  148) 

a case  of  recovery  of  phthisis  laryngis  under  the  influence  of  the 
seleniate.  Since  then  this  salt,  though  useful  in  many  other  respects, 
has  disappointed  me  in  this  disease.  Many  other  remedies  are  pre- 
scribed, but  their  sphere  is  mainly  found  in  the  concomitant  lung 
diseases.” 


* Diseases  of  the  Throat  and  Nose , p.  436. 


THE  TREATMENT  OF  CHRONIC  RHINITIS. 


1031 


THE  TREATMENT  OF  CHRONIC  RHINITIS  BY  THE 
HOMCEOFATH. 


By  Charles  E.  Teets,  M.D.,  New  York,  N.  Y. 


In  this  paper  I will  treat  of  two  forms  of  chronic  catarrh — those 
in  which  there  exist  permanent  hypertrophies;  and  those  which  are 
characterized  by  intermittent  swellings  of  the  Schneiderian  mucous 
membrane. 

These  two  forms  are  the  most  frequent  of  all  varieties  of  chronic 
rhinitis. 

In  the  treatment  of  chronic  catarrh,  where  there  exist  obstructions 
of  any  kind,  the  first  step  to  be  taken  is,  to  remove  these  obstruc- 
tions; then,  with  Homoeopathic  remedies,  we  may  expect  favorable 
results.  These  results  we  would  not  obtain  without  this  preliminary 
treatment. 

I know  that  objections  have  been  made  by  some  Homoeopathic 
physicians  to  such  a course;  they  claiming,  that  unfavorable  results 
follow  operative  treatment. 

These  objections,  however,  come  from  those  who  have  had  very 
little  experience,  but  who,  on  the  other  hand,  are  always  heavily 
loaded  with  theories.  The  large  practical  experience  which  I have 
had,  warrants  me  in  saying  that  these  objections  are  unfounded.  I 
shall  prove,  on  the  contrary,  that  only  the  most  favorable  results 
follow  operative  procedures  when  performed  in  a proper  and  skill- 
ful manner. 

It  has  been  said  that,  where  such  line  of  treatment  is  followed,  it 
does  not  differ  from  that  used  by  Old-School  specialists  ; and,  more- 
over, that  it  makes  very  little  difference,  whether  a patient  is  operated 
upon  by  an  Old-School  or  a Homoeopathic  specialist. 

I shall  have  to  take  exception  to  this ; because  the  two  have  dif- 
ferent objects  in  view  ; and  their  respective  operative  procedures  are 
entirely  different. 

In  the  first  place,  the  Old-School  specialist  uses  operative  meas- 


1032  world’s  homoeopathic  congress. 

ures  as  a last  resort,  and  expects  such  measures  will  complete  the 
cure.  This,  it  too  often,  does  not  do.  The  Homoeopathic  specialist, 
on  the  other  hand,  resorts  to  operative  measures  for  the  purpose  of 
paving  the  way  to  future  treatment,  which  must  be  in  part  Homoeo- 
pathic— to  effect  a permanent  cure. 

In  the  second  place,  Old-School  specialists,  as  a general  thing, 
remove  as  much  tissue  from  the  noseas  possible,  leaving  the  cavities 
spacious,  and,  often,  too  much  so.  The  Homoeopathic  specialist,  on 
the  other  hand,  removes  as  little  tissue  as  possible,  and  yet  quite 
enough  to  produce  the  desired  result — which  is,  to  prepare  the  case 
for  future  treatment. 

Having  differentiated  thus  between  the  Old-School  and  the 
Homoeopathic  specialist,  I shall  next  endeavor  to  meet  the  objections 
made  to  operative  treatment,  by  adducing  fads  instead  of  theories. 

It  is  claimed  that  the  removal  of  bone,  cartilage  and  mucous  mem- 
brane, from  the  nasal  cavities,  is  followed,  in  time,  by  their  becoming 
abnormally  large,  and  frequently  results  in  atrophic  catarrh. 

To  the  first  objection,  I will  say  that  it  has  been  proved  to  be 
groundless.  I have  not  one,  out  of  the  large  number  of  cases  upon 
which  I have  operated,  that  presented  results  claimed  above,  after 
the  operation.  In  fact,  in  two  cases  to  which  I wish  to  call  special 
attention,  the  operation  produced  effects  just  the  opposite.  Instead 
of  shrinkage  of  the  parts,  there  was  an  increase  of  tissue,  and  a con- 
sequent narrowing  of  the  nasal  cavity. 

Miss  M.  came  to  me,  complaining  of  an  obstruction  in  the  left 
nasal  cavity.  On  examination,  I discovered  that  -the  septum  was 
slightly  deflected  to  the  left,  while  along  the  cartilaginous  portion 
there  was  a horizontal  ridge,  which  completely  obstructed  the  left 
side.  The  latter  was  removed  and  the  septum  planed  off,  leaving 
the  cavity  large  enough  to  pass  a wooden  plug  one-quarter  inch  wide 
and  one-half  inch  high.  This  was  kept  in  position  for  six  days — 
removing  it  every  other  day  for  antiseptic  cleansing  of  the  parts. 
Three  months  afterwards,  I found  the  nasal  cavity  in  almost  as  bad 
condition  as  before  the  operation  was  performed.  A second  opera- 
tion was  resorted  to.  After  this,  I kept  the  patient  under  observa- 
tion, seeing  her  two  or  three  times  a week.  At  the  end  of  six  weeks, 

I could  see  that  the  cavity  was  gradually  filling  up,  and  that  some- 
thing must  be  done  to  arrest  the  overgrowth  of  tissue.  I then  had 
recourse  to  the  galvanic  cautery,  using  a flat  electrode.  This  was 


THE  TREATMENT  OF  CHRONIC  RHINITIS. 


1033 


effectual,  not  only  in  removing  some  of  the  redundant  tissue,  but 
also  in  arresting  the  further  progress  of  the  growth.  I will  not  tax 
your  patience  with  a description  of  the  second  case,  as  it  was  simi- 
lar to  the  one  just  cited,  and  was  treated  in  the  same  manner,  with 
good  results. 

In  reply  to  the  second  objection — that  operations  on  the  nasal  cavi- 
ties are  frequently  followed  by  atrophic  catarrh,  I would  say,  that 
it  is  without  any  foundation  whatever.  In  twenty-five  cases,  which 
I have  had  the  opportunity  of  keeping  under  observation,  and  which 
I examined  eighteen  and  thirty  months  after  the  operation,  not  one 
presented  any  evidence  of  dryness  of  the  parts  operated  upon,  or  of 
atrophic  catarrh.  In  fact,  it  would  have  been  impossible  for  any 
one  but  the  operator,  to  have  discovered  what  portion  of  the  septum 
had  been  operated  upon,  as  the  mucous  membrane  had  been  repro- 
duced, to  all  appearance  in  its  original  and  normal  condition.  I be- 
lieve, that  all  who  have  had  any  wide  experience  in  operations  upon 
the  nasal  cavities,  will  agree,  that  only  good  can  result  from  a prop- 
erly performed  operation. 

The  failure  to  obtain  good  results  from  operations  of  this  character 
is  due,  in  most  instances,  to  neglected  after-treatment.  Hence  its  su- 
preme importance.  It  must  be  frequent  and  long-continued. 

I am  decidedly  in  favor  of  conservative  surgical  procedures  in 
cases  of  chronic  catarrh  ; but  there  are  only  three  classes  of  cases  in 
which  I would  consider  it  necessary  to  use  operative  measures  : First, 
those  in  which  obstructions  prevent  proper  drainage  of  the  nasal 
cavities;  second,  those  in  which  the  passages  are  so  narrow  that  the 
least  irritation,  whether  the  result  of  atmospheric  changes,  particles 
of  dust  or  irritating  vapors,  causing  swelling  of  the  parts,  and  pro- 
ducing contact  of  the  external  and  internal  walls.  If  left  alone, 
this  would  result  in  adhesion  of  the  parts.  Third,  those  in*  which 
adhesion  of  the  external  and  internal  walls  has  already  taken  place, 
and  to  which  Browne  has  given  the  name  of  Synostosis. 

It  is  not  necessary  that  every  spur  and  ridge  upon  the  septum 
should  be  removed ; nor  is  it  necessary  that  the  septum  should  be 
perfectly  smooth.  It  is  not  good  surgery,  to  hold  that  every  depar- 
ture from  the  right  line  in  the  position  of  the  septum  demands  treat- 
ment. And  here  is  where  a great  many  inexperienced  operators 
make  their  mistake.  It  is  the  neglect  of  not  paying  particular  atten- 
tion to  what  is  proper  and  necessary  to  be  removed  that  justly  brings 


1034 


world’s  homceopathic  congress. 


specialism  into  disrepute.  It  is  desirable,  also,  to  operate  by  .artifi- 
cial light  reflected  from  the  forehead-mirror  ; but  in  that  case  the 
operator  must  be  familiar  with  the  use  of  the  head-mirror,  and  be 
able  instantly  and  automatically  to  follow  any  motion  of  the  patient’s 
head  with  the  directed  illumination  during  the  few  minutes  consumed 
by  the  operation.  Antiseptic  cleansing  of  the  parts  before  operating 
and  during  healing  is  desirable.  The  nasal  cavities  having  been 
cleansed,  the  parts  should  be  thoroughly  ansesthetized,  so  that  all 
pain  may  be  avoided.  This  is  best  accomplished  by  saturating  a 
strip  of  lintine,  about  half  an  inch  wide,  with  a 10  to  20  per  cent, 
solution  of  Cocaine.  This  is  passed  into  the  side  to  be  operated  upon 
by  means  of  a flat  applicator,  and  made  to  cover  the  tissue  to  be  re- 
moved. Satisfied  that  all  sensibility  has  been  destroyed,  we  should 
perform  the  operation  with  as  little  inconvenience  to  the  patient  as 
possible,  selecting  those  instruments  which  will  give  the  least  dis- 
turbance to  the  patient,  consistent  with  the  best  attainable  results. 
The  nasal  saw,  snare,  trephine,  drill,  chisel  and  gouge,  together  with 
various  other  accessories,  have  each  their  proper  place  in  the  domain 
of  nasal  surgery. 

Having  finished  the  operation,  the  next  important  part  is  the  after- 
treatment.  The  results  will  depend  largely  upon  the  attention  paid 
to  it. 

The  conditions  present  in  the  nasal  cavities  will  not  allow  of  an 
antiseptic  dressing  that  may  be  left  there  for  three  or  four  days,  as 
may  be  done  in  other  parts  of  the  body ; but  the  healing  process 
must  go  on  in  the  presence  of  septic  surroundings.  In  consequence 
of  this,  the  patient  should  be  seen  and  treated  every  other  day  for 
two  weeks ; afterwards,  twice  a week,  until  the  healing  process  is 
completed.  During  the  first  week  after  the  operation  I would  ad- 
vise insufflation  of  powdered  Europhen.  In  the  second  week,  and 
until  the  parts  are  completely  healed,  liquid  Petroleum,  to  which  has 
been  added  Calendula  and  Eucalyptol.  By  means  of  an  atomizer 
they  are  easily  brought  into  contact  with  the  membrane  of  the  nasal 
cavities,  and  are  not  only  soothing  to  the  mucous  surface,  but  also 
protect  the  membrane  from  atmospheric  influences.  During  the  first 
week,  Arnica  may  be  employed  with  good  results,  unless  some  other 
remedy  is  plainly  indicated. 

There  are  so  many  medicines  that  can  be  used  locally  in  chronic 
catarrh  that  it  would  consume  too  much  time  even  to  enumerate  them. 


THE  TREATMENT  OF  CHRONIC  RHINITIS. 


1035 


A few  only,  and  the  most  important,  may  be  mentioned  : Menthol, 
Eucalyptol,  Calendula,  Tar,  Thuja,  Carbolic  acid,  Aceto- tartrate  of 
aluminum.  By  various  means,  liquid  Petroleum  will  take  into  solu- 
tion the  drugs  mentioned  and  act  as  a better  medium  than  water, 
with  the  exception  of  the  Aluminum-aceto-tartrate,  which  should  be 
used  in  an  aqueous  solution. 

Some  specialists  have  been  quoted  as  using  Menthol  with  Petro- 
leum in  the  proportion  of  sixty  grains  to  the  ounce,  and  oil  of  Euca- 
lyptus, one  drachm  to  the  ounce.  This  proportion  I consider  far  too 
strong,  as  it  is  not  only  painful  but  irritating  to  the  membrane. 
Menthol  should  not  be  used  in  a proportion  to  exceed  ten  grains  to 
the  ounce,  and  sometimes  five  grains  will  suffice. 

Menthol  is  indicated  in  painful  inflammatory  affections,  and  where 
there  is  frequent  erection  of  the  mucous  membrane,  especially  of  that 
covering  the  turbinated  bodies. 

Eucalyptol  (Sanders)  should  not  be  used  stronger  than  half  a 
drachm  to  the  ounce,  and,  in  some  cases,  ten  drops  are  sufficient.  It 
is  indicated  in  inflammatory  swellings  of  the  mucous  membrane, 
accompanied  by  excessive  secretions. 

Thuja,  combined  with  Petroleum,  has  not  been  mentioned  by  Old- 
School  specialists,  yet  it  is  one  of  the  best  local  remedies  we  have. 
It  is  useful  after  operations  to  assist  the  healing  process,  and  is  also 
indicated  where  there  is  a discharge  of  offensive  purulent  mucus  and 
ulceration  and  scabs  in  the  nostril.  It  has  also  given  satisfactory 
results,  when  not  too  strong,  in  dry  coryza. 

The  Aceto- tartrate  of  aluminum  may  be  used  either  in  solution, 
in  the  proportion  of  one  drachm  to  the  ounce,  or  in  combination 
with  Boric  acid ; equal  parts.  It  has  styptic  and  antiseptic  quali- 
ties, and  is,  therefore,  used  chiefly  to  arrest  haemorrhage  after  oper- 
ations and  for  its  antiseptic  qualities.  It  is,  however,  also  useful  in 
hypertrophic  rhinitis,  a rapid  subsidence  of  the  swelling  being 
brought  about  by  insufflations  of  this  drug  with  Boric  acid  ; equal 
parts,  or  one  to  two. 

Hypertrophy  of  the  mucous  membrane,  covering  the  turbinated 
bodies,  may  be  reduced  either  by  the  galvano-cautery  or  some  strong 
acid.  I know  of  no  acid  that  answers  the  purpose  so  well  as  the 
Trichloracetic.  It  has  an  advantage  over  all  other  acids  of  which 
I have  any  knowledge.  The  pain  produced  by  the  cauterization  is 
insignificant ; the  eschar  which  is  formed  is  uniformly  thick,  is 


1036 


world’s  homoeopathic  congress. 


almost  inodorous,  produces  no  unsatisfactory  action,  and  leaves  no 
unpleasant  after-effects.  Immediately  after  the  application  of  the 
acid  a bright  ivory-white  scab  is  formed,  which  remains  localized  to 
the  point  of  application.  This  latter  quality  is  of  great  advantage, 
as  it  does  not  spread  to  other  parts,  as  do  many  deliquescent  caustics; 
for  instance,  Chromic  acid. 

Special  attention  should  be  paid  to  keeping  spray  tubes  and  in- 
struments clean,  for  back  of  the  unclean  instrument  is  an  unclean 
and  careless  operator. 

Having  journeyed  thus  far  with  the  Old-School  specialist,  oper- 
ating possibly  in  the  same  manner  and  with  the  same  kind  of  instru- 
ments, yet  with  different  objects  in  view,  come  we  to  the  place  where 
we  must  part  company. 

The  Old-School  specialist,  having  finished  the  operation,  and  the 
healing  process  being  completed,  if  the  case  is  not  entirely  cured, 
has  nothing  else  to  resort  to  but  local  remedies.  These,  too  often, 
fail  to  complete  the  cure. 

On  the  other  hand,  the  Homoeopathic  specialist,  having  prepared 
his  case  for  future  Homoeopathic  treatment,  looks  forward  with  con- 
fidence, knowing  that  he  has  a host  of  remedies  which,  if  carefully 
selected  and  applied  according  to  the  principle  of  similia  similibus 
curantur,  will  effect  a permanent  cure. 

There  is  no  branch  of  medicine  in  which  greater  laurels  could  be 
won  for  Homoeopathy,  if  we  were  not  too  conservative,  than  in  this 
branch  of  rhinology. 

After  the  obstructions  have  been  removed,  the  remedies  that  will 
be  found  to  give  the  best  results  are  as  follows : 

Belladonna. — Throbbing  headache;  worse  from  motion  and  lean- 
ing forward  ; tip  of  the  nose  red,  with  burning  in  the  nose;  discharge 
of  mucus  mixed  with  blood.  Especially  useful  in  the  first  and 
second  week  after  operation. 

Kali  Bichi'omicum. — Frontal  headache;  formation  of  hard  plugs 
in  the  nostrils;  dryness  of  the  nose,  with  a feeling  of  pressure  at  the 
root  of  the  nose;  tenacious,  ropy  discharge  from  the  posterior  nares, 
adhering  to  the  pharynx  and  removed  with  difficulty. 

Kali  Iodatum. — Acts  similarly  to  Kali  bichromicum,  except  that 
the  Kali  iodatum  patient  has  more  hypertrophy  of  the  mucous  mem- 
brane of  the  nose;  the  throat  is  dry;  the  glands  enlarged,  or  pre- 
senting some  evidence  of  scrofulous  or  syphilitic  taint. 


THE  TREATMENT  OF  CHRONIC  RHINITIS. 


1037 


Lobelia  Cerulea. — Great  depression  of  spirits ; pain  in  the  left 
side  of  the  head  and  over  the  root  of  the  nose;  first,  itching  and 
tingling  feeling  in  the  left  nostril,  followed  by  frequent  sneezing, 
with  copious  discharge  of  thick  mucus  from  both  nostrils;  nostrils 
very  sensitive,  so  that  inhalation  of  air  creates  a slightly  painful 
feeling.  This  remedy  is  especially  adapted  to  such  cases  as  are  sub- 
ject to  catarrhal  inflammation  of  the  posterior  nares  and  fauces,  and 
in  which  there  appear  upon  the  posterior  and  lateral  walls  of  the 
pharynx  red  elevated  spots. 

Passiflora  Incarnata. — Distressing  pain  at  the  root  of  the  nose; 
complete  stoppage  of  one  or  both  nostrils;  discharge  slight  and 
thick  ; restless  sleep. 

Paris  Quadrifolia. — Pain  in  the  right  temporal  region,  extending 
to  the  frontal  sinus  and  root  of  the  nose;  discharge  of  red  or  green- 
ish mucus  on  blowing  the  nose  ; stuffed  condition  and  fulness  at  the 
root  of  the  nose ; constant  hawking  of  tenacious  mucus ; fauces  dry 
in  the  morning. 

Ilyoscyamus. — Buzzing  and  singing  in  the  ears;  sense  of  smell 
weak;  jerking  pain  at  the  root  of  the  nose;  mucous  membrane  of 
the  nose  dry  ; this  remedy  is  given  by  the  Old-School  when  the 
secretions  are  excessive,  and  there  is  much  restlessness — a few  drops 
of  the  tincture  being  given ; when  the  secretions  are  suppressed, 
especially  after  operations,  it  will  give  good  results  when  given  in 
the  3d  or  6th  potency. 

Spigelia. — Pain  in  the  temple  or  forehead,  extending  towards  the 
eyes;  discharge  thin,  copious,  flows  mostly  through  the  posterior 
nares,  causing  choking  at  night,  and  when  lying  down  ; I have 
verified  the  latter  symptoms  in  my  practice  repeatedly. 

Senecio  Aurens. — Inability  to  fix  the  mind  on  anyone  subject; 
dull,  stupefying  headache;  secretions  slight  or  suppressed;  sneezing, 
burning  and  fulness  in  the  nostrils— the  burning  being  especially 
confined  to  the  naso-pharynx ; dryness  of  the  mouth  and  pharynx; 
some  pain  in  swallowing. 

Thuja. — Pain  at  the  root  of  the  nose;  ulceration  and  scabs  in  the 
nose;  discharge  of  thick,  sometimes  offensive,  green  mucus,  mixed 
with  blood ; red,  itching  eruption  on  the  alse  of  the  nose,  which  is 
frequently  moist. 

Wyethia. — Pain  over  the  right  eye;  pricking,  dry  sensation  in 
posterior  nares ; sensation  as  if  some  foreign  substance  were  in  the 


1038 


world’s  homoeopathic  congress. 


nasal  passages — an  effort  to  clear  them  through  the  throat  affords  no 
relief ; dryness  of  the  fauces,  with  constant  desire  to  clear  the  throat 
by  hemming. 

Besides  these  remedies,  the  following  deserve  due  consideration  : 
Arsenicum,  Ars.  iod.,  Calc,  phos.,  Calc,  carb.,  Calc,  iod.,  Hepar., 
Hydrast.  can.,  Hydrast.  mur.,  Puls.,  Sepia,  Bals.  Peru. 

As  a general  rule,  the  above  remedies  will  be  found  sufficient. 
However,  in  particular  cases,  other  remedies  may  have  to  be  chosen. 

In  addition  to  the  treatment  given  above,  the  nasal  cavities  should 
be  cleansed  once  a day  with  some  non-irritating  solution,  either  with 
a douche,  atomizer,  or  very  small  syringe. 

I always  advise  the  use  of  a small  glass  syringe,  directing  the 
patient,  as  the  piston  or  rod  is  pushed  in  to  gently  snuff  up  the  solu- 
tion, propelling  it  along  the  nose  to  the  naso-pharynx,  cleansing  this 
cavity,  and  allowing  it  to  pass  out  through  the  mouth. 

Discussion. 

George  H.  Quay,  M.D. : I like  the  ring  of  Dr.  Teets’  paper. 
Would  that  every  Homoeopathist  in  the  land  could  read  it  and  profit 
thereby. 

There  are  two  classes  of  men  in  our  school  : one,  who  thinks  that 
every  case  he  has  demands  an  operation,  and  when  he  is  unable  to 
perform  it  must  turn  it  over  to  an  Old-School  surgeon  who  will  not 
even  recognize  him  as  a physician  ; the  other  class,  who  imagine  that 
everything  under  the  sun  is  amenable  to  internal  medication — this 
is  the  class  who,  in  the  main,  bring  our  school  into  disrepute.  We 
accuse  the  Old  School  of  not  investigating,  when  our  own  ranks  are 
full  of  the  same  tribe. 

The  men  in  our  school,  possessing  the  largest  experience  in  the 
treatment  of  catarrhal  troubles  of  the  upper  respiratory  track,  are 
the  ones  who  most  readily  acknowledge  the  need  of  surgical  inter- 
ference in  these  complaints.  In  fact,  there  is  no  rhinologist  of  ex- 
tended experience  but  can  adduce  case  after  case  of  hypertrophic 
rhinitis  that  failed  to  obtain  relief  from  internal  prescribing  alone, 
or  combined  with  spray,  until  redundant  tissue  was  removed.  In 
the  form  of  rhinitis  just  alluded  to,  the  results  following  proper 
operative  treatment  are  often  little  less  than  miraculous. 

There  is  one  condition  that  I think  is  often  overlooked  or  neg- 
lected in  hypertrophic  rhinitis.  I refer  to  the  enlargement  of  the 
posterior  end  of  the  lower  turbinals.  In  my  experience  this  rasp- 
berry-appearing enlargement  is  one  of  the  most  frequent  accom- 
paniments of  hypertrophic  catarrh.  The  quickest  aud  surest  way 
to  reduce  it  is  to  slowly  amputate  with  the  cold  snare. 


THE  TREATMENT  OF  CHRONIC  RHINITIS. 


1039 


In  ca^es  combined  with  sneezing  do  not  fail  to  treat  this  portion 
of  the  lower  turbinal,  and  the  septum  directly  opposite. 

In  regard  to  the  means  of  cauterizing,  I find  nothing  that  gives 
the  pleasure  and  satisfaction  of  the  galvano-cautery.  Acids  I sel- 
dom resort  to,  except  acetic  on  the  septum.  The  fumes  of  chromic, 
in  fact  of  all  acids,  are  too  penetrating.  There  is  another  condition 
frequently  existing  in  chronic  rhinitis  that  causes  much  discomfort. 
I refer  to  hard  pieces  of  mucus  attached  to  the  vault  of  the  pharynx. 
The  remedy  is  the  post-nasal  douche ; sprays  usually  have  no  effect. 
Finally,  do  not  forget  local  cleanliness. 


1040 


world’s  homceopathic  congress. 


NASAL  SURGERY— ITS  USE  AND  ITS  LIMITATIONS. 

By  Eugene  L.  Mann,  M.D.,  St.  Paul,  Minn. 


Advance,  in  the  material  world,  is  always  gradual  and  perma- 
nent. A rock  adds  to  its  size  by  constant  accretions;  a tree  increases 
in  bulk  by  new  growth  each  year;  everything  moves  slowly  and 
surely;  each  advance  is  perfect  in  itself,  and  remains  for  all  time  or 
until  changed  into  other  forms  of  matter. 

Per  contra , advancement  in  the  mental  world  is  seldom,  if  ever, 
slow,  gradual,  and  permanent.  Mental  activity  moves  in  waves,  and 
each  wave  has  its  recoil.  The  early  steps  in  any  movement  may  be 
gradual,  but  a point  is  soon  reached  from  which  a leap  is  made,  and 
the  influence  of  this  has  been  usually  to  advance  too  far,  and  a par- 
tial retreat  has  been  made.  This  is  true  in  all  departments  of 
thought — religious,  scientific,  medical — even  fashions  go  by  fads. 

This  mental  movement  may  often  be  most  fittingly  illustrated  by 
the  pendulum.  It  swings  to  one  extreme,  then  back  to  the  other, 
and  finally  rests  at  a middle  point.  The  illustration  fails  only  in 
that  the  resting-point  is  a step  in  advance  of  the  starting.  The 
fabled  frog,  who  got  out  of  the  well  by  advancing  two  feet  by  day 
and  slipping  back  one  by  night,  is  perhaps  a better  simile. 

For  long  years  the  nose,  considered  as  an  organ  of  the  olfactory 
sense  alone,  was  given  very  little  attention.  The  sense  of  smell, 
while  giving  considerable  pleasure  and  warning  of  danger  from 
products  of  decay  and  disintegration,  was  not  an  important  sense ; 
it  had  no  standard  of  excellence,  and  its  loss  was  unaccompanied 
by  any  serious  distress;  hence,  there  was  little  call  for  its  treat- 
ment. 

At  the  discovery,  however,  of  the  respiratory  function  of  the  nasal 
chambers,  rhinology  sprang  into  existence,  and,  almost  coincidently, 
nasal  surgery.  From  an  organ  of  no  importance,  the  nose  vied  even 
with  the  uterus  in  the  complexity  and  multiplicity  of  the  ailments 
laid  to  its  disorders;  and  with  the  aid  of  a local  anaesthetic  surgical 


NASAL  SURGERY — ITS  USES  AND  ITS  LIMITATIONS.  1041 


treatment  advanced  from  an  occasional  operation  to  remove  polypoid 
growths  to  almost  daily  routine  practice. 

It  is  not  my  purpose  or  intention  to  dispute  the  value  of  nasal 
surgery  ; its  use  is  just  as  much  a part  of  the  title  to  this  paper  as 
its  limitations.  There  can  be  no  doubt  that  it  has  cured  many  cases 
of  chronic  catarrh  ; that  it  has  pointed  the  remedial  way  in  pharyn- 
geal and  laryngeal  cases  which  before  defied  treatment;  that  it  has 
helped  very  materially  in  the  development  of  children  by  placing 
them  in  a condition  to  use  their  lungs,  and  by  their  use  avoid  their 
diseases;  that  it  has  conquered  troublesome  and  persistent  neural- 
gias and  made  the  deaf  to  hear.  These  are  its  achievements.  I will 
not  dwell  upon  them  ; you  all  recognize  them  ; and  to  pronounce  an 
eulogy  on  the  achievements  of  nasal  surgery  would  be  valuable  only 
for  its  rhetorical  merit,  and  that  it  voiced  the  opinion  of  all. 

These  results  have  been  not  only  salutary  but  brilliant  and  imme- 
diate. Few  achievements  in  medicine  are  more  appreciated  by  the 
patient  or  gratifying  to  the  physician  than  the  relief  of  nasal  ste- 
nosis. This  immediate  and  gratifying  result  has  been,  I fear,  an  in- 
centive to  a too  frequent  and  at  times  ill-advised  use.  While  recog- 
nizing the  benefits,  we  must  not  generalize  too  broadly.  Every  case 
of  middle-ear  catarrh  is  not  cured  by  nasal  operation,  nor  is  every 
asthmatic  relieved  of  his  paroxysms.  Further  still,  every  case  that 
goes  from  our  hands  breathing  more  freely  through  the  nostrils  than 
formerly  is  not  permanently  benefited.  To  individualize  cases  is  a 
work  for  the  future.  To  precisionize  our  knowledge  and  be  able  to 
tell  just  what  reflex  symptoms  we  can  relieve  and  just  what  patho- 
logical changes  in  the  nasal  chambers  are  accompanied  by  peculiar 
symptoms,  must  be  a work  of  experience  and  compilation. 

All  physicians  who  do  special  work  in  the  upper  respiratory  tract 
appreciate  the  benefits  of  surgical  measures.  But  what  of  its  limi- 
tations? They  are  just  as  important  as  its  uses.  They  call  for  our 
more  special  attention  because  they  are  not  as  plainly  seen  and  are 
more  concerned  with  ultimate  than  present  results. 

Historically,  nasal  surgery  is  an  outgrowth  of  the  discovery  of  the 
respiratory  function  of  the  nose,  and  of  the  dependence  of  the  health 
of  the  more  delicate  structures  below  upon  the  power  of  the  nasal 
turbinated  bodies  to  warm  and  moisten  the  air  current  before  it 
reaches  the  larynx  and  lungs.  Its  object  is  to  make  possible  this 
respiratory  function;  to  bring  into  service  the  physiological  activity 

66 


1042 


world’s  homoeopathic  congress. 


of  the  turbinated  bodies,  and  it  should  stop  short  of  any  procedure 
that  would  interfere  with  this  physiology.  The  aim  of  nasal  sur- 
gery is  not  to  clear  an  obstructed  nostril,  but  to  restore  normal  physio- 
logical breathing. 

There  are  several  ways  in  which  the  physiological  function  of  the 
turbinated  bodies  is  lost:  first,  by  atrophy  or  loss  of  the  turbinated 
bodies  themselves ; second,  destruction  of  the  natural  sensitiveness 
of  the  mucous  membrane  so  that  it  fails  to  respond  to  the  stimulus 
of  cold  or  dryness;  and  third,  any  obstruction  that  prevents  the  air 
passing  through  the  nasal  chambers. 

The  first  class  includes  atrophic  catarrh,  specific  disease,  etc.  These 
are  unfortunate  cases;  the  turbinated  body  itself  is  wholly  or  par- 
tially lost,  and  little  can  be  done  except  in  a palliative  way;  surgi- 
cal interference,  other  than  the  removal  of  carious  bone,  is  not  to 
be  considered. 

In  the  second  class,  loss  of  sensitiveness  of  the  mucous  membrane, 
may  be  placed  a few  isolated  cases  of  uncertain  origin.  Atrophic 
catarrh  again,  and  those  cases  where,  from  many  and  repeated  cauter- 
izations, the  inside  of  the  nostril  becomes  a mass  of  scar-tissue.  The 
cautery  has  become  so  general  and  cocaine  has  made  its  use  so  painless 
and  easy,  that  it  has  been  much  abused ; it  has  been  used  fearlessly 
and  recklessly  and  by  everybody  without  regard  to  the  destruction 
of  epithelium.  Scar-tissue  is  not  sensitive-tissue,  and  a nostril,  where 
the  surfaces  have  been  broadly  seared  over,  while  it  may  be  more 
spacious  than  formerly,  is  scarcely  more  useful ; the  membrane  has 
lost  its  appreciation  of  the  stimulus  of  cold,  and  the  turbinated  bodies 
are  not  aroused  into  activity.  In  cauterizing,  much  more  is  gained 
by  burning  deeply  but  not  broadly;  the  contraction  following  is 
greater,  and  the  mucous  membrane  is  left  almost  intact,  and  its  sensi- 
tiveness preserved. 

The  third  class  embraces  all  cases  where  the  air  cannot  pass  through 
the  nostrils,  and  hence  does  not  come  under  the  influence  of  the 
turbinated  bodies.  It  is  in  this  class  of  cases  that  nasal  surgery  has 
won  its  laurels,  and  its  achievements  have  been  so  brilliant  that  we 
have  at  times  been  carried  away  by  them,  and  aimed  to  restore  the 
nasal  spaces  rather  than  the  respiratory  function  ; as  the  late  Sir  Mor- 
rell McKenzie  once  said,  the  nasal  spaces  have  been  cleared  with  an 
energy  that  would  do  credit  to  a backwoodsman.  When  a nasal  or 
post-nasal  tumor  exists  it  should  be  removed;  a deviated  septum, 


NASAL  SURGERY — ITS  USES  AND  ITS  LIMITATIONS.  1043 


when  it  obstructs  the  air-current,  should  be  straightened ; hypertro- 
phied mucous  membrane  should  be  reduced  in  the  way  that  will  do 
the  least  injury  to  the  turbinated  bodies.  I believe,  that  where  sep- 
tal spurs  coexist  with  enlarged  turbinated  bodies,  it  is  better  surgery 
to  operate  from  preference  on  the  septal  tissue  and  preserve  the  tur- 
binated bodies  intact.  In  those  cases  where  the  obstruction  is  caused 
by  a projection  of  the  turbinated  bone  into  the  lumen  of  the  nostril, 
we  are  sorely  tempted.  The  removal  of  the  bone  and  turbinated 
body  “in  toto”  would  have  an  immediately  gratifying  effect  upon 
the  patient,  but  in  gaining  this  we  have  removed  the  physiological 
respiratory  organ  of  the  nose;  we  have  also  produced  a nostril  of 
enlarged  calibre  and  dry,  and  the  ultimate  result  is  retained  hardened 
secretions  and  atrophy.  Instead  of  restoring  nasal  respiration  we 
have  destroyed  it,  and  destroyed  it  permanently.  A patient  had 
better  go  through  life  with  a partially  obstructed  nostril  than  become 
a sufferer  from  atrophic  catarrh. 

Nasal  surgery  has  achieved  wonders ; it  has  brought  great  relief, 
and  to  many ; but  the  very  fact  of  its  great  use  has  led  to  its  abuse. 
Patients  are  to-day  sighing  for  portions  of  their  anatomy  sacrificed 
to  the  temporary  relief  of  free  nasal  spaces. 

In  deciding  upon  operative  procedures,  let  us  consider  not  only 
present  effects  but  ultimate  results.  Bear  in  mind,  that  tissue  once 
removed  is  tissue  lost  and  cannot  be  regenerated  ; that  a nasal  space 
too  large  is  a more  serious  condition  than  one  too  narrow,  for  en- 
larged calibre  means  lessened  air-blast  and  imperfect  cleansing,  and 
retained  secretions  soon  dry  and  produce  atrophy. 

Recognizing  these  possible  and  ultimate  results  as  a warning 
against  too  great  zeal,  let  our  aim  always  be  to  restore  the  physiology 
of  the  nose  as  an  organ  of  respiration ; and  warned  on  the  one  hand 
and  guided  on  the  other,  we  are  safe  from  temptation  and  a more 
lasting  good  to  our  patients. 


REPORT 


OF  THE 

SECTION  IN  PAEDOLOGY. 


Chicago,  III.,  June  3,  1893. 

The  Section  in  Paedology  held  its  meeting  in  Hall  29  of  the  Art 
Building,  and  was  called  to  order  at  11  o’clock  a.m.  The  Section 
was  presided  over  by  Emily  Y.  Pardee,  M.D.,  of  South  Norwalk, 
Conn.,  Chairman,  who  opened  the  proceedings  by  delivering  her 
Sectional  Address. 

“ Prenatal  Medication,”  was  the  subject  of  the  next  paper,  which 
was  read  by  its  author,  Millie  J.  Chapman,  M.D.,  of  Pittsburgh, 
Pa.  Following  the  reading  of  the  paper  there  was  a discussion  par- 
ticipated in  by  Drs.  George  B.  Peck,  of  Providence,  R.  I.,  Phoebe 
J,  B.  Waite,  of  New  York,  N.  Y.,  Bushrod  W.  James,  of  Philadel- 
phia, Pa.,  W.  P.  McCracken,  of  Chicago,  111.,  G.  W.  Bowen  of  Fort 
Wayne,  Ind.,  Alfred  E.  Hawkes,  of  Liverpool,  Eng.,  J.  H.  Henry, 
of  Montgomery,  Ala.,  J.  A.  Whitman,  of  Beaufort,  S.  C , and  A. 

M.  Duffield,  of  Huntsville,  Ala. 

“ Rachitis,”  a paper  by  Robert  N.  Tooker,  M.D.,  of  Chicago,  111., 
was  presented  by  its  author,  and  was  discussed  by  Drs.  B.  W. 
James,  of  Philadelphia,  Pa.,  A.  M.  Duffield,  of  Huntsville,  Ala., 
C.  D.  Crank,  of  Cincinnati,  Ohio,  and  by  the  author  of  the  paper. 

“The  Awkward  Gait  of  Children,”  was  the  title  of  a paper  writ- 
ten and  forwarded  by  Sidney  F.  Wilcox,  M.D.,  of  New  York, 

N.  Y.  In  the  absence  of  the  author,  it  was  read  by  the  Secretary  of 
the  Section.  Discussion  of  the  essay  was  by  Drs.  Sarah  J.  Millsop, 
of  Bowling  Green,  Ky.,  William  D.  Gentry,  of  Chicago,  111.,  and 
Gertrude  G.  Wellington,  also  of  Chicago. 

The  Chairman  announced  that  she  had  a paper  from  Dr.  George 
E.  Gorton,  of  Albany,  N.  Y.  The  paper  had  been  presented  at  a 
meeting  of  Allopathic  physicians  at  Albany.  The  chair  said,  in 
presenting  it,  “ I should  like  to  leave  it  to  your  discretion  whether 


REPORT  OF  THE  SECTION  IN  PAEDOLOGY. 


1045 


it  shall  be  read  or  referred  to  the  Committee  of  Publication  after  it 
has  been  printed  in  the  Medical  Record” 

Dr.  Phillips  : There  is  a rule  that  no  paper  previously  published 
is  admissible  into  our  Proceedings. 

A motion  was  made  and  adopted  that  the  paper  be  not  received. 

“ Contagion  in  our  Public  Schools  and  its  Prophylaxis,”  by  Lucy 
Chaloner  Hill,  M.D.,  of  Fall  River,  Mass.,  was  read,  and  was  after- 
wards discussed  by  Dr.  George  B.  Peck,  of  Providence,  R.  I. 

“ Some  Notes  upon  Headaches  in  Children,”  by  Girard  Smith, 
M.R.C.S.,  of  London,  Eng.,  was  read  by  Alfred  E.  Hawkes,  M.D., 
of  Liverpool,  Eng.,  and  was  discussed  by  Drs.  Phoebe  J.  B.  Waite, 
of  New  York,  N.  Y.,  A.  M.  Duffield,  of  Huntsville,  Ala.,  and  by 
a physician  whose  name  was  not  mentioned. 

The  following  papers  were  then  presented  by  title  and  referred  for 
publication  : 

“ Albuminuria  in  Children,”  by  Henry  C.  Aldrich,  M.D.,  of 
Minneapolis,  Minn. 

“ The  Treatment  of  Meningocele,  Encephalocele  and  Hydren- 
cephalocele,  by  Means  of  a Collodion  Cap,”  by  J.  Martine  Kershaw, 
M.D.,  of  St  Louis,  Mo. 

“ Albuminuria  in  Children,”  by  William  W.  Van  Baun,  M.D., 
of  Philadelphia,  Pa. 

The  Sectional  Meeting  was  then,  on  motion,  adjourned. 


1046 


world’s  homceopathic  congress. 


SECTIONAL  ADDRESS  IN  PAEDOLOGY. 

By  Emily  V.  Pardee,  M.D.,  South  Norwalk,  Conn.,  Chairman. 


“Do  you  hear  the  children  crying,  O my  brothers, 

Ere  their  sorrow  comes  with  years? 

They  are  leaning  their  young  heads  against  their  mothers, 

And  that  cannot  stop  their  tears.” 

Do  you  question  why  they  have  such  sad  and  sunken  faces. 

Why  they  weep  so  bitterly  ? 

’Tis  because  the  Old-School  doctor  tends  their  cases 
And  they  never  lasted  Homoeopathy.” 

Mrs.  Browning’s  part  of  this  poem  prompts  my  almost  invol- 
untary continuation,  for  her  words  so  strongly  suggest  a dearth  of 
Homoeopathy,  or  ignorance  of  its  efficacy ; indeed  our  School  had 
not  at  that  time  attained  the  reputation  in  treating  the  diseases  inci- 
dent to  childhood,  which  it  now  enjoys.  Children  were,  as  Mrs. 
Browning  expressed,  “ Martyrs  by  the  pang  without  the  palm.” 

There  is  no  department  in  medicine  more  significant,  none  com- 
manding more  honest  work  and  study,  none  where  progress  is  more 
constant,  and  where  the  beneficence  of  our  School  is  more  apprecia- 
ted by  the  world,  than  the  department  over  which  you  have  asked 
me  to  preside  to-day. 

I will  not  review  in  detail  the  progress  in  literature  and  scientific 
research  ; in  the  discovery,  development,  and  proving  of  drugs,  and 
mechanical  appliances  with  which  the  past  year  has  been  pregnant. 
This  advance  has  been  referred  to  from  every  bureau  since  last 
Monday  morning,  and  at  this  hour,  Saturday  afternoon,  I feel  like 
the  ninth  orator  at  a temperance  mass  meeting.  Everything  has 
been  said  and  well  said,  and  my  repetition  would  only  emphasize 
the  old  truth  that  “ great  minds  run  in  the  same  canal.”  I cannot, 
however,  forbear  mentioning  the  most  notable  discoveries  in  our 
Materia  Medica,  which  are  now  being  made  by  the  Old  School  and 
are  incorporated  into  their  literature  as  comfortably  as  the  Sandwich 
Islands  annexed  themselves  to  our  United  States.  It  is  but  a few 


SECTIONAL  ADDRESS  IN  PiEDOLOGY. 


1047 


years  since  it  was  announced  in  one  of  their  leading  journals,  that 
some  profound,  but  perfectly  regular  thinker  had  demonstrated  that 
minute  doses  of  Ipecac  would  arrest  vomiting,  and  that  Pulsatilla 
would  correct  menstrual  irregularities,  and  later  that  Gelsemium  was 
relative  to  hysteria,  and  many  other  like  discoveries  of  our  proven 
remedies.  Grasping  at  these  abstract  facts,  and  prescribing  the 
mother  tincture  in  heroic  doses,  has  resulted  in  much  mischief  in 
their  hands.  Perhaps  a few  years  hence  some  ambitious  Yankee 
may  start  out  and  discover  America,  and  scoff  at  Columbus  because 
he  did  not  espy  Chicago  in  fact,  as  seen  at  the  World’s  Fair. 

The  successful  persistent  advance,  which  has  been  our  watchword 
ever  since  the  master  expounded  our  law  of  cure,  is  the  one  cause  of 
jealousy  to  our  medical  opponents.  If  we  would  stand  still  in  the 
very  footprints  where  Hahnemann  left  us,  and  not  attempt  to  fur- 
ther the  great  truth  he  discovered  and  outlined  for  us,  there  would 
be  little  to  disturb  their  envy,  and  the  field  of  advance  would  be  left 
to  their  own  ambition.  Did  that  grand  and  brave  man,  with  pro- 
phetic mind,  suppose  that  we,  as  physicians,  would  stand  by  a case 
of  obstipation,  caused  by  roast  clams  and  old  cheese  perhaps,  and 
wait  for  Sulphur  or  Nux  vomica  to  act;  or  did  he  trust  that  with 
judgment  untramelled  we  would  use  mechanical  auxiliaries?  Not 
Calomel  or  live  frogs  perhaps,  but  whatever  the  case  in  hand  calls 
for.  Would  he  have  us,  in  the  case  of  the  passage  of  biliary  cal- 
culi, wait  for  China  to  act,  or  assist  nature  by  the  use  of  Glycerine 
or  Olive  oil  internally  and  externally,  and  possibly  to  further  relax 
the  tubes  by  anaesthetics?  Would  he  have  us  satisfied  with  the 
provings  of  his  brief  life,  or  develop  and  enlarge  our  Materia  Medica 
by  annual  and  faithful  work?  We  want  no  “ nickel  in  the  slot” 
physicians,  but  personal  workers  every  one. 

Do  our  opponents  adhere  to  the  superstitions  in  vogue  in  the  days 
of  Hippocrates  and  Galen,  and  keep  themselves  fenced  in  by  the 
ignorance  and  delusions  of  that  age?  Why  no.  The  lancet  and 
nostrums  of  the  eighteenth  century  are  unknown  to  the  practitioners 
of  to-day,  and  their  pocket  cases  are  filled  with  our  remedies  which 
we  have  been  years  in  proving.  Our  modes  and  medicines  are 
adopted  by  the  advanced  minds  of  the  opposing  school ; and  that 
is  right;  let  them  learn  of  us  if  so  be  the  world  is  benefited 
thereby. 

To  this  I must  add  that  some  of  our  own  learned  physicians  “ad- 


1048 


world’s  homoeopathic  congress. 


vance  backward,”  and  use  thi  chemical  combinations  made  to  simu- 
late our  remedies,  and  which  would  deceive  the  very  elect  by  the 
versi-colored  tablets,  which  are  of  themselves  works  of  art.  “It  is 
easier  and  quicker,”  say  they,  and  if  such  national  calamity  ever 
occurs,  as  has  been  predicted  by  our  opponents  for  half  a century, 
as  that  Homoeopathy  dies , it  will  be  on  account  of  the  unfaithful 
haste  of  its  busy  advocates.  Every  work  done  with  fidelity  needs 
time  and  care,  and  we  should  aim,  when  we  take  a comfortable  fee 
for  a visit,  that  we  give  in  return  an  equal  amount  of  comfort. 
With  sick  children,  a prescription  of  medicine  does  not  end  our  duty, 
especially  when  the  mothers  are  themselves  only  grown  children. 
We  must  not  ignore  the  details  of  the  clothing,  the  food-tray,  the 
sleeping  apartment,  the  play-ground,  and  even  the  play-mates.  It 
all  takes  time  and  vitality,  and  we  all  take  pay  for  just  those  com- 
modities. We  can,  with  good  results,  also  prescribe  for  the  young 
mothers  that  they  read  Dr.  Winterburn’s  magazine,  Childhood  (I  do 
not  expect  to  get  a cent  for  this  advertisement !). 

Our  beloved  Dr.  Lilienthal  once  said  in  a lecture,  “ When  called 
to  see  a sick  child  on  general  principles,  it  is  always  safe  to  order  a 
bath,  because  many  times  it  is  indicated  and  many  times  it  is  such 
a treat,  as  the  child  never  had  one  before.”  That  seems  exaggera- 
tion, but  early  in  my  practice  I was  called  to  a very  comfortable 
home  to  see  a child  8 months  old  given  up  to  die  of  croup  by  an 
Old-School  doctor ; and  when  I ordered  a hot  bath  the  mother, 
grandmother,  and  nurse  all  informed  me  in  a breath  that  the  babe 
was  “not  a year  old,”  and  further  explained  that  they  had  always 
understood  that  water  must  never  touch  the  body  of  a child  under 
twelve  months.  I superintended  a thorough  bath,  while  the  family 
quaked  with  fear,  but  that  baby  is  now  alive,  and  I have  taught  her 
to  tell  this  story. 

Upon  one  occasion  I was  called  where  two  children  had  malignant 
diphtheria,  the  third  one  having  died.  The  attending  physician  was 
himself  taken  suddenly  sick  (and  I did  not  blame  him  for  so  doing), 
when  I was  called  to  take  charge  of  his  cases.  The  family  was  one 
of  wealth,  and  their  apartments  were  large  and  well  appointed  ; still, 
I could  not  quiet  an  odor  that  rose  above  all  other  smells,  nor  could 
I quite  determine  its  origin.  The  closet  door  was  “ on  a crack  ” and 
I peered  in.  On  the  floor  lay  the  wearing  apparel  taken  three  days 
previous  from  the  dead  child,  and  which  the  distracted  mother 


SECTIONAL  ADDRESS  IN  PAEDOLOGY. 


1049 


“ could  not  make  up  her  mind  to  have  touched.”  Now,  1 ask,  of 
what  avail  would  medication  have  been  so  near  communication  with 
this  seething  heap  of  germ  culture?  It  all  took  time,  and  there  was 
danger  of  its  taking  our  vitality  also. 

Again,  I believe  we  are  too  apt  to  trust  too  largely  to  nurses.  I 
confess  a good  nurse  helps  out  a poor  doctor  wonderfully.  I have 
seen  it  often  in  my  own  practice.  But  nurses  are  not  popes,  and 
they  may  be  human.  They  expect  us  to  direct  them,  and  if  we  fail 
to  do  so  the  blame  is  ours.  In  prescribing  for  children,  we  should 
always  bear  in  mind  any  family  taint  or  predisposition  to  constitu- 
tional diseases,  and  point  at  the  hereditary  or  congenital  diseases  by 
way  of  the  acute  malady.  Thus  we  often  check  serious  ills  and  get 
no  credit  for  it  save  on  our  own  conscience  books,  which  our  account- 
ants never  balance. 

In  the  treatment  of  children’s  diseases,  Homoeopathy  has  placed 
its  patrons  under  lasting  obligations  by  its  ability  to  cope  success- 
fully with  diseases  formerly  considered  fatal,  and  an  imperishable 
monument  is  reared  in  the  hearts  of  those  who  witness  to  the 
honesty,  learning,  and  industry  of  the  followers  of  Hahnemann. 
I say  most  humbly,  “Thanks  be  to  God  who  giveth  us  the  victory  ” 
over  disease. 

Let  us  not  forget  to  be  humanitarians  as  well  as  scientists  in  our 
care  of  the  little  ones,  and  never  resort  to  surgery  in  croup  or  pleu- 
ritic effusions  until  we  have  conscientiously  asked  and  answered  the 
question:  would  we  risk  this  little  life  if  it  were  our  own  child  ? It 
is  ours  to  sacrifice  for  our  clientele,  but  not  to  sacrifice  their  lives  on 
the  altar  of  experiment. 

The  future  is  ours,  and  so  is  the  continued  labor  which  alone  will 
keep  us  moving  onward.  Intelligence,  learning,  moral  integrity, 
and  personal  merit  will  be  recognized. 

So  tell  the  children,  O my  brothers, 

To  sing  like  little  thrushes  in  their  play, 

For  this  same  school  that  blesses  many  others, 

Will  bless  them  another  day. 


1050 


world’s  homoeopathic  congress. 


PRE-NATAL  MEDICATION. 


By  Millie  J.  Chapman,  M.D.,  Pittsburgh,  Pa. 


The  education,  evangelization  and  more  thorough  civilization  of 
the  world  demands  strong,  healthy  people. 

A large  percentage  of  all  children  born  cease  to  live  before  the 
fifth  year.  Of  those  surviving,  many  are  suffering  from  disease 
which  unfits  them  for  usefulness.  If  by  any  means  we  may  increase 
the  standard  of  health  among  children  such  efforts  make  us  public 
benefactors. 

The  knowledge  that  we  have  saved  a sick  child  for  its  mother 
brings  as  great  reward  as  follows  a brilliant  operation  ; but  the  con- 
sciousness of  having  aided  the  mother  in  developing  a strong,  well 
child  should  bring  increasing  interest  and  satisfaction. 

When  children  are  well-born  and  permitted  to  live  in  good  sur- 
roundings, having  correct  diet,  dress  and  care,  medication  is  uncalled 
for.  It  is  a truism  that  every  child  has  a right  to  thus  enter  life, 
but  of  the  hosts  as  we  meet  them  it  is  difficult  to  recognize  health  of 
infant  or  parent.  It  is  well  known  that  perfect  health  of  nerves  for 
the  mother  ensures  normal  position  and  presentation  of  the  foetus 
and  makes  labor  a physiological  process.  Humanity  as  yet  cannot 
yall  claim  perfect  health  of  nerve  or  development,  and  we  oftener 
meet  an  abnormal  nervous  state  which  if  continued  leaves  a lasting 
impress  upon  the  child.  Many  a case  of  wakefulness  or  restless 
irritable  child  has  no  other  aetiology.  We  have  had  valuable  instruc- 
tion upon  “ Preparation  for  Motherhood,”  but  we  should  not  lose 
sight  of  the  fact  that  every  child  has  two  parents,  and  disease  or  un- 
healthful tendency  of  either  or  both  is  of  equal  importance  and 
should  receive  medical  supervision. 

Prophylactic  medicine  is  of  the  greatest  importance.  Preserving 
health  is  more  desirable  for  the  individual  and  society  than  restoring 
health.  The  writings  of  Hahnemann  reveal  his  purpose  to  not  only 
cure  disease,  but  to  eradicate  the  tendency  thereto.  Following  the 


PRE-NATAL  MEDICATION. 


1051 


instructions  of  this  renowned  teacher  one  may  relieve  present  suffer- 
ing and  also  modify  the  blight  of  inheritance.  After  an  observation 
and  experience  of  years,  I am  convinced  that  every  prescription  which 
corrects  an  idiosyncrasy  or  constitutional  disturbance,  contributes  to 
a better  state  of  the  future  progeny. 

If  it  is  better  for  a child  when  his  training  begins  a century  be- 
fore his  birth,  how  much  more  perfect  will  he  be  when  his  medica- 
tion is  started  at  the  same  time.  If  such  training  and  treatment 
were  continued  for  a few  generations  every  abnormal  condition 
might  be  corrected,  and  healthy  parentage  would  be  the  rule  instead 
of  the  exception.  It  is  no  longer  considered  necessary  for  woman 
to  suffer  the  numerous  complications  of  pregnancy  for  medical  skill 
is  able  in  a large  degree  to  modify  or  wholly  remove  the  painful 
states.  It  will  soon  be  recognized  that  medicine  should  be  adminis- 
tered, hoping  to  benefit  the  coming  child.  We  can  offer  no  univer- 
sal panacea  for  inherited  ills  or  congenital  defects,  but  would  call 
your  attention  to  the  marked  improvement  possible  to  many  cases. 

We  conclude  that  potentized  remedies  will  correct  anatomical  or 
structural  deficiencies  from  knowing  that  Calcarea  carb.  30  given 
in  the  morning,  and  Sulphur  30  in  the  evening,  two  weeks  out  of 
each  month  of  pregnancy  resulted  in  a perfect,  healthy  child  where 
others  preceding  it  had  cleft  palate  or  hare  lip.  Calc.  phos.  and 
Sul.  given  as  above  during  seven  months  was  followed  by  a perfect 
child  where  the  former  one  had  spina  bifida,  talipes  and  muscular 
weakness. 

Graphites,  Lachesis,  Apis  and  Petroleum  have  at  different  times 
not  only  relieved  the  suffering  of  pregnant  women,  but  so  changed 
the  embryo  and  developing  foetus  that  the  unsightly  eczema  afflict- 
ing former  children  failed  to  appear.  Tuberculous  parents  having 
one  or  more  children  who  suffered  from  acute  hydrocephalus,  have 
later  received  Calcarea  phos.,  Sil.  or  Sul.  during  the  term  and  these 
children  not  only  escaped  the  common  perils  of  dentition,  but  re- 
sisted the  floating  germs  of  contagious  diseases,  even  the  Klebs- 
Loeffler  bacillus  finding  no  habitation.  Able  writers  report  instances 
where  one  parent  contracted  syphilis  before  marriage  and  the  child- 
ren were  classed  as  premature  labors  or  still  births,  but  they  changed 
the  record  to  that  of  living  children  by  a course  of  pre-natal  medi- 
cation. While  much  may  be  done  in  way  of  remedies  and  diet  for 
rachitis,  more  may  be  accomplished  by  medication  of  the  mother  be- 


1052 


world’s  homoeopathic  congress. 


fore  the  child’s  birth,  giving  her  health  that  she  will  not  transmit  a 
tendency  to  such  weakness.  Injuries  do  not  develop  this  malady  in 
a child  of  perfect  health.  We  may  not  only  give  ante-partum  medi- 
cation to  avoid  a repetition  of  ailments  developed  in  children  previ- 
ously born  as  the  celebrated  Von  Grauvogl  advised,  but  by  timely 
attention  we  may  secure  health  for  the  first  child.  We  would,  if 
possible,  have  pregnancy  begin  with  perfect  health,  physical  and 
mental,  of  both  parents.  Human  perfection  does  not  exist,  but  we 
may  strive  for  it  by  removing  the  abnormal  conditions  as  we  are 
permitted.  She  may  not  be  the  greater  invalid,  but  we  have  more 
frequent  opportunity  of  influencing  the  mother’s  system.  Every 
evidence  of  disease  in  her  which  is  recognized  and  overcome  during 
its  intra-uterine  existence  gives  the  infant  increased  advantage  at 
birth. 

If  conception  occur  where  marriage  was  prescribed  as  a cure  for  ex- 
isting suffering  dependent  upon  inflammation  or  spasmodic  nerve 
action,  we  may  expect  accidents  during  the  term  and  lying-in  for 
the  mother,  and  many  nervous  disturbances  for  the  infant.  There 
is  a form  of  infantile  paralysis  due  to  injury  of  the  nerves  of  the 
brachial  plexus,  caused  by  stretching  of  the  nerve- roots,  on  account 
of  the  position  of  the  head  during  labor.  To  one  who  has  witnessed 
a faulty  presentation  restored  by  the  action  of  remedies  upon  nerves 
and  uterine  muscles,  this  calamity  seems  to  be  an  avoidable  one. 

We  approve  of  all  sanitary  and  hygienic  influences  for  the  coming 
mother;  would  be  glad  if  every  one  had  daily,  in  unlimited  quan- 
tities, both  sunshine  and  love,  for  these  make  her  willing  to  endure 
and  able  to  meet  difficulties;  but  combined  with  all  these,  and  greater 
in  power,  is  the  influence  of  the  truly  indicated  remedy.  In  physi- 
cal or  mental  irritation,  our  Materia  Medica,  with  all  its  imperfec- 
tions, guides  us  to  measures  which  correct  for  the  time,  and  if  con- 
tinued cure  the  disease. 

Sometimes,  when  a woman  becomes  conscious  that  she  is  pregnant, 
she  looks  forward  to  nearly  a year  of  discomfort ; then,  a period  of 
greater  suffering  ending  in  death,  or,  if  not,  a continuance  of  inval- 
idism, increased  burdens  and  anxiety,  without  the  protection,  consid- 
eration, and  tenderness  of  her  life-companion  which  reconciles  many 
to  endure  the  inevitable,  and  in  her  agony  she  gives  expression  to 
the  accumulated  unreasonableness  of  generations  of  her  ancestors. 

The  mental  state  varies  from  a generally  unhappy  condition  to 


PRE-NATAL  MEDICATION. 


1053 


that  degree  of  insanity  which  makes  her  hate  the  coming  child,  and 
willing  to  risk  closing  her  own  life  to  accomplish  its  death  and  pre- 
mature delivery.  These  deep  emotions  impress  the  character  of  the 
child  she  fails  in  destroying,  and,  more  frequently  than  many  know, 
gives  bent  to  the  mind  of  a cruel,  hard  character,  an  outcast  and 
murderer.  The  intensity  of  the  evil  may  be  increased  by  the  united 
purpose  of  both  parents  to  limit  foetal  life.  “Some  biogenic  particle 
goes  astray  and  through  transmission  impresses  its  moral  bias  upon 
the  erring  offspring.” 

I have  seen  so  often  the  action  of  our  remedies  remove  the  feelings 
of  hate,  dread  or  fear,  that  to  me  it  is  evident  we  need  only  a closer 
study  of  indications,  and  their  application,  to  produce  a surprisingly 
improved  condition  of  the  moral  tone  of  society.  If  half  the  time 
and  energy  spent  in  visiting  prisons  and  in  behalf  of  ex-convicts 
were  devoted  to  soothing,  making  comfortable,  and  curing  the  morbid 
fears  of  pregnant  women,  we  should  have  less  demand  for  institu- 
tions for  the  feeble-minded,  children’s  hospitals,  reform  schools,  and 
penitentiaries. 

If  we  would  have  health  of  the  whole  organism,  a well-balanced, 
even  character,  every  organ  performing  its  function,  every  inclina- 
tion toward  normal  conduct,  we  cannot  too  early  begin  the  treatment 
of  these  morbid  feelings.  A close  study  of  our  provings  enables  us 
to  see  a similar  in  some  of  the  following  medicines,  which  you  will 
see  are  nerve  remedies  for  these  disturbances  or  neuroses  : Actea  rac., 
Ars.  alb.,  Cham.,  Coffea,  Beil.,  Hyos.,  Stram.,  Nux  vom.,  Plat.,  Ana- 
card.,  Magnesia  phos.,  and  Kali.  phos. 

Then,  we  would  have  pre-natal  medication  begun  with  the  birth 
of  the  parents,  and  wisely  continued  until  each  wife  in  full  develop- 
ment, free  from  disease,  with  active  brain  and  moral  strength,  is 
able  to  meet  wifehood  and  motherhood  with  never  a term  in  the 
hospital  nor  attention  of  surgeon,  until  she  may  feed  her  own  child 
without  poisoning  its  system  or  morals,  or  exhausting  her  strength; 
and  until  each  husband  shall  have  brain,  nerve,  muscle,  and 
lymphatics  in  such  normal  action  that  he  will  not  transmit  weakness 
of  character  nor  seeds  of  death. 

Discussion. 

Geo.  B.  Peck,  M.D. : The  object  for  which  the  admirable  paper 
to  which  we  have  just  listened  was  written  commends  itself  to  all, 
while  the  possibility  of  its  accomplishment,  even  in  part,  and  the 


1054 


world’s  homoeopathic  congress. 


efficacy  of  methods  recommended  may  be  doubted  by  many.  The 
reasonableness,  therefore,  of  its  teaching  alone  requires  consideration. 

In  a New  England  city,  in  May,  1848,  a young  wife  lay  upon  a 
sick-bed  covered  with  the  characteristic  eruption  of  measles  in  its 
most  intense  form  from  head  to  foot,  and  expecting  hourly  the  ad- 
vent of  her  first-born.  The  husband  was  informed  he  could  not 
expect  the  preservation  of  either.  Promptly  on  time  a girl  appeared 
as  roseate  hued  as  the  parent.  The  daughter  fell  a victim  to  Allo- 
pathic medication  three  months  prior  to  the  completion  of  her 
twenty-third  year.  The  mother  is  still  living.  Now,  if  it  was  pos- 
sible for  morbific  gems  or  their  products  to  enter  that  uterus  and 
produce  upon  its  inmate  the  same  phenomena  exhibited  upon  its 
possessor,  with  equal  rapidity,  and  at  the  same  time  it  can  be  no  less 
possible  for  our  finely  comminuted  preparations  to  penetrate  equally 
deep  and  perform  their  appropriate  functions. 

But,  again,  we  know  that  growth  and  development  depend  upon 
that  intangible  something,  for  convenience  denominated  nerve  force; 
that  variations  in  the  quality  or  intensity  produce  corresponding 
variation  of  result;  that  even  maternal  mental  emotion  leaves  its 
impress  on  the  offspring.  We  also  know  that  we  have  power  to 
produce  variations  in  the  nerve  force  at  will ; that  we  can  produce 
mental  impressions  at  will.  Failure,  then,  to  apply  this  knowledge 
can  only  be  ascribed  to  indifference  to  the  new-born  or  to  professional 
incapacity. 

Regard ing  the  particular  attenuations  recommended  it  need  only 
be  said  that  too  many  observations  have  been  made  and  recorded  of 
physiological  phenomena  and  drug  aggravations  produced  by  Ho- 
moeopathic preparations  above  the  twelfth  decimal  to  permit  any 
doubt  of  its  efficiency  to  be  considered  reasonable.  It  may  be  added 
that  the  physician  who  prescribes  even  occasionally  any  preparation 
above  the  twelfth  decimal  attenuation  unwittingly  adds  his  endorse- 
ment of  that  statement,  and  I am  inclined  to  count  in  with  them  all 
those  who  prescribe  above  the  sixth  decimal. 

I cordially  and  fully  endorse  Dr.  Chapman’s  paper,  including  the 
reference  to  the  importance  of  paternal  medication.  “ Whatsoever  a 
man  (or  woman)  sows  that  shall  he  (she)  also  reap ! ” 

Phoebe  J.  B.  Waite,  M.D.  : I would  like  to  have  heard  Dr. 
Chapman’s  paper  before  beginning  my  speech.  I would  like  to  have 
had  a copy  of  it  and  committed  it  to  memory.  It  is  too  valuable  to 
lose  any  part  of  it.  The  father  of  medicine,  Esculapius,  lived,  we 
are  told,  I think,  somewhere  about  nine  hundred  years  before  Christ. 
He  had  five  children,  three  sons  and  two  daughters,  and  all  these 
children,  admiring  the  skill  of  their  father  in  medicine,  took  to 
medicine,  the  whole  five,  the  sons  and  the  daughters.  From  the 
three  sons  have  descended  all  the  doctors  of  the  world,  that  is,  men 
doctors.  There  weren’t  women  doctors  then.  And  while  these  doc- 


PRE-NATAL  MEDICATION. 


1055 


tors  in  medicine  were  a long  time  getting  around,  you  see  the  woman 
has  got  there  just  the  same.  So  here  we  are  descended  from  these 
two  beautiful  daughters  of  E-culapius ; the  one  believed  in  preven- 
tive medicine,  and  the  other  in  curative  medicine.  I did  not  read 
that  these  sisters  ever  came  into  collision  in  their  practice,  but  their 
fame  has  come  down  to  us.  Hygeia,  the  beautiful  daughter  of  Es- 
culapius,  advocated  the  use  of  a medicine  which  I would  like  to  ad- 
vocate for  pre-natal  medication.  It  is  the  blessed  sunshine,  the 
fresh  home,  the  clean  heart,  and  the  loving  kindness  and  tender  mercy 
which  should  be  shown  for  wife  and  expected  mother.  These  are 
things  which  tell  upon  the  children.  If  we  believe  in  the  trans- 
mission to  the  child  of  the  mother’s  qualities,  shall  we  not  also  be- 
lieve in  the  healthy  organization  of  the  mother  and  the  healthy  or- 
ganization of  the  father  as  well,  because  the  father  has  something  to 
do  with  these  things.  Very  little,  you  may  say;  however,  we  will 
give  him  credit  for  what  he  has  to  do  in  the  matter.  Do  we  believe 
in  tobacco  blindness,  in  tobacco  neurasthenia?  Shall  we  not  believe 
that  these  diseases  are  transmitted  to  the  child,  and  shall  we  say  that 
any  wife  has  her  husband’s  full  share  of  kindness  who  is  brought  up 
in  the  air  of  the  vile  perfumes  of  tobacco?  It  is  poisoning  not 
only  the  husbands,  but  the  wives  and  the  children  of  this  land. 
Do  we  believe  in  tea  and  coffee  neurasthenia?  Then  shall  we  be- 
lieve that  the  mothers  who  are  sipping  tea  and  colfee,  who  do  not 
take  their  food,  and  who  cannot  get  through  the  day  without  a cup 
of  strong  coffee  in  the  morning  can  not  be  expected  to  rear  chil- 
dren strong,  vigorous  and  healthy.  Shall  we  not  expect  them  to 
be  u bundles  of  nerves?”  I have  looked  at  mothers,  and  have  seen 
them  so  proud  over  their  children,  beautifully  dressed,  and  they  say, 
“ My  little  girl  is  such  a nervous  little  thing  that  I hardly  know 
what  to  do  with  her.” 

Dr.  Chapman’s  paper  is  very  much  to  the  point.  The  medication, 
or  the  teachings  of  Hygeia,  ought  to  have  begun  in  the  mother  of  the 
mother  of  this  child  one  hundred  years  ago.  This  is  the  doctor  I 
am  speaking  for  now.  The  other  daughter  of  Esculapius — I am 
ashamed  to  say  I do  not  remember  her  name — is  immortalized  in  a 
tree,  the  leaves  and  bark  and  flowers  and  fruit  of  which  are  for  the 
healing  of  the  nations.  I suppose  the  use  of  this  tree  must  have  been 
to  prevent  disease,  and  it  is  used  by  the  Homoeopathic  school,  be- 
cause we  cure  all  the  diseases  that  are  curable.  And  so  it  may  be 
necessary  ; indeed,  it  is  quite  necessary,  to  prescribe  remedies  for 
the  mothers  of  unborn  children. 

Professor  Lilienthal  says,  that  cocaine  and  sulphur  will  save  more 
children  than  all  other  remedies  put  together.  We  must  not  forget 
these  remedies.  Silicia,  Gelsemium,  etc.,  we  will  not  forget ; neither 
will  we  forget  the  remedies  for  those  diseases  which  are  inherited, 
but  will  prescribe  for  every  mother  the  things  which  we  have  tried 


1056 


world’s  homoeopathic  congress. 


to  emphasize  to-day;  and  we  would  prescribe,  if  we  knew  enough, 
the  Homoeopathic  drug  which  woidd  remove  the  sordid  condition  in 
a mother  and  help  her.  I believe  that  children  are  born  to  live,  not 
to  die;  and  the  fact  that  one-half  the  children  of  the  world  succumb 
before  they  are  five  years  of  age  is  a terrible  commentary  on  modern 
civilization. 

B.  W.  James,  M.D. : I am  much  in  favor  of  this  latter  daughter 
of  Esculapius.  I am  very  thoroughly  in  love  with  the  first  one  that 
Dr.  Waite  has  spoken  of,  simply  because  she  was  in  favor  of  hygi- 
enic measures.  If  we  are  going  to  make  a good,  healthy  future 
nation,  we  must  begin  our  hygienic  measures  in  all  our  surroundings. 
Sanitary  science  is  doing  good  work,  but  it  deals  with  the  external 
world.  It  gives  us  good  houses  to  live  in,  good  air  to  brea*the,  good 
surroundings  in  every  way.  That  is  all  very  good,  but  the  founda- 
tion of  health  must  be  laid  also  by  placing  good,  healthy  matters  in 
the  tissues  of  the  human  system,  and  we  are  not  going  to  do  that 
unless  we  give  the  proper  medicines.  Give  the  system  of  a mother 
good  blood  ; make  the  cells  act  in  harmony  ; make  the  nervous  sys- 
tem act  properly  upon  these  cells  and  upon  these  tissues. 

I look  forward  to  the  time  when  diseases  may  be  annihilated  ; 
when  the  human  race  may  reach  that  point  of  millennial  health  that 
we  shall  be  exempt  from  disease.  We  shall  do  it,  if  at  all,  by  anni- 
hilating one  disease  after  another,  and  then  our  mission  as  physicians 
will  be  ended. 

W.  P.  McCracken,  M.D. : I am  not  foolish  enough  to  think  [ 
can  discuss  a paper  that  I have  not  read.  Henry  Ward  Beecher 
once  said,  when  asked  for  his  rules  for  longevity:  “ Choose  your 
father  and  mother;”  and  I think  that  is  what  one  would  have  to  do 
to  be  very  long-lived.  I remember  a case  where  the  mother,  during 
gestation,  shut  herself  up  in  her  own  house  and  refused  to  go  out 
upon  the  street.  Now,  we  cannot  alter  God’s  plan  of  creation, 
and  the  man  or  woman  who  sneers  at  or  ridicules  a woman  on 
the  street  or  anywhere,  who  is  fulfilling  the  law  of  God,  is  not  fit 
to  be  upon  this  earth.  She  cannot,  probably,  bring  forth  an  in- 
tellectually nor  physically  strong  man  or  woman,  and  be  shut  up  in 
a house  during  the  nine  months  before  confinement.  Then  I would 
make  a strong  cry  against  the  dress  of  woman  at  that  time.  Many 
women  think  that  if  they  are  tightly  laced  around  the  waist,  and 
keep  their  waist-measure  as  usual,  that  is  all  that  is  necessary.  I 
think  more  can  be  done  by  dressing  than  any  one  thing,  and  then 
plenty  of  fresh  air  and  bathing  and  good,  common-sense  diet,  and 
I don’t  believe  there  would  be  much  need  for  medication. 

G.  W.  Bowen,  M.D. : The  first  ten  years  of  a doctor’s  life  he  has  to 
learn  what  he  doesn’t  know,  and  establish  his  reputation  as  a phys- 
ician. In  the  next  ten  years  he  works  for  pay.  1 have  passed  those 
years,  and  have  spent  a great  deal  of  time  in  learning  how  we  can 


PRE-NATAL  MEDICATION. 


1057 


cure  the  results  of  a father’s  indiscretion  and  of  a mother’s  sensitive- 
ness. If  the  weakness  is  below  the  belt,  Sepia  will  remedy  that 
surely.  If  there  are  dyspeptic  troubles,  Nux  vomica  and  Belladonna 
will  prevent  it.  Consumption  we  can  guard  against  by  Bryonia  and 
Calcarea,  etc.  In  weak  heart,  we  can  obtain  benefit  from  Belladonna 
and  Arsenic,  and,  perhaps,  Calcarea;  and  so  on,  through  the  list  of 
parental  ailments. 

Alfred  E.  Hawkes,  M.D.,  of  Liverpool,  England  : I think  this 
is  one  of  the  most  important  papers  that  we  have  had  during  the 
Congress;  and  I am  very  glad  to  have  such  a thoroughly  Homoeo- 
pathic paper.  Of  course,  I don’t  think  that  hygeia  can  be  neglected 
for  one  moment.  What  I will  say  will  be  chiefly  on  ante-natal 
medication.  I would  like  to  refer  to  some  five  families  in  as  many 
minutes.  One  disease  has  not  been  referred  to  this  morning — laryn- 
gismus stridulus.  In  one  family,  three  children  had  died  of  it,  and 
I was  called  in  to  see  the  fourth  child.  Cuprum,  etc.,  were  tried, 
but  the  child  died.  During  the  fifth  pregnancy  I had  early  oppor- 
tunity of  giving  Calcarea  and  Sulphur,  and  in  the  sixth  pregnancy 
the  same  course  was  followed,  and  to-day  that  woman  has  two  healthy 
children  of  which  she  is  thoroughly  proud.  Since  that  time  I have 
saved  others.  In  another  case  of  trouble  of  the  bladder,  a record  of 
which  you  will  find  in  this  month’s  Review , the  child,  a boy  of  two 
or  three,  had  tubercular  disease  of  the  bladder.  That  was  diagnosed 
by  Reginald  Harrison,  who  assisted  me,  and  the  child  was  cured  of 
it  by  Calcarea  alone.  The  mother  was  given  it,  and  the  next  child 
was  perfectly  healthy.  Another  child  was  born  rachitic.  The  mother 
was  treated  in  the  same  way,  and  the  next  child  was  born  perfectly 
healthy ; the  third  child,  the  mother  not  having  received  treatment, 
was  born  rachitic.  During  the  fourth  pregnancy  I had  full  sway, 
and  treated  the  mother  in  the  usual  way,  and  the  fourth  chi  hi  was 
absolutely  healthy. 

J.  H.  Henry,  M.D.,  of  Alabama:  I am  very  glad  to  be  here  to- 
day, to  see  this  question  discussed  in  the  light  of  Homoeopathy.  Take 
a series  of  abortions  in  a family;  we  commenced  with  our  remedies 
as  high  as  the  thirtieth,  and  we  followed  Hahnemann’s  treatment.  I 
will  say,  I have  seen  more  fatality  with  men  who  offered  thousands 
of  dollars  for  the  cure  of  their  children,  and  where  every  single  rule 
of  hygiene  was  carried  out;  the  drainage  was  perfect,  the  house 
upon  the  mountain  top;  and  I have  seen  six  children  lie  down  in 
one  family  and  die,  one  after  another,  with  every  hygienic  principle 
carried  out  for  years.  I remember  one  case,  where  a man  says  to  the 
doctor,  “ Here  is  a check  for  a million  dollars  if  you  will  cure  my 
last  child.”  Every  sanitary  measure  was  carried  out,  but  the  child 
died.  Coca  is  the  remedy  that  it  seems  to  me  the  Homoeopathic  phy- 
sicians have  forgotten.  Muller,  of  Leipsic,  published  in  the  British 
Journal , of  October,  1857,  49  pages  upon  Coca,  and  he  expresses 


1058 


world’s  IIOMCEOPAT1IIC  congress. 


the  opinion  that,  in  the  nervous  diseases  of  children,  it  is  one  of  the 
most  potent  remedies.  He  speaks  of  the  benefit  of  dropping  it  in 
the  eye,  and  producing  a partial  deadness.  The  allopathic  physicians 
have  taken  that  up,  and  published  it  as  something  new. 

J.  A.  Whitman. M.D. , of  South  Carolina:  Every  one  has  a hobby, 
but  you  havn’t  hit  my  hobby,  and  that  is  diet.  What  is  medicine  if 
we  don’t  have  food?  If  the  mother  does  not  have  the  proper  nu- 
triment for  her  child,  what  can  we  expect  of  the  child  ? I think  we 
should  look  to  the  table  for  a great  deal  of  benefit,  as  this  is  lost 
sight  of  more  than  anything  I know  of. 

W.  P.  McCracken,  M.D. : I beg  your  pardon  for  rising  again.  I 
would  like  to  say  one  word  to  the  philosopher  who  has  come  very 
near  to  the  Creator  in  his  work.  I would  like  to  suggest  to  him 
that  if  he  would  teach  the  husband  of  a pregnant  woman  how  to 
control  himself,  it  is  a surer  preventive  of  evil  than  Mereurius. 

A.  M.  Duffield,  M.D. : There  is  one  point  that  I would  like  to 
speak  of  that  has  not  been  mentioned,  and  that  is  pre-natal  treat- 
ment for  easy  child-birth.  There  are  some  children  who  are  born 
with  very  little  vitality,  when  treatment  has  been  employed  to  pre- 
vent hardening  of  the  foetal  bones.  I wish  to  add  my  word  of  warn- 
ing in  carrying  this  treatment  out.  I had,  two  years  ago,  a little 
one  come  to  this  world,  and  it  has  been  s‘ck  ever  since.  The  starv- 
ing of  the  osseous  tissue  has  had  such  an  impression  upon  its  body 
that  it  will  never  amount  to  anything.  The  treatment,  prior  to  labor, 
had  the  desired  effect.  In  two  cases,  prior  to  this,  the  mother  was  a 
great  sufferer,  but  in  this  third  case  the  mother  abstained  from  all 
those  articles  of  diet  which  would  favor  osseous  development,  and 
the  result  to  the  little  one  was  starvation. 


RACHITIS. 


1050 


RACHITIS. 

By  Robert  N.  Tooker,  M.D.,  Chicago,  III. 


I know  of  no  disease  in  the  whole  list  of  human  ailments  more 
interesting  than  that  which  forms  the  subject  of  this  essay,  whether 
it  he  considered  from  a pathological,  an  historical,  ora  clinical  point 
of  view.  Here  we  have  a disease  common  to  all  nations,  climes, 
and  kindred,  with  symptoms,  phases,  and  features  that  ar«  plainly 
recognized  the  world  over;  a disease  which,  while  rarely  fatal,  pro- 
duces serious  and  irreparable  ravages  in  the  framework  of  the  organ- 
ism, which  in  its  advanced  stages  affects  every  organ  and  every  tis- 
sue in  the  body;  stunting  the  growth  of  the  young,  a blemish  upon 
the  beauty  of  the  mature,  a serious  menace  to  maternity  from  dis- 
tortion of  the  pelvis ; a disease  whose  effects  we  are  powerless  to 
overcome,  and  yet  one  which  is  conceded  by  all  authorities  to  be 
easily  preventable.  Such  is  a brief  and  partial  description  of  the 
affection  to  which  I invite  your  attention.  I shall  waste  no  time 
in  describing  the  features  of  well-marked  cases.  Its  pigeon- 
breasted,  narrow-chested,  bow-legged  victims  are  common  sights  in 
every  land,  and  their  clinical  history  is  familiar  to  every  physician. 
I shall  not  spend  your  time  either  in  a discussion  of  controverted 
points,  such  as  heredity,  syphilitic  complications,  etc. 

I desire  rather  to  point  out,  as  clearly  as  I may,  the  early  symp- 
toms by  which  the  rachitic  cachexia  may  be  recognized  before  any 
serious  damage  is  done  to  the  organism,  and  which,  to  my  mind, 
have  been  ignored  or  treated  carelessly  by  those  who  have  written 
upon  the  subject ; and  then  to  give  you  what  my  own  experience  has 
taught  me  to  regard  a specific  means  of  averting  all  harm  by 
promptly  arresting  the  progress  of  those  symptoms,  as  well  as  abort- 
ing the  disease  itself. 

However  we  may  regard  rachitis  from  a controversial  standpoint; 
however  so  many  factors  may  be  considered  as  entering  into  the 
aetiology  of  a given  case,  all  authorities  are  agreed  upon  one  point, 


1060 


world’s  homoeopathic  congress. 


viz.,  that  the  one  factor  that  enters  prominently  into  every  case  is  the 
factor  of  defective  food.  It  matters  not  whether  the  rachitic  child 
has  been  nursed  at  the  breast  or  bottle-fed,  the  one  indictment  that 
cannot  be  quashed,  the  one  fact  that  cannot  be  denied,  is  the  insuf- 
ficiency or  inefficiency  of  the  food  supply.  In  the  beginning  of 
every  case  of  rickets  there  is  somewhere  a fault  that  amounts  to  a 
failure  in  the  matter  of  alimentation.  The  nourishment  does  not 
nourish.  Some  essential  element  necessary  to  the  economy  is  either 
absent  or  is  presented  in  a form  which  is  ineffective.  With  a rav- 
enous appetite  there  is  lack  of  normal  growth.  With  abundance  of 
aliment  there  is  perverted  nutrition.  Abundance  does  not  satisfy  ; 
there  is  starvation  in  the  midst  of  plenty.  When  breast-fed  chil- 
dren develop  the  rachitic  habit  it  is  usually  due  to  prolonged  lacta- 
tion, and  it  is  of  nurselings  that  I desire  first  to  speak.  In  doing 
so,  the  necessity  of  brevity  must  excuse  my  apparent  dogmatism. 

Now  there  are  certain  facts  regarding  lactation  that  have  a bearing 
on  this  subject,  and  these  facts  are  so  frequently  observed  as  to  be 
incontrovertible. 

First.  The  health  of  the  mother  and  the  abundance  of  her  milk 
is  not  always  a reliable  criterion  by  which  to  judge  of  its  nutritive 
qualities.  In  other  words,  there  are  many  women  in  perfect  health 
and  with  an  ample  supply  of  milk  who  cannot  successfully  nurse 
their  offspring. 

Second.  It  is  a law  of  nature,  to  which  there  are  few  if  any  ex- 
ceptions, that  every  nursing  woman’s  milk  begins  to  deteriorate  in 
quality  after  she  has  nursed  for  a period  of  from  seven  to  ten  or 
twelve  months,  and  this  deterioration  progresses  steadily,  what- 
ever may  be  her  general  health,  until  she  ceases  to  perform  the  func- 
tion. 

Now  it  is  a significant  fact  that  while  rachitis  is  far  more  common 
among  bottle-fed  than  breast-fed  children,  it  still  does  occur  among 
children  who  are  nursed  at  the  breast,  and  is  very  much  more  com- 
mon among  those  who  are  nursed  into  the  second  year.  Indeed, 
statistics  show  indubitably  that  there  is  a direct  and  proportionate 
relationship  between  prolonged  lactation  and  rachitis.  I know  of 
no  accurate  means  of  ascertaining  the  time  when  the  milk  begins 
to  deteriorate  in  a given  case  by  any  chemical,  microscopical,  or  me- 
chanical test. 

The  time  unquestionably  varies  with  different  women  and  with 


RACHITIS. 


1061 


the  same  woman  at  different  times,  but  I am  satisfied  from  personal 
observation  that  with  American  women,  especially  with  those  living 
in  the  large  cities,  the  time  of  beginning  deterioration  is,  on  the  aver- 
age, less  than  twelve  months.  In  some  cases  it  may  occur  as  early 
as  the  fifth  or  sixth  month.  As  soon  as  the  milk  begins  to  dete- 
riorate the  child  feels  it.  The  evidences  of  mal-nutrition  are  soon 
manifested,  and  to  the  experienced  physician  the  signs  are  unmistak- 
able. Its  body  may  still  be  plump  and  its  color  normal.  Its  bowels 
may  be  regular  and  its  appetite  unimpaired.  It  may  not  as  yet 
show  any  marked  changes  in  temper  or  reluctance  to  being  fondled. 
Long  before  there  are  any  signs  of  articular  enlargements  anywhere; 
long  before  there  is  any  development  of  a “ rachitic  rosary;”  long 
before  there  is  any  flattening  of  the  cranial  bones  or  incipient  cranio- 
tabes,  there  are  symptoms  of  unmistakable  import  if  only  they  are 
given  their  true  significance.  The  first  of  these  signs  to  appear 
usually  is  habitual  sweating  of  the  head  while  sleeping.  Cranial 
perspiration  during  sleep,  and  especially  during  the  day-naps,  is 
always  ominous.  It  may  not  always  point  to  rickets,  but  it  is  always 
a dyscrasia. 

But  the  most  significant  and  certain  of  the  early  signs  of  impend- 
ing rickets  is  found  in  the  delayed  evolution  of  the  teeth.  I do  not 
refer  altogether  to  the  eruption  of  the  teeth,  although  this  has  its 
significance,  but  to  the  whole  phenomena  of  teething.  A perfectly 
healthy  child  should  show  some  of  the  usual  signs  which  accompany 
this  process  by  the  fifth  or  sixth  month.  If  this  age  be  reached,  and 
there  be  no  increase  of  the  salivary  secretion  ; no  tumefaction  of  the 
sums;  no  irritation  of  the  nervous  system,  accompanied  with  sug- 
gestive actions  pointing  to  the  mouth  as  its  seat;  if,  in  a word,  there 
is  no  change  in  the  inner  contour  of  the  jaw  indicative  of  activity 
there;  and  if  this  condition  goes  on  to  the  seventh  or  eighth  month, 
the  watchful  physician  should  be  on  his  guard.  If,  in  addition, 
cranial  perspiration  is  present  whenever  the  child  slumbers;  and 
further,  if  the  mental  condition,  the  settled  characteristic  melancholy, 
is  apparent,  we  need  not  wait  for  further  development  to  diagnose 
the  disease. 

Another  symptom  connected  with  teething  is  often  present  in 
children  in  whom  the  disease  has  started,  after  one  or  more  teeth 
have  erupted.  It  is  the  prolonged  interval  that  elapses  between  the 
cutting  of  single  teeth  or  pairs  of  them.  These  intervals  are,  as  a 


1062 


world’s  homoeopath rc  congress. 


rale,  reasonably  regular  in  healthy  children,  and  any  unusual  delay 
in  the  continuance  of  the  process  of  tooth  evolution  should  not  be 
allowed  to  pass  unnoticed. 

When  these  conditions  are  recognized,  it  is  neither  an  act  of  pru- 
dence or  wisdom  to  delay  a radical  change  of  diet.  The  child  should 
be  taken  from  the  breast  at  once  and  placed  on  artificial  food.  At 
the  same  time  it  should  be  given  systematically  and  persistently  the 
indicated  Homoeopathic  remedy.  Our  pharmacopoeia  is  rich  in  rem 
edies  of  untold  value  in  these  cases.  Mereurius  Solubilis,  Colchicumy 
Asafcetida,  Silicea  and  Sulphur  have  all  been  given  successfully  in 
appropriate  cases,  besides  many  more  which  I need  not  name.  But 
the  remedy  of  all  remedies — the  one  which  is  in  the  truest  sense 
Homoeopathic  to  the  typical  case  of  rachitis  in  all  its  stages  and 
phases ; the  one  remedy  to  be  first  thought  of  in  the  incipiency  of 
the  disease ; the  remedy  which,  in  itself,  is  a standing  monument  to 
the  genius  of  him  who  gave  to  the  world  the  immortal  aphorism, 
“ similia  similibus  curantur ■” — is  Phosphorus.  Whoever  reads  a 
proving  of  Phosphorus,  reads  a description  of  the  essential  features 
of  rachitis.  Even  in  the  cases  of  poisoning  from  this  drug,  there  is 
much  that  is  suggestive  of  its  disease  similimum.  Phosphorus  has 
produced  osteo-malachia  in  the  adult,  a diseased  condition  which,  in 
its  course  and  nature,  is  almost  identical  with  the  rachitis  of  infancy. 
But  clinical  experience  shows  that  we  do  not  get  the  best  value  of 
Phosphorus  when  we  give  it  in  its  simple  and  direct  form.  It  com- 
bines too  readily  with  oxygen  to  form  Phosphoric  acid  for  it  to  serve 
our  use.  By  adding  it  to  lime,  however,  and  forming  our  Calcarea 
phosphorica,  we  have  a remedy  for  rachitis  par  excellence.  Calcarea 
phosphorica  covers  more  completely  than  any  other  single  remedy 
the  full  picture  of  a typical  case  of  this  disease.  It  has  both  fonta- 
nel lea  open,  tardy  dentition,  sweating  of  the  head,  the  pot-bellied 
abdomen,  indisposition  to  being  handled,  the  settled  melancholy,  the 
soft,  spongy  condition  of  the  bones;  and,  indeed,  the  whole  catalogue 
of  symptoms  with  which  you  are  so  familiar.  Many  of  these  symp- 
toms are  also  covered  by  Calcarea  carbonica,  but  not  to  the  same 
extent  and  fulness.  Comparing  the  two  drugs,  I should  say  that 
Calcarea  carbonica  meets  more  quickly  the  objective  symptoms,  while 
Calcarea  phosphorica  more  its  subjective  ones.  In  other  words,  the 
first  acts  on  the  blood  and  the  soft  tissues,  while  the  other  affects  the 
osseous  and  the  harder  tissues.  The  one  acts  superficially,  the  other 
more  profoundly. 


RACHITIS. 


1063 


But  medicine  alone  will  not  cure  rachitis.  The  treatment  must 
be  hygienic  and  dietetic,  as  well  as  medicinal.  As  we  have  seen 
already,  the  original  setiological  factor  always  present  in  the  disease 
is  defective  food.  This  defect  must  be  corrected.  The  food  must 
be  changed.  Cow’s  milk,  as  an  exclusive  diet,  is,  in  these  cases,  in- 
admissible. Its  tendency  to  form  lactic  acid  simply  feeds  the  morbid 
condition.  All  foods  requiring  an  addition  of  sugar  to  make  them 
palatable  are  injurious  for  the  same  reason.  If  you  take  an  atom  of 
sugar  and  split  it  in  two,  you  get,  as  a result,  an  atom  of  lactic  acid 
and  an  atom  of  alcohol.  But  lactic  acid  is  already  in  excess  in  the 
blood,  and  is  creating  mischief  in  all  the  tissues.  To  add  more  is  to 
add  fuel  to  the  flame.  For  this  reason  all  starchy  foods  are  perni- 
cious, and  this  is  why  the  great  majority  of  the  so-called  “ baby 
foods”  fail  to  meet  the  requirements  of  these  cases. 

Undoubtedly,  the  nearest  approach  to  an  ideal  substitute  for  human 
milk,  and  certainly  the  one  best  adapted  to  the  needs  of  a rachitic 
child,  is  the  dextrinized  food  of  Liebig.  In  the  preparation  of  this 
food  all  of  the  starch  of  its  constituents — wheat  and  malted  barley 
— is  transformed  into  dextrine  and  grape  sugar.  It  therefore  re- 
quires no  additional  sweetening.  Being  prepared  from  the  entire 
grain,  it  is  rich  in  phosphates  and  other  earthy  salts  and  all  needed 
nitrogenous  matters. 

There  are  various  preparations  of  malted  foods  in  the  market,  but 
I am  free  to  say  that  I prefer  that  known  as  Mellin’s  food  to  any 
other.  Perhaps  my  preference  for  it  is  due  to  the  fact  that  I am 
more  familiar  with  it.  Certain  it  is,  that  in  the  nearly  twenty  years 
that  I have  used  Mellin’s  food  I have  never  seen  a child  become 
rachitic  under  it,  while  I have  seen  numerous  cases  that  had  become 
rickety  under  other  foods  restored  to  sound  health  by  its  use.  It  is 
more  highly  dextrinized  than  any  other  of  the  malted  foods,  and  is 
more  uniform  in  its  preparation.  When  mixed  with  cow’s  milk  in 
due  proportion,  it  fulfils  every  requirement  for  the  full  nutrition  of 
a healthy  child. 

The  brief  time  allotted  to  me  precludes  a scientific  comparison  of 
different  foods  or  even  a mention  of  them.  I have  made  no  attempt 
to  exhaust  the  subject  which  is  here  presented  either  in  the  matter 
of  food  or  other  aspects,  but  only  to  draw  attention  to  certain  points 
that  to  my  mind  needed  emphasis,  and  to  record  my  personal 
experience  and  individual  observation  in  the  matter  of  thera- 
peutic and  dietetic  treatment. 


1064 


world’s  homoeopathic  congress. 


Discussion. 

B.  W.  James,  M.D.:  This  is  one  of  the  diseases  that  will  come 
under  my  idea  of  annihilation.  I apprehend  that  the  disease  does 
not  always  originate  from  an  insufficient  amount  of  nourishment. 
There  seems  to  be  some  abnormal  condition  of  the  body  which  re- 
quires a remedy.  We  must  endeavor  to  cure  the  disease  as  we  find 
it.  The  symptoms  are:  Sweating  of  the  head  ; great  irregularity  in 
teething,  showing  that  the  osseous  structure  is  not  getting  its  proper 
amount  of  material  for  building  up  the  teeth  ; and  then  there  is  like- 
wise a determination  of  too  much  or  too  little  material  to  one  struc- 
ture or  another.  In  the  application  of  our  remedies  we  endeavor  to 
harmonize  all  the  tissues  and  make  them  go  on  as  nature  intended 
throughout  the  economy.  In  regard  to  the  best  remedy,  I fully  co- 
incide that  it  is  Phosphorus.  I have  been  in  the  habit  of  giving 
Calcarea  phos.,  which  answers  every  purpose,  and  is  perhaps  better 
in  many  cases.  Frequently  the  glands  of  the  intestinal  tract  are  in- 
volved, and  those  of  the  neck  and  other  parts  of  the  body  greatly 
disturbed,  and  Calcarea  carb.  is  a magnificent  remedy  in  that  condi- 
tion. An  excellent  remedy,  where  ansemia  exists,  is  Baryta  carb. 
Sulphur  is  an  admirable  remedy  to  add  to  the  Calcarea.  In  many 
cases  all  our  efforts  will  not  enable  us  to  change  the  condition  of  the 
system,  and  yet  in  many  cases  we  can  do  a great  amount  of  good  by 
adopting  Homoeopathic  treatment. 

Dr.  Duffielp  : I had  a case  in  my  student  days  which  was  a 
very  good  illustration  of  this  rachitic  condition.  It  was  a negro  boy 
of  4 years.  He  was  unable  to  stand  ; his  legs  were  bowed  and 
crossed,  and  he  had  a very  large  head  on  a very  little  neck.  There 
was  a hole  through  the  spinal  column,  and  the  soft  matter  could  be 
touched  with  the  finger.  His  pulse  was  204  and  his  temperature 
105,  and  the  pulsation  of  the  heart  was  so  pronounced  that  you  could 
see  it  through  the  chest  wall.  Physicians  of  the  opposite  school  said 
he  could  not  live  twenty-four  hours.  I had  heard  the  lectures  on 
Calcarea  carb.  and  used  it  then.  The  next  day  I found  my  little 
patient  was  better,  and  as  I went,  day  by  day,  he  improved,  until, 
finally,  in  the  course  of  six  months  he  was  able  to  stand  up  and  get 
around  by  holding  on  the  chairs.  I gave  the  Calcarea  carb.  in  the 
third  decimal  trituration,  at  first  once  an  hour  and  then  once  in  three 
hours,  and  then  every  other  day. 

C.  D.  Crank,  M.D. : I think  one  mistake  lies  in  the  fact  that 
rachitis  is  not  recognized  early  enough.  I will  give  you  three  symp- 
toms in  recognizing  this  disease:  first,  a peculiar  watery  discharge 
from  the  nose;  second,  a peculiar  wakefulness  and  restlessness  at 
night — touch  the  crib  and  the  child  will  start;  third,  the  sweating 
of  the  head.  It  may  be  rachitis;  it  may  be  tabes  raesenterica.  If 
the  child  lives  long  enough,  it  may  be  epilepsy.  If  you  wait  until 
the  trouble  is  developed,  you  will  have  difficulty  in  treating  it.  Cal- 


RACHITIS. 


1065 


carea  phos.  is  a grand  remedy,  and  there  is  another  which  I resort  to 
successfully.  It  is  not  medicine  but  food  that  feeds  the  nervous  cen- 
tres. I refer  to  oil.  Rub  the  child  with  the  best  Olive  oil,  and  feed 
it  Cod-liver  oil  to  build  up  its  little  organism. 

R.  N.  Tooker,  M.D. : I am  rather  disappointed  that  no  one  has 
taken  exception  to  some  statements  in  my  paper.  I can  only  repeat 
what  I said  in  the  paper,  that  I think  it  a great  mistake  for  the  aver- 
age American  woman  to  nurse  her  babe  beyond  twelve  months.  Her 
milk  then  becomes  thin  and  watery,  and  the  babe  should  not  be 
nursed  through  the  second  summer.  We  have  artificial  foods  that 
will  be  far  better  substitutes. 

Now  let  me  enter  protest  against  another  practice  I find  common 
among  physicians,  and  that  is  correcting  the  acidity  of  the  milk  by 
keeping  the  milk  in  an  alkaline  condition  by  the  addition  of  lime- 
water.  It  is  a very  irrational  practice.  If  you  want  to  correct  the 
acidity,  give  soda,  which  is  far  better  than  lime-water. 

When  the  chairman  solicited  a paper  from  me,  she  limited  me  to 
fifteen  minutes;  and  so,  when  I got  to  the  matter  of  food,  I found 
I had  only  a minute  left  to  discuss  it.  If  I had  had  time,  I would 
have  mentioned  other  foods  that  I regard  very  highly. 


1066 


world’s  homoeopathic  congress. 


THE  AWKWARD  GAIT  OF  CHILDREN. 

By  Sidney  F.  Wilcox,  M.D.,  New  York,  N.  Y. 

I desire  to  call  attention  to  a class  of  cases  which,  as  a rule,  are 
much  neglected.  These  cases  are  the  children  who  walk  awk- 
wardly, with  toes  turned  in  and  knees  knocking  together,  but  not 
to  a degree  sufficient  to  induce  the  parents  to  seek  surgical  advice. 

This  awkward,  shuffling  gait  is  generally  attributed  to  laziness  or 
carelessness  on  the  part  of  the  child,  who  may  be  constantly  lectured 
on  the  subject  and  told  to  turn  out  his  toes,  which  he  may  do  for  a 
short  time  in  a constrained  manner,  with  hands  spread  out  as  though 
he  was  trying  to  walk  and  balance  himself  on  the  edge  of  a board. 
Frequently,  under  the  watchful  eye  of  the  parent  or  nurse,  the  child 
may  with  difficulty  maintain  a correct  position,  but  the  moment  his 
attention  is  diverted  the  bad  position  is  resumed,  or,  if  very  much 
wearied  by  a long  walk  or  other  exercise,  the  deformity  (for  such  it 
becomes  then)  will  be  greatly  exaggerated. 

The  toeing-in  is  not  the  only  form  of  the  trouble,  but  it  is  fre- 
quently, if  not  generally,  combined  with  a partially  flexed  knee. 
Sometimes  the  toes,  instead  of  turning  in,  turn  out,  and  the  arch  of 
the  foot  is  depressed. 

The  general  belief  is  that  the  child  will  outgrow  the  trouble,  and 
to  a great  extent,  as  he  grows  older  and  becomes  more  self-conscious, 
he  does  manage  to  conceal  it,  but  neither  the  cause  nor  the  difficulty 
itself  becomes  entirely  removed.  As  the  child  grows  older,  he  be- 
comes ashamed  of  his  crooked  legs  and  awkward  gait,  and  makes  an 
effort  to  correct  them,  but  he  does  it  at  the  expense  of  unusual  fatigue 
and  a strain  upon  weakened  muscles. 

The  cause  of  the  difficulty  under  consideration  is  that  there  is  an 
unequal  balance  of  muscular  power  on  the  opposite  sides  of  the 
limbs.  Either  through  some  prenatal  influence  or  some  condition 
developing  subsequent  to  birth,  the  muscles  of  one  or  more  groups 
become  partially  enervated;  in  other  words,  partially  paralyzed. 


TIIE  AWKWARD  GAIT  OF  CHILDREN. 


1067 


This  term  is  perhaps  too  strong  to  apply  to  this  condition  ; probably 
the  term  weakened  muscles  is  better.  At  any  rate,  whichever  term 
is  applied,  the  fact  remains  that  the  weakened  muscles  fail  to  do 
their  whole  duty,  and  the  consequence  is  the  bad  position  and  awk- 
ward gait  before  mentioned.  Under  the  stimulus  of  the  will,  the 
position  may  be  corrected  and  remain  so  as  long  as  this  stimulus  is 
acting  or  until  over-fatigued,  when  the  muscles  give  up  in  despair 
and  become  more  relaxed  than  ever.  I have  seen  a child  who  had  a 
moderate  degree  of  toeing-in  under  ordinary  conditions  become  abso- 
lutely deformed  on  returning  weary  from  a picnic,  and  the  feet  so 
badly  turned  in  that  in  walking  he  raised  one  foot  over  the  other  to 
avoid  hitting  them  together. 

The  study  of  the  reflexes  and  causes  of  nervous  and  muscular 
strains  are  now  being  actively  pursued  by  the  profession,  and  why 
not  pay  some  attention  to  the  condition  here  presented.  The  nervous 
irritation  induced  by  unequal  muscular  balance  of  the  ocular  mus- 
cles, and  the  reflex  irritation  of  spasmodic  contraction  of  sphincter 
muscles,  will  doubtless  be  considered  at  this  meeting,  but  we  must 
remember  that  the  human  system  is  a confederaton  of  parts,  and  a 
weakness  in  one  part  weakens  the  whole,  and  that  anything  which 
acts  as  a drag  or  which  causes  an  unhealthy  weariness  during  the 
formative  period  of  life,  must  leave  a more  or  less  lasting  effect  if 
allowed  to  remain  uncorrected.  I do  not  wish  to  exaggerate  the  im- 
portance of  the  subject  ; the  children  thus  afflicted  may  not  give  evi- 
dence of  any  special  reflex  irritation.  As  a rule,  if  a child  does  not 
suffer  actual  pain  he  does  not  complain  ; the  only  indication  perhaps 
is  the  awkward  hobbeldehoy  gait  and  weariness. 

The  muscles  usually  most  affected  are  the  peronei  in  the  leg  and 
the  quadriceps  extensor  in  the  thigh.  The  other  muscles  may  be 
affected,  but  weakness  of  these  in  particular  is  most  likely  to  cause 
the  condition  of  toeing-in  and  flexed  knee.  If  combined  with  laxity 
of  the  internal  lateral  ligaments  of  the  knee-joint,  we  also  have  the 
condition  of  “ in-knee ” or  a knock -knee.” 

As  the  whole  trouble  consists  in  the  lack  of  muscular  balance,  the 
indications  for  treatment  are  plain.  The  strength  of  the  affected 
muscles  should  be  brought  up  to  the  normal  after  a careful  compar- 
ative test  of  the  strength  of  the  opposing  groups.  This  should  be 
done  by  one  skilled  in  finding  the  motor  points  on  the  surface  of  the 
limb  with  the  galvanic  current. 


1068 


world’s  homoeopathic  congress. 


The  comparative  tests  should  be  made  of  the  excitability  of  the 
opposing  sets  of  muscles,  and  the  results,  as  shown  by  the  milliam- 
pere-meter  carefully  noted,  due  allowance  being  made  of  course  for 
the  varying  resistance  on  account  of  the  varying  distances  of  the 
nerves  from  the  surface,  etc.  Then  the  treatment  of  the  affected 
muscles  by  galvanism  should  be  carried  on  systematically,  the  appli- 
cations being  made  from  two  to  six  times  a week,  as  the  case  may 
require.  In  addition  to  this,  massage  to  the  affected  muscles  should 
be  given  regularly,  and  if  any  constitutional  condition  seems  to  in- 
dicate their  use,  internal  remedies  should  be  employed. 

In  some  cases  mechanical  treatment  may  be  necessary  as  an  ad- 
junct to  the  electricity  and  massage.  For  this  purpose  a light  bar, 
fastened  to  the  shoe  and  running  up  the  outside  of  the  leg  to  a pelvic 
band,  should  be  employed.  There  should  be  joints  in  the  bar  cor- 
responding to  the  ankle,  knee,  and  hip-joints,  and  the  amount  of 
eversion  of  the  foot  may  be  regulated  by  a set  screw  between  the 
knee  and  hip.  This  brace  may  be  made  very  light,  and  only  strong 
enough  to  produce  the  effect  desired. 

It  is  necessary  to  have  the  pelvic  band  with  the  brace  extending 
from  it  to  the  shoe,  as  it  is  impossible  otherwise  to  get  sufficient 
leverage  to  evert  the  foot. 

In  very  severe  cases  it  may  even  be  necessary  to  employ  a more 
powerful  apparatus,  like  Doyle’s  spring  rotator,  but  cases  of  such 
severity  hardly  come  within  the  range  of  this  paper. 

Discussion. 

Sarah  J.  Millsop,  M.D.,  Bowling  Green,  Ky. : It  is  with  hesi- 
tancy that  I comply  with  Dr.  Pardee’s  request  to  discuss  this  paper, 
for  the  reason  that  I belong  to  that  large  and  formerly  very  useful 
army,  the  general  practitioner,  now  being  relegated  to  the  top  shelf 
as  back  numbers. 

We  have  been  told  here  that  women  have  not  been  asked  to  take 
a more  active  part  in  these  deliberations  for  the  reason  that  they  were 
not  specialists.  • 

But,  as  all  women  are  specialists  in  diseases  of  children,  I may 
venture  to  say  a few  words  on  this  most  important  subject,  a subject 
to  which  not  enough  attention  is  paid,  as  the  awkward  gait  of  children 
means,  when  not  corrected,  the  awkward  gait  of  men  and  women. 

In  the  South,  where  I live,  I have  found  it  positively  painful  to 
watch  the  crowds  of  country-people  who  flock  to  our  city  on  what  is 
called  “show  day.”  So  many  have  not  only  an  awkward,  shuffling 


THE  AWKWARD  GAIT  OH  CHILDREN. 


1069 


gait,  but  they  are  round-shouldered,  slouching,  knock-kneed  and 
club-footed. 

This  I think,  in  great  measure,  is  the  fault  of  mothers,  who,  not  re- 
alizing the  importance  of  forming  correct  early  habits,  or  being  bur- 
dened with  domestic  cares,  leave  their  children  to  “ grow  ” like  Topsy, 
or,  to  come  up,  hap-hazard,  like  the  young  of  the  lower  animals, 
but  without  their  natural  grace  of  motion. 

In  my  opinion,  a judicious  course  of  calisthenics  in  the  school  or  at 
the  home  would  do  much,  not  only  to  prevent  but  to  counteract  the 
bad  conditions  the  doctor  refers  to. 

Where  the  muscles  are  at  fault  from  a weakened  condition,  no 
better  measure  can  be  recommended  than  the  use  of  massage,  with 
the  inunction  of  some  nutrient  oil.  Where  constitutional  dyscrasia 
underlies  these  bad  conditions,  our  materia  medica  will  give  us  most 
effectual  aid.  We  have,  doubtless,  all  found  a most  potent  ally  in 
our  Calcareas,  especially  in  Cal.  phos.,  in  overcoming  deformities  in 
children.  One  dietetic  measure  I should  recommend  above  all  others 
is  the  use  in  some  form  of  the  entire  wheat. 

Chemists  tell  us  that  the  kernel  of  wheat  contains,  not  only  most 
of  the  elements  needed  in  the  system,  but  just  in  the  proportion  in 
which  they  are  needed,  even  to  the  constituents  of  teeth,  nails  and 
hair.  That  our  children  are  fed  on  the  least  nutritious  portion  of 
this  cereal,  which  forms  our  “staff  of  life,”  while  the  most  nutritious 
portion  is  given  our  lower  animals,  may  account  for  the  greater 
physical  superiority  of  the  latter. 

The  whole  wheat  is  not  only  a builder-up  of  the  young,  but  there 
is  nothing  to  equal  it  as  a repairer  of  waste  tissue  in  the  adult.  Its 
constant  use  will  keep  brain  and  body  young  and  active  long  past 
the  allotted  three  score  and  ten. 

W.  D.  Gentry,  M.D.  : I want,  in  this  connection,  to  earnestly 
suggest  to  the  physicians  of  this  country  the  importance  of  looking 
after  this  very  serious  matter  of  phymosis,  and  if  time  allowed  me, 
I would  like  to  speak  at  more  length  on  this  subject. 

Gertrude  G.  Wellington,  M.D.,  Chicago,  111. : I would  like 
to  add,  that* in  cities  like  New  York,  we  find  a great  deal  more  of 
that  complaint  than  in  Chicago,  I believe,  largely  from  the  fact  that 
the  children  are  confined  to  pavements  which  are  very  hard  on  their 
little  bones.  The  remedy  for  that  is  putting  them  where  their  feet 
can  have  access  to  the  soil,  that  when  the  little  foot  is  put  on  the 
ground  the  heel  sinks. 


1070 


world’s  homoeopathic  congress. 


CONTAGION  IN  OUR  PUBLIC  SCHOOLS , AND  ITS 
PROPHYLAXIS . 

By  Lucy  Chaloner  Hill,  M.D.,  Fall  River,  Mass. 


America’s  pride  is  her  common  schools. 

Decade  vies  with  decade,  State  with  State,  in  furnishing  better 
means  of  education. 

Edifices  are  erected  which  adorn  the  city,  and  afford  comfort  and 
pleasure  to  the  pupil. 

The  committee  on  public  property  inspects  the  same,  making  sure 
of  their  safe  structure,  and  that  egress  according  to  size  is  sufficient 
in  case  of  fire. 

The  board  of  health  condemns  school-houses  improperly  venti- 
lated, or  otherwise  in  an  unsanitary  condition. 

For  so  long  a time  have  separate  forms  been  provided,  that  we  no 
longer  call  it  a modern  improvement,  although  that , perhaps,  was  the 
first  great  step  toward  a healthier  condition  for  the  children. 

No  longer  could  they  so  easily  come  in  contact,  or  inhale  each 
other’s  breaths. 

Every  city  and  town  has  its  laws  in  regard  to  the  so-called  con- 
tagious diseases, — variola,  scarlatina,  diphtheria,  etc., — but,  as  if 
ignorant  of  the  yet  more  dreaded  contagious  tuberculosis  and 
syphilis — more  dreaded  because,  in  some  cases,  entailing  a life  of 
suffering,  if  not  extending  to  more  than  one  generation — no  pro- 
tection or  attempt  at  protection  has  been  made. 

On  the  other  hand,  with  an  eye  single  to  the  idea  of  education, 
separating  it  entirely  from  the  necessity  of  a healthy  body,  a sys- 
tem of  supplies — books,  slates,  pencils,  clay,  and  the  various  kinder- 
garten outfit,  has  been  adopted  by  many  cities  and  towns,  whilst  a 
dozen  or  more  States  have  legislated  to  the  same  effect. 

Very  few  of  our  public  schools  could  boast  that  not  a child  at- 
tended capable  of  conveying  disease  to  another,  whilst  many  receive 
pupils  loathsome  to  sight  and  smell. 


CONTAGION  IN  PUBLIC  SCHOOLS  AND  ITS  PROPHYLAXIS.  1071 


Should  the  parents  of  carefully  raised  children  but  visit,  the 
schools,  and  see  the  filthy  and  unwholesome  condition  of  many  who 
use  the  supplies  in  common  with  the  cleanly,  they  would  shrink  with 
horror  from  what  their  children  become  accustomed  to. 

An  educator,  of  many  years’  experience,  gave  me  as  his  opinion, 
that  fully  fifty  per  cent,  of  the  children,  in  cities,  attending  school 
were  too  filthy  to  be  allowed  admission,  and  yet  your  children  inhale 
the  air  of  the  school-room  made  foul  by  such  pupils. 

Cases  of  typhoid  fever  in  children  have  been  traced  to  this  source 
of  poisonous  infection. 

The  child  who,  at  home,  has  his  individual  toilet  outfit,  an  hour 
later,  in  school,  is  handling  what  filthy,  diseased  hands  have  often 
handled.  The  child  who  must  have  a clean  glass  to  drink  from 
at  home,  eagerly  uses  the  common  cup,  which  often  is  metal,  and 
when  cleaned — who  can  tell ! 

Greater  attention  has  been  given  to  the  prevention  of  small-pox 
than  to  any  other  disease,  and  yet  it  holds  a comparatively  low  rank 
amongst  diseases  in  its  deadly  influence. 

Vaccination  is  compulsory , but  there,  all  compulsion  ends.  To  be 
sure,  we  have  laws  forbidding  the  school  to  children  living  in  a 
house  where  there  is  illness  from  contagious  diseases,  but  the  experi- 
ence of  New  England,  during  the  past  six  months,  has  proven  how 
powerless  are  such  laws  in  controlling  the  epidemic  of  scarlatina. 
Many  cases  have  been  of  so  light  a character  as  to  be  unrecognized, 
and  no  physician  was  called,  until  some  members  of  the  family  de- 
veloped a more  serious  form  of  the  malady;  the  children  of  such 
families,  in  the  meantime,  attended  school,  using  the  books,  slates, 
pencils,  clay,  and  other  materials  which,  later  on,  will  be  given  to 
other  children. 

Knowing  the  ease  with  which  the  scarlatina  germ  is  carried  from 
place  to  place,  and  its  great  vitality — lasting  for  months  if  not  years 
— is  it  reasonable  to  expect  that  this  disease  will  not  again  and  again 
develop  from  those  very  germs  ? True  it  is,  that  schools  have  been 
closed,  all  books,  etc.,  burned,  and  the  houses  thoroughly  disinfected 
when  the  enemy  has  become  recognized  as  sufficiently  epidemic  in  a 
given  school. 

The  other  exanthemata  are  likewise  spread  in  our  public  schools, 
but  being  considered  so  little  harmful  to  child-life  and  health,  the 
common  rule  of  protection  is  sufficient. 


1072 


world’s  homoeopathic  congress. 


Diphtheria  is  another  disease  recognized  as  fatally  harmful,  and 
therefore  to  be  guarded  against  ; and  yet  not  until  a case  is  reported 
to  the  authorities  is  any  step  considered  necessary  to  protect  the 
children. 

The  text-books  in  our  public  schools,  furnished  the  pupils,  are  in 
use  from  four  to  six  years.  These  may  be  used  one  year  at  a time 
by  the  older,  but  much  less  time  by  the  younger  pupils,  whilst  in 
certain  grades  the  readers  are  taken  up  daily  or  oftener  and  passfed 
indiscriminately. 

Hence,  where  greatest  protection  is  needed,  least  is  afforded. 

It  is  in  young  life  that  the  lymphatic  system  is  most  active;  that 
the  tissues  are  softest  and  most  susceptible  to  infection. 

How  do  children  use  books? 

They  bury  their  faces  in  them  ; the  child  with  festering  eyes  to- 
day, your  child  to-morrow;  the  child  with  syphilitic  discharges  from 
the  nose  to-day,  your  child  to-morrow. 

They  pillow  their  heads  in  them  ; the  child  with  corruption 
pouring  from  its  ears  to  day,  your  child  to-morrow;  the  child  with 
hair  matted  with  filth  to-day,  your  child  to-morrow. 

They  cough  into  them  the  catarrhal  secretion  preceding  diphthe- 
ria; it  may  be,  they  sneeze  into  them,  they  breathe  into  them. 

Can  a child,  with  any  abrasion  upon  its  hands,  come  in  contact 
with  syphilitic,  cancerous,  or  tuberculous  discharges  and  be  exempt 
any  more  than  a surgeon  ? And  yet  many  a child,  with  corruption 
breeding  on  its  hands,  uses  the  same  clay  to-day  that  your’s  will  use 
next  week.  Cold  water  poured  through  the  clay  is  the  cleansing 
process.  When  dried  and  ready  for  use  again,  who  can  tell  what 
is  in  it  ? 

The  disease  above  all  to  be  most  dreaded  and  guarded  against, 
the  disease  which  may  be  and  often  is  hereditary,  is  probably  the 
least  recognized  by  teacher  or  pupil. 

Although  hereditary  syphilis  often  ends  in  early  life  before  the 
child  attends  school,  yet  it  is  a fact  that  for  years  it  may  again  and 
again  make  its  appearance.  « 

How  can  this  disease  be  guarded  against? 

Every  child  must  furnish  a certificate  of  vaccination.  Why  not, 
in  case  of  eruptions,  a certificate  declaring  contagion  or  non-conta- 
gion ? 

Cannot  the  public  mind  be  made  to  understand  the  importance  of 


CONTAGION  IN  PUBLIC  SCHOOLS  AND  ITS  PROPHYLAXIS.  1073 


preserving  and  promoting  health  ? A few  careful,  thoughtful  pa- 
rents purchase  new  books,  etc.,  and  substitute  for  those  publicly 
supplied.  They  also  provide  their  children  with  drinking-cups. 
Were  the  danger  lurking  in  these  sources  appreciated,  more  would 
do  so. 

Massachusetts,  in  1882,  took  the  lead  amongst  States  in  providing 
school  supplies. 

She  has  ever  proved  herself  a leader  in  good  works.  One  step 
farther  in  this  direction  will  crown  the  deed  as  good. 

Let  her  supply  each  pupil,  or  at  most  each  family,  with  books, 
etc.,  unused  by  others. 

But  what  shall  be  done  to  prevent  contagion  from  other  sources? 

Every  home  provided  for  destitute  children  that  deserves  the 
name  has  those  suffering  from  specific  disease  isolated,  or  else  the 
other  children  guarded  from  contact. 

Why  should  children  in  our  public  schools  have  less  careful  atten- 
tion ? 

Is  it  necessary  that  disease  should  be  disseminated  with  educa- 
tion ? 

Is  it  considered  democratic  to  allow  every  child  the  freedom  of 
filth  and  contagion,  whether  to  keep  it  or  impart  it,  as  a part  of  his 
inalienable  rights? 

However  much  it  might  at  first  savor  of  class  distinction  to  have 
baths  and  clean  clothing  provided  for  those  who  need  them,  would 
it  not  be  an  elevating  influence?  Would  not  the  children  learn  a 
self-respect,  in  their  clean  school  apparel,  that  would  lead  them  to 
wish  and  do  their  part  for  better  home  surroundings? 

If  cleanliness  is  next  to  godliness,  where  and  how  can  the  truth 
be  better  taught? 

Some  will  cry  out  against  inspectors,  baths  and  clean  apparel. 

They  will  have  such  sympathy  for  the  injured  feelings  of  the  un- 
fortunate class. 

Have  such  visited  the  homes  from  which  these  children  come? 
I will  not  describe  them.  Every  city  has  its  slums. 

We  are  here  witnessing  the  great  progress  the  world  is  making  in 
science,  art,  industry,  medicine  and  surgery.  Is  it  not  an  appropri- 
ate time  to  arouse  the  public  mind  to  a still  more  important  matter? 

So  thoroughly  has  it  been  demonstrated  that  an  educated  mind 
can  excel  the  uncultivated,  that  unconsciously,  as  it  were,  the  foun- 

68 


1074  world’s  homoeopathic  congress. 

elation  of  all  education,  cultivation  and  refinement  has  been  made  to 
take  a secondary  place. 

It  has  almost  been  lost  sight  of  that  a healthy  body  is  indispen- 
sable to  a sound  mind. 

Of  all  progressive  movements,  what  will  compare  with  the  preser- 
vation and  improvement  of  our  children’s  health  ? 

What  of  so  great  importance  as  shutting  the  gates  that  shall  sap 
the  health  of  not  only  the  rising  generation  but  of  generations  yet 
unborn  ? 

Teach  the  children  hygiene  in  a broader  sense.  Call  diseases  by 
their  names.  Teach  your  children  to  loathe  and  shun  those  who  are 
accursed,  and  no  longer  consider  your  child  tenderly  reared  because 
kept  in  ignorance  of  unpleasant,  painful,  disgusting  fads. 

It  has  been  my  purpose  to  speak  but  a word  for  child  life;  to  give 
but  a glimpse  at  the  dark  cloud  hovering  about  school  days. 

Let  us,  as  physicians,  sound  the  note  of  alarm  until  the  school 
world  is  awakened  to  the  real  though  subtle  danger. 

Discussion. 

George  B.  Peck,  M.D. : It  has  been  my  privilege  to  serve  as 

member  of  a school  board  toward  fifteen  years,  and  to  graduate  from 
the  public  schools,  but  I have  never  seen  a counterpart  of  the  scene 
portrayed  by  the  essayist.  So  far  as  my  native  city  is  concerned, 
and  of  that  only  can  I speak  definitely,  the  picture  is  entirely  over- 
drawn. Children  loathsome  to  sight  and  smell  are  not  found  in 
the  public  schools  of  Providence.  Should  they  apply  for  admission 
they  would  promptly  be  directed  to  return  home  and  wash.  Where 
that  educator  lives  who  finds  50  per  cent,  of  the  pupils  too  filthy  to 
be  allowed  admission  I cannot  conceive.  It  probably  is  outside  the 
United  States  ; certainly  is  beyond  the  limits  of  New  England. 

The  dangers  of  modelling  in  clay  are  obviated  in  my  schools  by 
excusing  children  with  sore  or  cracked  hands  from  the  exercise. 
Those  of  syphilis  by  sending  those  with  noticeable  symptoms  to  my- 
self or  to  the  superintendent  of  health  for  examination.  Those  of 
tuberculosis  are  practically  nil.  Children  do  not  get  books  as  de- 
scribed. If  typhoid  fever  has  been  proven  to  result  from  the  inha- 
lation of  air  befouled  by  the  breaths  of  dirty  children,  alas  for  the 
stability  of  bacteriology  and  the  germ  theory. 

The  essayist  declares  that  “ where  the  greatest  protection  is  needed 
the  least  is  afforded.”  That  statement  I deny.  I never  have  seen 
any  statistics  that  afford  the  slightest  foundation  for  the  popular  idea 
that  children  are  more  susceptible  to  certain  disorders  than  adults, 
though  I have  searched  long  and  widely.  I should  like  to  find  a 


CONTAGION  IN  PUBLIC  SCHOOLS  AND  ITS  PROPHYLAXIS.  1075 


single  iota  of  evidence  that  the  seclusion  of  a child  from  scarlatina 
germs  until  ten,  or  even  fifteen  years  of  age,  will  diminish  in  the 
least  his  liability  to  contract  the  disorder  upon  the  first  exposure. 
On  the  contrary,  I believe  that  the  children  of  the  common  people, 
those  who  cannot  attend  school  beyond  the  age  of  fourteen  years  at 
the  farthest,  are  cruelly  robbed  of  a very  considerable  portion  of 
their  educational  opportunities  by  unnecessarily  rigid  sanitary  regu- 
lations. In  the  average  family  of  four,  unless  it  should  chance  that 
all  are  sick  simultaneously  or  during  vacation,  each  one  is  unjustly 
and  to  a great  degree  needlessly  deprived  of  at  least  one-seventh  of 
its  school  advantages,  crippling  to  that  extent  its  ability  to  fight  life’s 
battle,  darkening  to  that  extent  its  life’s  prospects.  That  is  a point 
never  considered  by  rabid  sanitarians. 


1076 


world’s  homoeopathic  congress. 


SOME  NOTES  UPON  HEADACHE  IN  CHILDREN 

By  Gerard  Smith,  M.R.C.S.,  London,  England. 


The  President  of  the  British  Homoeopathic  Society  has  asked  me 
to  provide  some  material  for  discussion,  at  your  Congress,  connected 
with  the  branch  of  work  in  which  I happen  to  be  specially  inter- 
ested— that  of  children's  disorders.  I have  rashly  acceded  to  his 
request,  and  have  now  to  ask  your  kind  indulgence  for  a very  me- 
diocre and  “half-cooked  ” paper  on  a point  of  detail.  The  time  at 
my  disposal  is  short,  and  I am  very  hard  worked  in  my  professional 
duties.  This  will,  perhaps,  plead  for  me. 

The  Homoeopathic  treatment  of  headache  in  children  is  my  sub- 
ject. I think,  that  the  therapeutic  treatment  of  headache,  either  in 
adults  or  children,  is  a point  where  Homoeopathy  has  most  signally 
triumphed  over  Old-School  treatment.  In  treating  adults  for  head- 
ache, we  have  an  instance  of  the  great  value  of  purely  subjective 
symptoms,  and  at  the  same  time  we  are  obliged  to  run  the  risk  of 
being  led  astray  by  our  patient’s  account  of  those  subjective  symp- 
toms. I suppose  that  the  patient  who  can  accurately  describe  and 
locate  his  headache,  with  all  its  attendant  effects,  is  even  more  rare 
than  the  man  who,  in  proving  a drug,  can  give  a true  account  of  the 
head  sensations  produced. 

This  latter  rarity  brings  about  another  difficulty,  for  we  have  such 
a glut  of  head  symptoms  under  almost  every  proved  drug  that  to 
select  a remedy  becomes  an  appalling  task. 

I have  been  inquiring  into  the  therapeutics  of  Allopathy  in  head- 
aches recently,  and  my  Allopathic  friends  tell  me  that  besides  the 
mere  narcotics,  which  they  agree  with  me  can  only  smother  the 
symptoms,  they  have  a few  new  drugs,  which  are  what  they  call 
specifics  in  some  forms  of  headache.  They  have  been  lighted  on 
“quite  empirically/’  but  I note  that  very  pretty  pathological  theo- 
ries have  subsequently  been  produced  to  fit  the  facts  of  the  success 
attending  the  use  of  these  drugs.  It  will  interest  ns  as  Homoeo- 
paths to  learn  from  our  friends  something  new . The  drugs  are : 


SOME  NOTES  UPON  HEADACHE  IN  CHILDREN. 


1077 


Aconite,  Belladonna,  Gelsemium,  Phosphorus,  and  Nitro-glyc- 
erine. 

In  dealing  with  children,  we  have  not  the  difficulty  of  the  pa- 
tient’s inability  to  be  exact  in  recounting  the  symptoms,  or  to  accept 
our  suggestions  as  to  the  nature  of  the  pain  if  they  be  only  suffi- 
ciently expressive  of  great  sufferings;  but  we  have  the  still  greater 
difficulty  that  our  little  patient  gives  us  no  verbal  and  personal  de- 
scription at  all  of  his  feelings.  Where  the  child  is  old  enough  to 
give  us  a hint,  we  find  the  description  generally  more  truthful  than 
the  average  sick  adult,  less  exaggerated,  and  often  very  picturesque, 
as  in  one  case  I have  in  mind,  where  a little  girl  said  her  head  had 
“eyes  worked  with  a lead  weight,  like  dolly, ” and  this  weight  was 
out  of  gear,  and  scraped  inside  her  forehead. 

But,  as  a rule,  we  are  forced  to  depend  chiefly  upon  objective 
symptoms  with  children,  and  I submit  that  this  fact  accounts  for  our 
comparative  non-success  in  the  therapeutics  of  headache  in  children. 
We  are  tempted  to  build  too  much  upon  pathological  theories,  a 
fault  which  is  not  common  in  Homoeopathy,  for,  on  the  whole,  it  is 
probable  that  we  neglect  pathological  condsiderations  too  much  in 
our  therapeutics. 

I will  not  attempt  a classification  of  headaches  in  children;  such 
would  be  only  arbitrary  and  artificial;  but  there  are  some  general 
points  which  experience  has  led  me  to  think  of  value.  I have  formed 
an  opinion,  perhaps  on  too  slight  reasons,  that  frontal  headaches  in 
children  are  more  generally  the  result  of  some  distant  affection,  or 
of  a constitutional  or  blood  disorder;  whilst  occipital  headaches  are 
often  local,  and  more  often  than  not  they  are  ocular,  or  the  result  of 
injuries.  Hereditary  headaches  seem  to  tend  to  one  circumscribed 
spot,  generally  unilateral,  and  supra  orbital  or  temporal. 

One  of  the  most  common  grounds  of  error  in  therapeutics,  in 
these  affections  (speaking  for  myself),  is  that  of  founding  treatment 
upon  the  supposition  that  the  pain  is  due  either  to  cerebral  hyperse- 
mia  or  the  reverse  condition,  anaemia.  We  often  meet  with  children 
who  have  headaches  accompanied  with  flushed  face,  bright  eyes,  and 
restlessness,  who  are  usually  anaemic;  and  my  experience  tells  me 
that  these  children  are  not  successfully  treated  with  Belladonna  or 
Aconite.  More  frequently  remedies  which  are  homoeopathic  to 
their  usual  constitutional  slate,  such  as  Ferrum  or  Arsenicum,  will 
prove  valuable. 


1078  world’s  homoeopathic  congress. 

In  ansemic  children,  with  apparently  hyperseraic  headaches,  it  will 
usually  be  found  that  hot,  nourishing  food,  such  as  hot  milk  or  soup, 
will  relieve  the  pain,  whereas  in  true  hypersemic  headache  such  a 
course  would  perhaps  increase  the  pain. 

I think  that  the  examination  of  the  urine  will  prove  valuable  in 
most  cases  of  headache  in  children.  Many  anaemic  children  will 
be  found  to  pass  excess  of  phosphates  or  urates  during  their  head- 
aches, and  we  may  draw  valuable  indications  for  diet  from  such 
facts. 

I had  a very  painful  case  of  persistent  headache  in  a child  under 
my  care,  in  which  great  quantities  of  phosphates  were  passed  whilst 
the  urine  was  copious.  The  child  was  depressed  and  stupefied;  had 
severe  pain  over  the  region  of  the  kidneys ; vomited  his  food,  and  his 
face  was  flushed,  with  photophobia ; he  had  vertigo,  so  that  he  stag- 
gered. Many  remedies  were  tried  unsuccessfully,  but  the  rather  un- 
usual one,  Helonias,  proved  curative  given  in  the  sixth  potency. 

Another  case  I have  notes  of  is,  perhaps,  instructive.  A child, 
9 years  of  age,  a boy,  who  had  epistaxis  with  his  headaches;  but 
this  symptom  could  not  be  taken  as  an  indication  of  cerebral  hyper- 
semia,  for  the  child  was  pale  and  markedly  anaemic;  he  was  men- 
tally depressed;  the  headache  was  in  the  vertex ; he  had  palpitation 
of  the  heart,  and  auscultation  revealed  a mitral  insufficiency.  La- 
chesis  12  proved  the  remedy.  I mention  this  case  as  an  example  of 
the  error  of  taking  symptoms  which  often  point  to  cerebral  hyper- 
semia  as  always  indicating  that  state  in  children.  I venture  to  say 
that  we  too  often  look  upon  epistaxis  as  a proof  of  abnormal  fulness 
of  the  cerebral  vessels.  In  children  we  can  usually  afford  to  neglect 
the  possibility  of  the  bleeding  being  due  to  disease  of  the  coats  of 
the  vessels,  as  it  may  be  in  adults;  but  we  should  be  on  our  guard, 
and  remember  that  epistaxis  in  children  may  be  a sign  even  of  con- 
stitutional ansemia  or  of  a passive  congestion  due  to  valvular  disease 
of  the  heart. 

What  are  called  “ school  headaches,”  bring  great  responsibility 
upon  us;  we  are  called  upon  to  advise  as  to  the  nature  and  extent 
of  the  education  which  some  children  can  bear,  and  if  we  decide 
wrongly  we  may  do  much  harm  to  the  children  in  their  future  life. 
There  is  a grave  responsibility  attaching  to  any  man  who  causes  a 
child  to  be  withdrawn  from  its  lessons,  and  to  miss  that  period  of 
life  when  habits  of  thought  and  memory  may  be  most  easily  required; 


SOME  NOTES  UPON  HEADACHE  IN  CHILDREN. 


1079 


and,  on  the  other  hand,  great  errors  have  been  made  in  the  op- 
posite direction ; school-headaches  have  been  neglected,  and  the 
child’s  brain  powers  undermined  by  suffering,  and  its  normally 
happy  child-time  rendered  very  miserable.  My  experience  is,  that 
under  the  modern  system  of  education,  which  recognizes  the  facts  of 
evolution  in  these  matters,  and  leads  a child  up  by  gradual  steps 
from  play  to  “ play-work,”  and  so  on  to  exercise  of  memory  and  per- 
ception by  slight  and  easy  stages,  we  see  less  of  genuine  school- 
headaches  ; by  which  I mean,  headaches  which  are  actually  the  re- 
sult of  overstrain  of  brain-powers,  and  yet,  children  at  school  do 
very  often  suffer  from  headache;  after  errors  of  “ cramming 19  have 
been  eliminated,  and  all  the  hygienic  surroundings  of  children  at 
school  have  been  reformed  to  the  modern  scientific  standard,  we  yet 
have  too  many  of  these  cases  to  deal  with.  Our  children — of  course 
I mean  English  children  only — are  very  glad  at  times  to  get  out  of 
school  before  the  regulation  hours,  and  if  they  choose  malingering 
as  the  means  to  this  end,  they  are  clever  enough  to  select  maladies 
which  are  diagnosed  by  subjective  symptoms  only,  for  obvious  rea- 
sons; and  this  kind  of  school- headache  is  the  first  to  claim  our  at- 
tention. 

I would  not  be  so  discourteous  as  to  suggest  that  the  American 
child  ever  shams;  but  there  are  English  children  in  your  schools  ; 
and  if  these  should  be  frequently  away  from  school,  with  headache, 
it  is  sometimes  found  that  it  is  a headache  which  comes  on  very  early 
in  school-hours;  is  vague  in  its  situation,  and  the  youngster  is  able 
to  read  books  of  amusing  stories,  or  engage  in  other  occupations  re- 
quiring considerable  concentration  both  of  eye  and  memory,  without 
a return  or  increase  of  the  headache  ; I have  found  that  isolation  from 
the  class  in  which  the  child  is  placed  at  school,  and  the  use  of  special 
large  type,  not  interrupting  the  usual  school-hours  of  work,  is  worth 
trying  as  treatment  here;  children  will  not  hold  out  for  long  if  they 
are  malingering  when  thus  kept  apart  from  their  fellows. 

But  the  fact  that  children  know  that  there  is  such  a thing  as  head- 
ache from  reading  print,  shows  that  this  is  no  uncommon  form  of  the 
affection  ; and  1 think  that  a large  proportion  of  school  headaches 
are  due  to  eye-strain. 

Headaches  due  to  eye-strain  are,  I have  noticed,  more  often  occip- 
ital than  frontal  or  vertex;  considerable  success  in  their  treatment 
is  gained  by  simple  attention  to  the  general  health ; but  so-called 


1080 


world’s  homoeopathic  congress. 


“ tonic  treatment  ” is  never  more  than  palliative;  the  headache  may 
be  kept  away  so  long  as  artificial  stimulation  is  kept  up,  but  will  re- 
turn when  it  is  removed  ; when  the  child  is  in  exceptionally  good 
health,  the  headache  may  be  absent,  as  after  the  holidays;  but  as  the 
school  term  progresses,  the  trouble  returns;  in  such  cases  it  will  gen- 
erally be  found  that  the  vision  is  apparently  normal,  unless  the  child 
is, at  the  moment  of  examination,  suffering  from  pain;  but  when  tired, 
or  when  under  the  influence  of  Atropine  in  the  eye,  the  refraction 
will  be  found  at  fault;  the  child  is  able,  under  ordinary  conditions, 
to  produce  accommodation  by  an  effort  which  is  unconscious,  but  in 
excess  of  what  should  be  demanded  of  the  child  ; and,  under  ill- 
health  or  prolonged  application,  this  strain  is  evidenced  by  head- 
ache. 

I have  seen  one  case,  that  of  a girl  of  1 2 years  of  age,  who  suf- 
fered from  severe  neuralgic  pain  in  the  neck,  radiating  down  the 
cervical  nerves  on  both  sides,  which  was  caused  entirely  by  eye- 
strain,  and  was  cured  by  the  use  of  the  proper  glasses. 

I have  no  doubt  that  the  Homoeopathic  therapeutics  of  such  con- 
ditions are  well  known  to  all  present,  but  they  will  be  of  little  avail 
if  the  help  of  properly-adjusted  glasses  is  neglected;  not  “ Pince- 
nez,”  which  sometimes  provoke  fresh  headache  in  a sensitive  child 
by  their  pressure  on  the  bridge  of  the  nose,  but  light-framed  spec- 
tacles. There  are  three  drugs  which  I have  been  led  to  use,  of  which 
the  first,  Acid  picric.,  is  perhaps  not  sufficiently  valued  ; thepathogen- 
esy  of  this  drug  points  to  both  the  headache  and  the  ocular  symptoms  ; 
I have  used  it  in  the  higher  potencies,  by  which  I mean  from  12  to 
30;  Nitrate  of  silver  and  Cimieifuga  are  the  other  two;  these  I 
mention  as  being,  possibly,  outside  the  general  run  of  headache  rem- 
edies, and  because  they  have  served  me  well.  I use  the  two  latter 
in  varying  doses,  but  the  Cimieifuga  in  lower  potencies,  3x,  or  there- 
abouts. 

I think  that  the  headaches  of  girls  at  approaching  puberty  are  be- 
coming more  general  in  our  times;  the  new  physical  regime  has  not 
been  universally  adopted  as  yet,  though  in  families  where  it  has  been 
practiced  from  childhood,  I find  less  suffering  among  the  girls  as 
menstruation  comes  on  ; the  cause  of  a girl’s  headache  at  this  period 
of  her  life  is  generally  well  recognized  by  mothers,  who  are  awake 
to  the  necessity  of  physiological  rest  at  these  times ; I need  not  de- 
tain you  with  therapeutics  here,  but  drop  a word  to  attract  your 


SOME  NOTES  UPON  HEADACHE  IN  CHILDREN. 


1081 


attention  to  the  tendency  of  Homoeopathic  mothers  having  a fancy 
for  Pulsatilla  in  all  these  troubles  of  their  girls;  it  seems  very  apt 
to  act  upon  the  ovaries  rather  too  freely,  for  the  tendency  in  most 
girls  is  to  rather  free  loss  of  blood  at  the  first  few  periods,  more  often 
than  the  opposite  (in  my  own  experience),  and  Pulsatilla  increases 
this  tendency  unduly  ; Coffea  and  Ferrum  seem  often  useful. 

The  “ genital  headaches  ” of  boys  at  puberty  often  cause  much 
suffering,  and  in  all  cases  of  intractable  headache  in  boys  the  possi- 
bility of  approaching  puberty  should  receive  attention.  Other  geni- 
tal irritations  in  boys  also  seem  to  play  a prominent  part  in  causing 
headache,  and  in  my  own  experience  I have  found  that  phymosis  is 
not  seldom  a cause  of  headache  in  boys,  as  it  is  of  many  nervous 
symptoms;  and  you,  no  doubt,  will  all  remember  cases  where  cir- 
cumcision has  cured  such  troubles.  I have  known,  in  several  cases, 
the  most  happy  results  from  circumcision  in  boys’  headaches. 

I will  not  deal  with  the  headache  of  febrile  states,  since  our  atten- 
tion in  such  cases  is  turned  to  the  fever  rather  than  the  headache 
alone;  but  there  are  headaches  accompanied  by  fever,  and  due  to 
malaria,  which  are  instances  of  the  headache  being  the  main  guiding 
symptom.  I think  they  are  usually  intermittent ; they  are  either 
very  vague  and  general  in  the  locality  they  affect,  or  occasionally 
will  be  truly  neuralgic,  the  pain  being  fixed  in  one  or  other  of  the 
cranial  nerves,  or  at  least  being  felt  over  the  surface  where  the  nerves 
are  distributed,  and  perhaps  the  supra  orbital  is  the  most  common 
situation.  I think  that  when  a malarial  headache,  intermittent,  and 
chiefly  felt  in  the  supra-orbital  region,  comes  before  us,  we  have  the 
true  sphere  for  Quinine  to  be  used  Homoeopathically. 

I may,  perhaps,  be  at  variance  with  others  when  I state  that  I do 
not  think  that  true  “ migraine”  is  often  seen  in  children.  In  the 
case  of  the  children  of  parents  who  are  sufferers  from  migraine  we 
certainly  often  see  headaches,  but  I find  them  usually  to  be  coinci- 
dent with  some  digestive  upset,  and  the  vomiting,  if  present,  to  be 
more  often  controlled  by  remedies  acting  upon  the  stomach  than  by 
such  as  are  chosen  upon  the  cerebral  supposition.  I recognize  that 
these  pathological  suppositions  are  alien  to  the  Homoeopathy  held 
by  many,  but  I think  that  in  most  cases  it  will  be  found  that  a 
remedy,  chosen  first  on  the  ground  of  the  totality  of  the  symp- 
toms, turns  out,  on  further  examination,  to  be  also  the  pathological 
similar. 


1082  world’s  homoeopathic  congress. 

Still,  there  are  cases  of  headache  in  children  in  which,  before  the 
onset  of  pain,  we  hear  of  various  warning  symptoms,  such  as  flashes 
of  light  before  the  eyes,  or  sensations  of  dimness  of  sight,  or,  in  some 
cases,  temporary  weakness  or  paralysis  of  an  arm  or  leg,  either  motor 
or  sensory,  or  both.  Then  the  pain  in  the  head,  localized  generally 
in  a definite  spot  on  one  side  of  the  forehead,  comes  on,  and  is  fol- 
lowed by  vomiting.  Such  headaches,  if  frequent  in  onset,  are  prob- 
ably true  migraine,  not  coincident  with  dyspeptic  trouble,  and  they 
may  be  hereditary.  The  first  point  is  to  eliminate  the  possibility  of 
eye  strain,  for  this  is  more  frequently  the  cause  of  migraine  than  is 
sometimes  supposed.  In  such  cases  of  true  migraine  in  children, 
Cofifea  6 and  Acid  carbolic  12  have  served  me  well. 

I need  scarcely  mention  the  importance  of  headache  where  the  pain 
is  felt  near  the  mastoid  bones  or  round  the  ear,  as  indicating  ear  dis- 
ease, but  I have  seen  the  neglect  of  timely  surgical  interference  very 
injurious  in  at  least  three  such  cases.  The  pain  is  not  headache, 
though  generally  described  as  such. 

And  we  must  always  be  on  our  guard  when  we  meet  with  serious 
nervous  symptoms,  snch  as  spasm  of  the  muscles  of  the  neck  or 
spine,  paralysis  of  muscles,  twitchings  or  convulsions,  in  connection 
with  children’s  headaches.  Such  indications  of  possible  cerebral 
mischief,  tubercle  or  tumor,  are,  of  course,  known  to  us  all. 

Finally,  I would  note  the  headache  of  renal  disorder.  I would 
urge  regular  testing  of  the  urine  in  all  cases  of  children’s  head- 
aches, for  if,  as  is  sometimes  the  case,  the  pain  is  coincident  with 
uraemia  or  albuminuria,  our  remedies  will  be  of  no  use  unless  these 
symptoms  are  placed  in  the  front  rank  when  drawing  up  the  total 
symptoms. 

Ladies  and  gentlemen,  I ask  your  kind  indulgence  for  this  hur- 
ried, incomplete,  and  very  unscientific  contribution.  If  you  have 
any  discussion  upon  this  matter  of  practical  detail,  you  will  find 
material  in  the  mere  demolishing  of  my  observations. 

Discussion. 

Phcebe  J.  B.  Waite,  M.D. : The  last  paper  read  was  especially 
interesting  because  I believe  so  many  children  suffer  from  headaches 
when  they  ought  to  be  made  comfortable  and  cured,  and  the  one 
thing  above  all  others  which  gives  suffering  to  children  I believe 
to  be  eye-strain.  As  soon  as  they  are  put  in  schools  they  commence 
to  droop.  If  the  child  is  myopic,  there  is  a request  that  he  be  put 


SOME  NOTES  UPON  HEADACHE  IN  CHILDREN. 


1083 


in  the  front  of  the  room,  but  no  thought  is  given  to  the  hyperopic 
child.  I believe  the  uses  of  the  ophthalmoscope  are  going  to  pro- 
long the  lives  of  children  in  bringing  out  this  infirmity.  Many 
children  suffer  from  headaches,  but  we  have  our  Pulsatilla  and  kin- 
dred drugs  to  help  them.  If  your  child  suffers  with  headache,  don’t 
forget  to  take  it  to  the  oculist.  This  would  be  a beautiful  specialty 
for  a woman. 

Dr.  Duffield  : There  are  many  cases  of  nearsightedness  which 
can  be  cured  simply  by  having  the  patient  accustom  himself  to  dis- 
tant objects.  Take  them  out  in  the  country,  and  in  this  way  we  get 
the  muscles  stretched,  which  is  as  good  as  nerve-stretching  in  other 
cases.  I have  cured  cases  of  nearsightedness  by  having  the  patient 
go  to  live  in  the  country,  and  so  accommodate  the  eye  to  long 
distances. 

A physician  in  the  audience:  I remember  a case  coming  under 
my  care  several  years  ago  of  a girl  having  epilepsy,  and  she  had  a 
spasm  once  in  about  eight  days.  I found,  on  inquiry,  she  used 
sugar  excessively,  and  when  she  left  off  sugar  the  spasms  ceased  in 
two  or  three  months.  There  is  a great  deal  in  diet.  Another  cause 
of  headache  is  want  of  ventilation  in  the  schoolroom.  Most  of  our 
schoolrooms  are  \ery  poorly  ventilated.  There  ought  to  be  a radi- 
cal change  in  this  matter.  We  ought  to  turn  our  attention  to  hy- 
gienic methods  more  than  we  do. 


1084 


world’s  homoeopathic  congress. 


ALBUMINURIA  IN  CHILDREN. 

By  Henry  C.  Aldrich,  M.D.,  Minneapolis,  Minn. 


Madame  President  and  fellow-practitioners:  My  line  of 
thought  for  some  time  past  has  been  turned  rather  persistently  in 
the  direction  of  albuminuria.  At  the  present  time  medical  opinion 
appears  to  me  to  be  in  somewhat  of  a transition  stage  in  regard  to 
the  pathology  of  diseases  of  the  genito-urinary  organs.  A good 
many  ancient  (and  Allopathic)  fallacies  have  been  exposed  and 
dropped,  and  we,  the  Homoeopath ists,  are  building  up  newer  views 
upon  surer  foundations.  The  process  will  be  slow  (it  is  hardly 
more  than  begun),  for  the  problems  to  be  solved  are  so  very  numer- 
ous. I have  endeavored  to  look  at  the  subject  of  my  paper  in  the 
light  of  present  knowledge  only,  and  not  to  go  one  step  beyond  what 
that  state  of  knowledge  would  seem  to  justify.  I have  kept  rigidly 
before  my  mind,  too,  the  fact  that  childhood  only,  at  the  present 
time,  is  my  sphere  and,  as  a consequence,  I can  only  touch  upon 
such  points  in  the  general  pathology  of  albuminuria  as  are  within 
the  limits  of  this  restriction.  Albuminuria,  we  know,  may  be  pro- 
duced in  children  from  a variety  of  causes;  the  rarest  causation, 
however,  is,  I think,  due  to  pressure  on  the  renal  veins;  but  let  the 
causative  agent  be  what  it  may,  I believe  albuminuria  should  always 
be  viewed  with  gravity.  If  I might  occupy  a few  moments  of  time 
with  a hasty  review  of  the  physiology  of  the  kidneys,  I should  be 
glad,  as  I think  it  will  freshen  our  memories  and  assist  us  in  the 
discussion  of  this  subject — a subject  I am  most  anxious  to  have  dis- 
cussed both  here  and  now;  for  I am  assured  that  a finer  opportunity 
for  eliciting  important  truths  from  a conflict  of  fine  minds  will  never 
arise. 

Physiology  of  the  Kidneys  : Gaze  with  a retrospective  eye,  if  you 
please,  and  we  find  that  the  membranous  covering  of  the  internal 
surface  of  the  secretory  cells  of  the  kidney  is  really  a true  protective 
organ,  keeping  from  the  protoplasm  of  the  cells  any  substances  likely 


ALBUMINURIA  IN  CHILDREN. 


1085 


to  interfere  with  their  functions.  We  remember,  too,  that  this  mem- 
brane varies  in  its  structure,  and  the  variation  is  due  to  the  degree 
of  functional  activity  of  the  epithelium. 

In  conditions  of  repose  this  membrane  is  homogeneous;  in  condi- 
tions of  activity  it  is  peculiarly  marked,  having  a quantity  of  clear 
streaks  running  through  it,  and  taking  on  the  appearance  of  a 
structure  formed  of  small  straight  rods,  these  being  held  together 
or  separated  by  an  intermediate  substance  of  a clear  fluid  character. 
After  some  great  functional  excitation  a remarkable  change  takes 
place;  the  collected  urine  detaches  and  pushes  away  this  membrane 
from  the  protoplasm. 

The  products  of  the  renal  secretion  collect  within  the  epithelial 
cells  in  the  form  of  liquid  masses,  having  either  a rounded  or  elon- 
gated appearance,  and  clear,  like  the  contents  of  the  tubules.  This 
fluid  percolates  through  openings  in  the  limiting  membrane,  some- 
times breaking  through  the  latter  to  gain  the  interior  of  the  canali- 
culi,  often  detaching  and  carrying  it  away. 

A great  advance  has  been  made  in  our  study  of  aetiology,  proven 
by  the  fact  of  our  knowing  that  a micro-organismal  factor  exerts  its 
most  prominent  pathological  influences  upon  the  kidneys. 

Within  the  past  year  or  two  some  notable  contributions  have  been 
made  to  the  literature  of  this  disease,  notably,  that  of  Clifford  Mitchell, 
whose  able  exposition  of  the  relation  of  urinary  analysis  to  diet  is 
of  untold  value;  of  Mannaberg,  upon  the  relation  of  acute  nephritis 
and  the  streptococci  found  in  endocarditis.  In  eleven  cases  of  acute 
nephritis,  Mannaberg  found  the  urine  to  contain  streptococci,  which 
disappeared  from  the  excretion  with  the  disappearance  of  the  symp- 
toms of  disease.  In  patients  affected  by  other  maladies,  and  in 
healthy  individuals,  this  micro-organism  is  not  to  be  found,  although 
searched  for  in  a long  series  of  urines.  Mannaberg  has  cultivated 
this  streptococcus  in  question  and  separated  it,  by  peculiarities  in  its 
cultivation,  from  other  varieties  of  streptococci.  These  do  not  appear 
to  select  the  kidneys  as  an  especial  position  for  growth ; they  proba- 
bly multiply  in  the  blood  and  tissues  generally  ; and  in  their  escape 
through  the  renal  structures.,  produce  their  serious  consequences. 
This,  undoubtedly,  is  a form  of  blood-poisoning  specially  involving 
the  kidneys.  As  I before  said,  a great  many  old  fallacies  have  been 
dropped  ; the  trend  of  thought  and  study  to-day  is  carrying  us  still 
further  and  further  from  the  old  lines  of  thought;  views  formerly 


1086 


world's  homoeopathic  congress. 


held  are  either  passing  into  desuetude  or  becoming  very  much  re- 
stricted; causes  of  disease,  formerly  hardly  conjectured,  are  being 
added  to  the  list,  and  some  factors  of  causation,  such  as  exposure  to 
dampness,  cold,  etc.,  are  dropped  out. 

I might  occupy  your  time  by  citing  almost  numberless  cases,  pub- 
lished both  abroad  and  at  home  by  adherents  of  both  schools,  where 
there  is  no  apparent  causation  of  renal  disease  from  exposure  to 
dampness  or  cold.  I will  merely  cite  from  Letzerich.  He  observed 
a number  of  cases  of  renal  inflammation,  due  to  a characteristic  ba- 
cillus, from  cultures  of  which  he  could  reproduce  nephritis  in  rab- 
bits. The  symptoms  he  found  in  general  similar  to  those  in  other 
cases  of  nephritis,  somewhat  mild  in  form,  but  showing  a predomi- 
nance of  gastric  phenomena. 

He  found  the  spleen  apt  to  be  swollen,  with  considerable  fever, 
and  often  rapidly  developing  oedema  and  effusion  into  the  serous 
cavities.  The  urine  contained  short,  straight  or  curved  rods,  in 
large  numbers.  These  symptoms,  finding  no  history  of  exposure  to 
dampness  or  cold,  make  the  suggestion  of  a micro-organism  exceed- 
ingly relevant,  especially  so,  when  taking  into  consideration  the 
manner  of  onset,  the  involvement  of  the  lungs,  and  the  prostration 
accompanying  the  affection.  The  affection  in  question  was  found 
most  commonly  in  children,  and  in  cases  which  came  to  post-mortem 
section,  it  was  found  that  the  bacilli  developed  only  in  the  intersti- 
tial structure  of  the  kidney  ; the  spores  were,  however,  found  gener- 
ally throughout  the  body.  At  no  previous  time  has  the  question  of 
the  infectious  nature  of  the  renal  affection,  known  as  Bright’s  dis- 
ease, been  so  forcibly  placed  before  the  profession  ; and  there  can  be 
no  doubt  whatever  as  to  the  prominence  which  will  hereafter  be 
accorded  to  infectious  influences  in  the  production  of  the  malady. 
An  exceedingly  interesting  and  instructive  paper,  published  by 
Agnes  Bluhm,  upon  the  aetiology  of  Bright’s  disease,  is  based  upon 
an  analysis  of  8442  cases,  material  derived  from  clinics  during  a 
period  of  five  or  six  years;  and  the  vast  majority  of  these  cases  were 
clearly  traced  to  an  infectious  origin. 

We  find  to-day  a good  many  men  in  our  own  school,  besides  num- 
bers of  outsiders,  who  still  pin  their  faith  to  a belief  in  the  constant 
existence  of  albumin  in  normal  urine.  After  having  made  a great 
number  of  carefully  conducted  examinations  of  normal  urine,  I feel 
compelled  to  place  myself  in  opposition  to  these.  The  result  of  my 


ALBUMINURIA  IX  CHILDREN. 


1087 


experiments  have  proven  most  satisfactorily  to  my  own  mind  that 
the  presence  of  albumin  is  not  characteristic  of  normal  urine.  There 
are  some  of  us  who  argue,  that  small  amounts  occurring  in  normal 
urine  tentatively  is  of  no  significance ; that  it  is  only  where  it  reaches 
any  proportion  that  it  should  be  seriously  considered.  I believe 
that  the  smallest  possible  amount  should  be  viewed  with  gravity, 
and  that  under  any  circumstances  whatever,  albuminuria  means 
some  fault  of  the  epithelial  covering  of  the  glomerules.  Probably 
Purdy’s  experience  along  these  lines  has  been  as  large  as  any  one 
man’s.  He,  in  a publication  of  his  upon  examinations  of  urine  for 
life-insurance,  takes  this  position:  “ No  applicant  for  life-insurance 
should  be  debarred  on  account  of  albuminuria,  but  the  time  has 
arrived  for  stamping  out  the  idea  so  prevalent  among  the  profession, 
that  the  slighter  traces  of  albumin  in  the  urine  are  of  no  significance. 
It  has  been  my  experience  during  the  past  five  years  to  make  a large 
number  of  analyses  of  urine,  from  cases  of  all  sorts,  but  never  once 
have  I met  with  a single  case  of  albuminuria  in  which  a microscopi- 
cal examination  did  not  discover  some  pathological  condition  of  the 
kidney  or  uropoietic  system  sufficient  to  account  for  the  symptom. 
Single  examinations  have  not  always  returned  me  the  foregoing  re- 
sult, but  repeated  searching  has  never  failed  to  disclose  pathological 
evidence,  so  I have  arrived  at  this  conclusion  : there  is  positively  no 
such  thing  as  a physiological  albuminuria.” 

Physiological  albuminuria,  however,  is  a term  which  has  found 
so  much  favor  with  the  profession  generally,  that  whatever  the  be- 
lief may  be,  it — the  term — will,  in  all  probability,  remain  in  vogue. 
I believe  that  albuminuria  is  many  times  the  product  of  an  incom- 
plete or  pernicious  digestion.  The  incomplete  transformation  of 
the  albumin  leads  to  the  production  of  a relative  albuminuria,  and 
from  this,  by  very  evident  steps,  to  a true  albuminuria.  So,  too, 
the  various  toxic  substances,  from  a perverted  digestion,  are  brought 
to  the  kidneys,  in  their  excretion  producing  a like  train  of  events. 

I think,  when  we  are  testing  for  albumin,  we  should  select  the 
specimen  of  urine  voided  at  the  time  when  the  patient  is  most  fa- 
tigued; the  amount  of  albumin,  as  we  know,  is  greatly  influenced 
by  circumstances.  Then  should  begin  an  exhaustive  examination 
for  casts,  and  if  one  fail  to  find  them  when  they  are  actually  pres- 
ent, the  result  must  be  a serious  error  in  diagnosis. 

Since  I have  insisted  upon  the  entire  collection  of  urine  voided 


1088 


world’s  homoeopathic  congress. 


within  the  twenty-four  hours,  my  experiments  have  proved  much 
more  satisfactory  to  myself  and  beneficial  to  my  patients.  When 
searching  for  albumin,  I have  the  child  exercise  as  vigorously  as  is 
prudent  before  voiding  urine  for  examination,  and  where  the  case  is 
doubtful,  I examine  the  urine  of  each  micturition  during  the  entire 
twenty-four  hours.  I need  hardly  say  that  the  commonest  cause  of 
albuminuria  is  Bright’s  disease,  but  I do  consider  it  my  duty  to  say 
that  I believe  a large  proportion  of  the  so-called  “ physiological  or 
functional  albuminurias”  eventuate  in  this  malady  unless  treated 
before  being  allowed  to  endure  for  any  length  of  time. 

We  are  to-day  familiar  with  the  fact  that  nephritis  is  a disease 
common  to  childhood,  arising  most  frequently  after  scarlatina  or 
other  blood  poison.  Formerly  it  was  considered  as  one  of  the  re- 
sults of  cold,  dampness  and  drinking  habits — its  especial  province 
the  adult. 

The  average  of  disease  in  childhood  is  acute,  so  the  prognosis  for 
nephritis  as  regards  complete  recovery  is  mostly  good.  As  a mere 
matter  of  enumeration  we  are  perfectly  familiar  with  the  symptoms 
of  acute  Bright’s  disease — the  pallor,  the  vomiting,  convulsions, 
cough,  dropsy,  a pulse  that  intermits,  oppressed  breathing,  scanty 
urine,  with  a large  percentage  of  albumin  ; but  individual  cases  are 
of  most  interest  just  now.  Howard  B.,  a boy  aged  ten,  was  placed 
under  my  care.  His  previous  history  was  good,  except  for  an  attack 
of  typhoid  fever  some  nine  months  previous.  The  boy  was  hardly 
to  be  called  sick  (from  the  time  of  his  recovery  from  the  fever  until 
placed  under  my  care),  at  least  for  the  greater  part  of  the  time. 
Ailing  at  times  for  two  or  three  days  together,  causing  great  anxiety 
then,  and  again  appearing  to  be,  and  insisting  upon  the  fact  of  his 
being,  perfectly  well.  There  had  been  an  occasional  slight  swelling 
of  the  lower  limbs — a fact  to  which  the  mother  attached  no  import- 
ance. When  I first  saw  him  he  was  in  bed,  and  the  swelling  had 
been  on  the  gradual  increase.  I found  the  lad  in  a condition  ot 
extensive  anasarca,  the  action  of  the  heart  very  irregular.  The 
urine  was  only  a few  ounces  in  twenty-four  hours;  sp.  gr.  1024; 
full  of  albumin  and  containing  granular  and  hyaline  casts.  The 
boy  during  all  this  time,  a period  of  nine  months  of  treatment,  in- 
sisted that  he  was  well.  The  sp.  gr.  of  the  urine  rose  as  high  as 
1030,  and  for  a period  of  eight  months  the  albumin  averaged 
throughout  from  a third  to  a sixth.  From  that  time  on  it  decreased 


ALBUMINURIA  IN  CHILDREN. 


1089 


from  one-fifth  to  one-twenty-fifth,  and  during  the  last  five  or  six 
days  it  disappeared  entirely.  I began  treatment  by  restricting  his 
diet — much  to  the  boy’s  chagrin — keeping  him  to  milk  and  water, 
jelly,  bread  and  butter,  sweet  potatoes  and  peptonized  milk  toast. 
Digitalis  and,  later  on,  Ferrum  continually,  brought  the  boy  around. 
Since  that  time  he  has  remained  well. 

A somewhat  interesting  case  of  incontinence  of  the  urine  came 
under  my  care  recently — the  patient  a girl  six  years  of  age.  The 
previous  history,  according  to  the  mother’s  statement,  was  one  of 
perfect  health.  Application  was  made  for  admission  to  the  public 
schools.  The  child  could  not  gain  admission  until  vaccinated.  From 
that'time  on  she  was  ailing,  the  entire  body  breaking  out  in  sores. 
There  was  a discharge  from  the  right  ear,  and  back  of  the  ear  a 
superficial  abscess.  The  urine  at  the  time  was  dark,  contained  col- 
oring-matter and  was  loaded  with  albumin.  The  child  was  suffering 
at  the  same  time  from  prolapsus  uteri,  with  leucorrhoea.  I need 
hardly  speak  here  of  the  two  avenues  for  physical  examination. 
There  is  but  one  way  to  treat  such  cases  as  the  foregoing:  by  means 
of  combined  rectal  and  abdominal  palpation.  In  the  case  of  the 
child  just  mentioned  the  belly  walls  were  both  fat  and  relaxed,  and 
there  seemed  a great  possibility  of  considerable  resistance  being  of- 
fered. It  was  important  that  the  examination  should  be  thorough, 
therefore  I anaesthetized  at  once.  Indeed,  I think  it  advisable  in  all 
such  cases;  the  effects  are  rapid,  the  duration  short  and  the  resist- 
ance slight.  The  rectal  touch  is  the  most  certain  way  of  approaching 
tubes  and  ovaries  to  be  questioned,  and  combined  with  palpation  by 
the  other  hand  on  the  abdomen,  is  greatly  enhanced  in  value.  Fectal 
and  bimanual  massage  proved  very  effective  in  restoring  the  pelvic 
organs  to  their  normal  tone.  This  accomplished,  the  albumin,  which 
heretofore  had  appeared  with  the  greatest  regularity,  disappeared.  No 
casts  were  discoverable ; so  the  altered  condition  of  the  urine  I con- 
sidered as  due  to  the  altered  conditions  of  pressure  in  the  pelvic  and 
renal  circulations.  The  muscular  tone  of  the  patient  was  influenced 
considerably  by  daily  applications  of  electricity.  China  proved  very 
useful  here.  I had  a favorable  and  uninterrupted  action  of  the  sin- 
gle prescription  and  minimum  dose  of  the  single  indicated  remedy. 
This  Hahnemannic  trio,  I rejoice  to  say,  speaks  for  itself  without 
any  trumpeting. 

We  have  been  accused  by  the  Old-School  men  of  “Never  having 

69 


1090 


world’s  homoeopathic  congress. 


discovered  a single  bacillus.”  Shall  we  ever  rally  from  the  thrust 
or  dare  to  look  a brother  Allopath  in  the  face  again  after  being  told 
such  a thing  as  this?  And  yet  who  is  specially  benefited  by  know- 
ing that  a certain  comma  bacillus  is  found  in  this  or  a rod-shaped 
one  in  another?  We  have  a law,  that  a particular  medicine  pro- 
duces a definite  result,  and  that  one  thing  we  have  proven  to  be  of 
more  practical  use  than  the  natural  history  of  all  diseases  combined 
could  ever  be. 

In  cases  of  incontinence  of  the  urine  treatment  must  be  given 
with  an  eye  to  the  cause,  the  principal  causes  being  the  various 
motor  neuroses.  A large  number  of  such  cases  are  exceedingly  trou- 
blesome ; when,  however,  there  is  irritability  of  the  bladder,  I be- 
lieve Belladonna  will  prove  your  friend  in  almost  every  instance. 
In  such  cases  I believe  we  cannot  lay  too  much  stress  upon  massage 
of  the  bladder  per  rectum.  It  has  given  me  most  excellent  results, 
together  with  a daily  salt-water  bath,  accompanied  by  a brisk  rub- 
bing in  the  region  of  the  spine;  there  must,  too,  in  such  cases,  be  a 
careful  consideration  given  to  hygiene  and  diet,  and  last,  but  by  no 
means  least,  attend  to  the  psychical  surroundings. 

This  may,  on  first  thought,  appear  overstrained  and  far-fetched ; 
I make  it  a strong  point  simply  because  I have  watched  the  effects 
on  a nervous  child  of  a nurse  thoroughly  uncongenial.  I have  seen 
the  same  kind  of  thing  obtain  in  the  hospital,  where  children  were 
away  from  home,  everything  strange  and  new.  It  must  be  unneces- 
sary for  me  to  say  that  “ powerful  emotions”  bring  an  increase  of 
albumin  in  the  urine.  And,  believe  me,  you  will  experience  unex- 
pected results  frequently,  if  you  turn  your  attention  with  vigor 
toward  this  one  thing.  I think,  if  I remember  rightly,  our  own 
Dr.  Clifford  Mitchell  lays  considerable  stress  upon  this;  to  my  mind, 
it  is  something  to  be  strongly  considered,  whatever  the  malady  may 
be.  I was  asked,  in  preparing  this  paper,  to  show  the  prophylactic 
properties  of  Homoeopathy  in  relation  to  my  subject.  I confess 
myself  almost  totally  at  a loss  here.  The  causes  of  “ Albuminuria 
in  Children  ” are  many,  are  unforeseen,  and  it  appears  to  me  quite 
impossible  to  treat  of  it  prophylactically.  In  concluding  this  has- 
tily written  and  very  imperfect  paper,  I should  like  to  say  a few 
words  to  our  confreres  from  abroad. 

An  Englishman,  some  time  since,  said,  in  a way  that  wds  quite 
characteristic  of  the  national  generosity  and  kindliness  of  spirit,  “It 


ALBUMINURIA  IN  CHILDREN. 


1091 


is  to  the  American  Homoeopathists  we  owe  it — to  their  indomitable 
independence,  energy  and  pluck — that  Homoeopathy  stands  in  the 
position  it  does  to-day  in  the  United  States  and  before  the  world  ; 
aided  by  the  free  institutions  of  their  country  and  the  emancipated 
minds  of  the  people,  they  have  been  able  to  achieve  what  we  have 
scarcely  attempted.”  The  gentleman  who  wrote  those  words  may 
be  here  to-day ; if  he  is,  I should  esteem  it  a pleasure  and  privilege 
to  meet  him.  That  the  onward  sweep  of  Homoeopathy  in  this,  our 
own  land,  has  been  overwhelmingly  irresistible  is  a fact  far  and  away 
beyond  dispute.  We  owe  its  success,  in  a large  measure,  to  the  atti- 
tude taken  by  the  Homoeopathic  pioneers.  If  only  you  Englishmen 
would  acquire  or  wrest  the  right  to  teach,  and  grant  diplomas  to 
your  own  students,  headway  would  be  made  immediately.  Why 
should  you  beg  recognition  from  Allopathic  colleges  for  a fact  which 
the  entire  world  at  large  accepts?  If  any  one  thing  more  than  an- 
other would  stand  as  proof  of  the  progress  of  scientific  medicine,  it 
is  the  fact  that  the  men  of  the  Old  School  are  rapidly  incorporating 
into  their  materia  medica  our  laws  of  cure;  by  giving  medicines 
both  palatable  to  the  sense  of  taste  and  pleasant  to  the  sense  of  sight, 
they  are  so  thoroughly  revolutionizing  their  style  of  practice  that, 
except  for  the  old  empirical  tendencies  still  clinging  to  them,  we 
should  almost  fail  in  recognizing  them.  The  time  has  arrived,  I 
think,  for  sweeping  some  of  these  pirates  from  their  medical  high 
seats;  it  is  being  done  rapidly  here.  In  the  name  of  these  assem- 
bled Homoeopathists,  let  me  beg  of  you  to  gird  up  your  loins,  buckle 
on  your  armor,  and  fight  the  good  fight,  doing  for  Homoeopathy  in 
England  what  we  have  done  for  it  in  America — place  it  to  the  fore. 


1092 


world’s  homceopathic  congress. 


THE  TREATMENT  OF  MENINGOCELE , ENCEPHALO- 
CELE  AND  HYDRENCEPHALOCELE,  BY 
MEANS  OF  A COLLODION  CAP. 

By  J.  Martine  Kershaw,  M.D.,  St.  Louis. 

It  has  been  my  misfortune  to  meet  with  several  eases  of  menin- 
gocele, encephaloeele,  and  hydreneephalocele.  Most  of  them  died  in 
the  course  of  a few  weeks  or  months  ; convulsions  preceding  death. 
Of  the  three  forms  of  tumor,  hydreneephalocele  may  be  considered 
the  most  unfavorable.  These  tumors  consist  of  brain  substance,  the 
meninges,  and  fluid.  Encephaloeele  consists  of  cerebral  substance 
only,  while  a meningocele  contains  the  membranes  of  the  brain. 
These  protrusions  have  been  mistaken  for  polypi,  abscesses,  vascular 
growths,  and  cephalsematoma.  These  tumors  have  been  treated  by 
injection  of  iodine;  “ Mr.  Annandale  ligatured  the  mass  in  one  in- 
stance, and  effected  a cure.”  Bandages  have  been  employed,  mus- 
lin caps  lined  with  cotton,  and  gutta-percha  caps  filled  with  wadding, 
all  of  these  get  out  of  place  easily;  they  have  to  be  reapplied  fre- 
quently, and  besides,  they  do  not  afford  the  child’s  head  any  protec- 
tion. From  the  moment  these  protrusions  appear,  they  are  con- 
stantly in  the  way,  and  as  constantly  being  bruised  or  injured  in 
some  way.  If  the  child  is  lifted  up,  or  laid  down,  the  diseased  part 
is  almost  certain  to  receive  injury,  and  thus  retard  any  disposition 
towards  recovery. 

After  some  very  disappointing  experience,  I adopted  the  follow- 
ing treatment:  Immediately,  on  the  discovery  of  a case  of  cerebral 
protrusion,  I paint  the  protruding  part  with  collodion ; I order  the 
nurse  to  do  this  three  times  a day.  The  collodion  is  carried  entirely 
over  the  tumor,  and  down  upon  the  scalp  one-half  an  inch  below 
the  lower  line  of  the  protrusion.  In  twenty-four  hours  the  hardened 
collodion  has  made  a light,  strong,  cartilaginous-like  cap,  which  fits 
loosely,  yet  perfectly,  the  protruding  cerebral  substance.  From  the 
moment  it  is  applied  the  child  is  protected  from  all  ordinary  chances 


THE  TREATMENT  OF  MENINGOCELE,  ETC. 


1093 


of  head  injury.  Its  head  can  be  washed,  its  hair  brushed,  and  it 
can  be  laid  upon  its  pillow  with  but  little  chance  of  injuring  the  dis- 
eased parts.  If  the  tumor  protrudes  much,  it  raises  the  plate,  and 
yet  is  still  covered  by  it.  At  the  expiration  of  a week  or  sp,  I only 
paint  the  upper  half  of  the  plate  and  scalp,  leaving  the  lower  half 
free  to  permit  of  spraying  or  syringing  with  carbolized  water.  This 
is  done  three  times  a day.  I have  prescribed  Belladonna  and  Cal- 
carea  phosphorica,  as  indicated.  I have  just  dismissed  a case  of  this 
kind,  the  treatment  of  which  was  very  satisfactory.  The  opening 
closed  gradually,  new  matter  being  deposited,  until  at  this  date  not 
a trace  of  disease  can  be  seen,  and  the  child  is,  to  all  appearances, 
mentally  and  physically  well.  Dr.  S.  B.  Parsons  saw  this  case  with 
me,  and  at  his  suggestion  I prescribed  Calcarea  phosphorica,  and 
this,  I believe,  hastened  the  cure.  I present  this  paper  for  your  con- 
sideration, because  the  management  of  this  class  of  cases  is  usually 
difficult  and  very  unsatisfactory;  while  the  formation  of  a protective 
cap  with  collodion  is  original  with  me,  as  far  as  I am  able  to  learn 
in  looking  over  the  literature  of  this  subject. 


1094 


WORLD’S  HOMCEOPATHIC  CONGRESS. 


ALBUMINURIA  IN  CHILDREN 

By  William  W.  Van  Baun,  M.B.,  Philadelphia,  Pa. 


Albuminuria  in  children  is  frequently  overlooked,  especially  in 
private  practice,  in  cases  presenting  none  of  the  well-known  charac- 
teristic symptoms  usually  accompanying  the  disease.  The  oversight 
depends  upon  a lack  of  frequent  and  systematic  urinary  examina- 
tions. It  is  now  axiomatic  that  the  younger  the  child  the  less 
dominant  the  “old  time"  symptoms.  The  indications  often  point 
to  involvement  of  organs  remote  from  the  kidney  centre;  for  in- 
stance, a simple  high  fever  may  be  present,  or  vomiting,  purging, 
and  collapse,  or  drowsiness  and  mild  convulsive  seizure,  or  simply 
anaemia. 

The  common  cause  of  albuminuria  in  children  is  Bright’s  dis- 
ease as  a sequela  of  the  acute  infectious  diseases  so  frequent  in 
childhood.  Again,  Bright’s  disease  may  exist  without  any  apparent 
cause  and  practically  without  indicating  symptoms  in  children  even 
as  young  as  six  months  or  less.  In  these  cases,  when  an  urinary 
analysis  is  desired,  the  urine  can  be  collected  by  keeping  the  child 
on  pieces  of  well-boiled  linen  on  a rubber  pad  for  some  hours.  By 
this  method  sufficient  urine  can  be  wrung  out  to  give  the  desired 
chemical  and  microscopic  tests.  A sterilized  silk  sponge  can  be  used 
in  the  same  way.  If  retention  is  present,  a small  catheter  will  secure 
the  fluid.  Pus,  blood,  or  chyle  are  rare  causes  of  albumin  in  the 
urine  of  children.  Morbid  growths  resulting  in  pressure  will  also 
give  rise  to  presence  of  albumin.  The  mast  interesting  phase  of 
the  question  of  albuminuria  in  children  is  the  so-called  functional 
albuminuria.  By  this  is  meant  a renal  albuminuria  with  absence 
of  casts  and  all  characteristic  signs  of  Bright’s  disease  or  any  other 
disease,  the  victim  being  to  all  intent  and  purpose  in  perfect  health 
The  claim  has  been  made  that  this  condition  is  more  frequent  in 
boys  than  in  girls.  In  cases  of  adolescence  this  seems  to  be  estab- 
lished. It  frequently  accompanies  the  habit  of  masturbation.  The 


ALBUMINURIA  IN  CHILDREN. 


1095 


amount  of  albumin  present  varies  greatly  ; sometimes  it  is  quite 
large.  As  a rule,  it  is  limited,  some  in  the  morning,  more  at  noon, 
and  none  at  night;  or,  again,  there  may  be  none  in  the  morning  and 
quite  marked  at  night;  or,  when  the  patient  has  been  resting  in  bed, 
it  may  disappear  altogether,  remaining  absent  for  some  days  after 
resuming  the  usual  occupation  of  the  day,  and  then  from  some  ap- 
parently insufficient  mental  emotion  or  excitement  a large  quantity 
may  reappear.  The  ingestion  of  food,  or  certain  articles  of  food,  like 
eggs,  seem  to  cause  it  to  return.  Time  and  again  the  chemical 
urinary  analyses  show  an  entire  absence  of  albumin  in  the  morning 
urine,  with  a gradually  increasing  amount  as  the  day  advances,  being 
highest  in  urine  voided  on  retiring.  For  this  condition  no  attribu- 
table cause  can  be  determined,  excepting  the  daily  muscular  activity 
of  a child  in  contradistinction  to  the  night’s  repose,  which  gives  a 
morning  urine  free  from  albumin.  If  exhaustive  microscopical 
examinations  fail  to  give  evidence  of  Bright’s  disease,  such  as  tube- 
casts,  renal  epithelium,  etc.,  then  the  cause  of  the  albuminuria  be- 
comes speculative  and  unsatisfactory.  To  many  authorities  the 
diagnosis  of  functional  albuminuria,  or  albuminuria  of  adolescence, 
is  sufficient,  while  others  fail  to  accept  this  comforting  opinion  and 
view  with  apprehension  intermittent  paroxysmal  albuminuria,  or  the 
daily  recurrence  of  a slight  albuminuria  as  indicative  of  the  exist- 
ence of  some  unrecognized  kidney  lesion,  or,  at  least,  as  the  advance 
signal  of  the  oncome  of  some  form  of  Bright’s  disease.  I hold  with 
the  latter,  and  view  skeptically  the  existence  of  a physiological  albu- 
minuria. The  diagnosis  of  these  masked  conditions  is  extremely 
interesting  and  vexatious.  I recently  came  in  contact  with  a case  in 
a girl,  aged  13,  who  had  an  attack  of  diphtheria,  with  secondary 
glandular  involvement.  She  convalesced  nicely.  On  the  fourteenth 
day*the  temperature  rose  suddenly  to  103°  F.,  with  albumin  in  a 
scanty  urine,  amounting  to  nearly  one-half  the  amount  of  urine 
examined  in  test-tube.  The  temperature  fell  rapidly,  the  albumin 
diminishing  in  pace  with  the  fall  of  temperature;  the  latter  re- 
maining stationary  at  99°,  and  the  urine  containing  a trace  of  albu- 
min for  four  weeks,  no  tube-casts  ever  being  present.  The  follow- 
ing six  weeks  the  urine  was  tested  as  follows:  A morning,  noon, 
and  night  sample,  separately,  every  other  day  and  a twenty-four 
hour  sample  every  second  day  with  negative  results.  The  men- 
strual function  was  then  established,  and  albumin  appeared  regularly 


1096 


world’s  homceopathic  congress. 


for  five  days  without  casts.  Then  a period  of  six  weeks  passed  with- 
out albumin,  followed  by  a reappearance  of  albumin  after  a short 
period  of  nervous  excitement,  and  so  on.  The  question  in  this  case 
arises:  When  was  the  albuminuria  established  ? Was  it  the  result 
of  the  diphtheria,  or  did  it  exist  beforehand  ? In  either  event,  there 
being  no  other  symptoms  but  a high  fever  and  a scanty  urine  at  the 
time  of  the  discovery  of  the  albumin,  the  prognosis  must  be  of  the 
tentative  or  experimental  type.  The  lesson  to  be  drawn  is  the 
necessity  of  careful,  exhaustive,  and  persistently-repeated  examina- 
tions of  the  urine  for  casts,  in  order  to  establish  a diagnosis  and 
prognosis  in  the  by  no  means  infrequent  cases  of  albuminuria  in 
children  without  symptoms. 


INDEX. 


PAGE 

Accurate  Vision,  Conditions  of, 376 

A Comparative  Study  of  the  Operative  Procedures  Applicable  to  the  Com- 
moner Varieties  and  Degrees  of  Pelvic  Deformity 679 

A Contribution  to  Thoracic  Surgery, 265 

Address.  By  Hon.  C.  C.  Bonney, 17 

Address.  By  Mrs.  Charles  Henrotin, 20 

Address.  By  J.  H.  McClelland,  M.D., 22 

Address.  By  Julia  Holmes  Smith,  M.D., 23 

Address.  By  Alfred  E.  Hawkes,  M.D., 26 

Address.  By  J.  Cavendish  Molson,  M.D., 27 

Address.  By  Carl  Bojanus,  M.D., 29 

Address.  By  P.  C.  Majumdar,  M.D., 30 

Address.  By  Rev.  T.  G.  Milsted,  D.D.,  . 32 

Address,  Inaugural.  By  J.  S.  Mitchell,  M.D.,  Chairman  of  the  Congress,  . 35 

Address.  By  Wm.  Tod  Helmuth,  M.D.,  on  “Surgery  in  the  Homoeopathic 

School,” 49 

Discussion, .65 

Address.  By  Richard  Hughes,  M.D.,  on  “The  Further  Improvement  of  our 

Materia  Medica, 69 

Address.  By  F.  Parke  Lewis,  M.D.,  “ Ou  the  Value  of  Specialties  in  Medicine,”  82 
Address.  By  J.  P.  Dake,  M.D.,  on  “The  Future  of  Homoeopathy,”  . . 94 

Address.  By  I.  Tisdale  Talbot,  M.D.,  on  “Medical  Education  in  the  Homoeo- 
pathic Hospitals  and  Colleges  in  the  United  States, 108 

Address.  By  Alexander  Villers,  M.D.,  on  the  “ History  of  Homoeopathy  in 

Germany,” 117 

Address.  By  T.  F.  Allen,  M.D.,  on  “The  Selection  of  the  Homoeopathic 

Remedy,” 125 

Address.  By  R.  Ludlam,  M.D.,  on  “ Homoeopathy  and  the  Public  Health,”  . 136 

Address.  By  Alfred  E.  Hawkes,  M.D.,  on  “ Homoeopathy  in  Great  Britain,”  . 148 

Address.  By  P.  C.  Majumdar,  on  “ The  History  of  Homoeopathy  in  India,”  . 152 

Address.  By  Charles  F.  Fisher,  M.D.,  on  “ Homoeopathy  in  Australia,”  . 159 

Address.  By  E.  Vernon,  M.D.,  on  the  “ Progress  of  Homoeopathy  in 

Ontario,” 161 

Address.  By  J.  Cavendish  Molson.  M.D.,  on  “ Homoeopathy  in  London,  Eng,,”  163 
Address.  By  David  A.  Strickler,  M.D.,  on  “ Comparative  Vital  Statistics,  Hom- 
oeopathy vs.  Allopathy,” 167 

Address.  By  Martha  A.  Canfield,  on  “ The  Development  of  Medical  Science 

through  Homoeopathy,” 193 

Address.  By  Carlos  Plata,  M.D.,  on  “Observations  on  Some  of  the  Axioms, 

Aphorisms  and  Rules  of  Homoeopathy,” 207 

Address  in  Surgery,  Sectional.  By  W.  B.  Van  Lennep,  M.D.,  ....  215 

Address,  Sectional.  In  Ophthalmology  and  Otology.  By  A.  B.  Norton,  M.D.,  349 


1098 


INDEX. 


PAGE 

Address,  Sectional.  In  Gynaecology.  “The  Sine  Qua  Non.”  By  O.  S.  Run- 
nels, M.D., 480 

Address,  Sectional.  In  Materia  Medica.  “ The  Present  Condition  of  the  Hom- 
oeopathic Materia  Medica.”  By  A.  C.  Cowperthwaite,  M.D.  . . . 589 

Address,  Sectional.  In  Obstetrics.  By  T.  Griswold  Comstock,  . . . 651 

Address,  Sectional.  Clinical  Medicine.  “Recent  Discoveries  in  the  Treat- 
ment of  Disease  by  the  Use  of  Disease  Products,  and  their  Relations  to 

Homoeopathy.”  By  Charles  Gatchell,  M.D., 736 

Address.  Recent  Work  and  Progress  in  the  Field  of  Psychology,  . . . 925 

Adjournment  of  the  Congress, 209 

Albuminuria  in  Children, 1084 

Albuminuria  in  Children, 1094 

Aldrich,  Henry  C.,  M.D.  Albuminuria  in  Children, 1084 

Aldrich,  Henry  C.,  M.D.  Some  of  the  Diseases  Preventing  or  Complicat- 
ing Pregnancy, 728 

Allen,  Geo.,  M.D.  Some  Statistical  Facts  Concerning  Insanity,  . . . 969 

Allen,  T.  F.,  M.D.  The  Selection  of  the  Homoeopathic  Remedy.  Address  by,  125 

Amblyopia,  Homoeopathic  Remedies  in 371 

Anaesthesia  with  A.  C.  E.  Mixture, 245 

Antisepsis  in  Ophthalmic  Surgery, 410 

A Plea  for  Early  Operation  in  Pleurisy  with  Effusion, 746 

Appendages,  Removal  of  the  Entire  Uterus,  Together  with,  ....  580 

Appendicitis,  Operations  in, 221 

A Report  on  Orificial  Surgery,  Including  Analysis  of  1000  Cases.  By  E.  H. 

Pratt,  M.D., 321 

A Study  of  Sepia,  Pathological,  Clinical  and  Comparative,  ....  594 

Atrophic  Rhinitis, 981 

Aural  Disease,  the  Efficacy  of  the  Vibrometer  in  Applying  Vibratory  Massage,  434 

Aural  Therapeutics,  The  Homoeopathy  of, 444 

Aural  Therapeutics, 451 

Australia,  Homoeopathy  in, 159 

Banerjee,  B.  N.,  M.D.  Prophylaxis  in  Cholera 765 

Bellows,  Howard  F.,  M.D.  Some  Recent  Advancements  in  Otology,  . . 457 

Biggar,  H.  F,,  M.D.  Caesarean  Section, 536 

Biggar,  H.  F.,  M.D.  Thoracoplasty, 286 

Biliousness.  By  F.  H.  Orme,  M.D.,  .........  833 

Bissell,  Elmer  J.,  M.D.  Ophthalmic  Surgery, 399 

Blake,  Edward,  M.D.  Some  of  the  Clinical  Aspects  of  Septic  Invasion,  . 501 

Bojanus,  Carl,  M.D.  Address  by,  . 29 

Bonney,  Hon.  C.  C.  Address  by, 37 

Boocock,  Robert,  M.D.  Phytolacca — Leaf,  Fruit,  Root.  The  Value  of  Each,  643 
Bright’s  Disease,  .............  803 

Bright’s  Disease,  Homoeopathic  Remedies  in, 814 

Bryonia  Day,  My, 601 

Buck,  J.  D.,  M,D,  The  Octave  (Septenary)  in  Nature  and  in  Man  as  the  Key 

to  Psychology, 945 

Butler,  William  Morris,  M.D.  The  Causes  of  an  Increase  in  Melancholia,  963 

Caesarian  Section, 536 

Caesarian  Section,  Advantages  of, 702 

Caesarian  Section,  History  and  Statistics  of, 536 


INDEX 


1099 


PAGE 

Caesarian  Section,  Modifications  of, 540 

Caesarian  Section,  Mode  of  Operating,  ........  541 

Caesarian  Section,  Suggestions  on, 546 

Caesarian  Section  vs.  Craniotomy,  .........  703 

Campbell,  James  A.,  M.D.  Ocular  Reflex  Neuroses, 467 

Canfield,  Martha  A , M.D.  Address  by,  The  Development  of  Medical 

Science  through  Homoeopathy, 193 

Cataract,  Immature, 411 

Cephalalgia,  Cranial  Surgery  in,  .........  310 

Chapman,  Millie  J.,  M.D.  Pre-natal  Medication, 1050 

Children,  Albuminuria  in, 1084 

Children,  Albuminuria  in, 1094 

Children,  Headache  in, 1076 

Chloroform  Anaesthesia,  Prolonged,  .........  236 

Chloroform,  Deaths  from, 232 

Chloroform  or  Ether,  227 

Cholera — Its  Curative  Treatment,  .........  768 

Cholera,  Prophylaxis  in, 765 

Chronic  Diseases,  Orificial  Surgery  in, 337 

Cigarette  Smoking  a Cause  of  Melancholia, 967 

Clark,  John  H.,  M.D.  The  Curative  Action  of  Homoeopathic  Remedies  in 

Cases  of  Organic  Disease  of  the  Heart, 838 

Clinical  Medicine,  Report  and  Minutes  of  the  Section  in,  ....  734 
Clinical  Medicine,  and  in  Mental  and  Nervous  Diseases,  Meetings  of  the  Sec- 
tions in, 204 

Clinician,  The  Scientific, 825 

Cocaine  in  Ophthalmic  Surgery, 410,  432,  413 

Comparative  Statistics  of  New  York  Insane  Hospitals, 934 

Comparative  Vital  Statistics — Homoeopathy  vs.  Allopathy,  ....  167 

Comstock,  T.  Griswold,  M.D.  Sectional  Address  in  Obstetrics,  . . . 651 

Congress,  Adjournment  of  the, * 209 

Constriction  of  the  (Esophagus,  Treatment  of, 1009 

Contagion  in  Public  Schools  and  its  Prophylaxis, 1070 

Co wperth waite,  A.  C.,  M.D.  The  Present  Condition  of  Homoeopathic  Ma- 
teria Medica, 589 

Cranial  Excision  and  Incision,  Treatment  by, 305 

Curative  Treatment,  Cholera,  its, 768 

Custis,  J.  B.  Gregg,  M.D.  Puerperal  Fever, 709 

Dake,  J.  P.,  M.D.  The  Future  of  Homoeopathy.  Address  by,  ...  94 

Danforth,  L.  L.,  M.D.  A Comparative  Study  of  the  Operative  Procedures 

Applicable  to  the  Commoner  Varieties  and  Degrees  of  Pelvic  Deformity,  679 
Development  of  Medical  Science  through  Homoeopathy,  The,  . . . 193 

Diphtheria 986 

Disease  Products,  Recent  Discoveries  in  the  Treatment  of  Disease  by  the  Use 

of,  and  their  Relations  to  Homoeopathy, 736 

Discussion  on  Puerperal  Disorders, 626 

Discussion  on  the  Year’s  Progress  in  Obstetrics, 700 

Discussion  on  Headache  in  Children, 1082 

Discussion  on  Prophylaxis  in  Cholera, 767 

Discussion,  on  Cholera,  its  Curative  Treatment, 780 

Discussion  on  Neurasthenia  and  its  Treatment, 798 


1100 


INDEX. 


PAGE 

Discussion  on  Bright’s  Disease,  . 819 

Discussion  on  the  Scientific  Clinician, 830 

Discussion  on  Progress  in  Rhinology  and  Laryngology, 979 

Discussion  on  Nasal  Epithelioma, 997 

Discussion  on  Malignant  Growths  in  the  Larynx, 1006 

Discussion  ou  Treatment  of  Constriction  of  the  (Esophagus,  ....  1009 

Discussion  on  Treatment  of  Chronic  Rhinitis, 1038 

Discussion  on  Pre-natal  Medication,  1053 

Discussion  on  Rachitis, 1064 

Discussion  on  the  Awkward  Gait  of  Children, 1068 

Discussion  on  Contagion  in  Schools, 1074 

Discussion  on  Surgery  in  the  Homoeopathic  School, 65 

Discussion  on  Further  Improvement  of  our  Materia  Medica,  ....  74 

Discussion  on  the  Value  of  Specialties  in  Medicine, 93 

Discussion  on  the  Future  of  Homoeopathy, 105 

Discussion  on  Medical  Education  in  the  United  States, 198 

Discussion  on  Homoeopathy  iu  Germany, 123 

Discussion  on  the  Selection  of  the  Homoeopathic  Remedy,  ....  131 

Discussion  on  Homoeopathy  and  the  Public  Health, 143 

Discussion  on  Comparative  Vital  Statistics,  . 189 

Discussion  on  the  Development  of  Medical  Science  through  Homoeopathy,  . 204 

Discussion  on  Ether  or  Chloroform,  .........  240 

Discussion  on  Surgical  Shock, 251 

Discussion  on  Vivisection  and  Pulmonary  Surgery, 294 

Discussion  on  the  Treatment  of  Epilepsy,  Idiocy,  and  Allied  Diseases,  by  Cra- 
nial Excision  and  Incision,  305 

Discussion  on  a Report  on  Orificial  Surgery,  including  Analyses  of  1000  Cases,  343 

Discussion  on  Ophthalmic  Therapeutics, 368 

Discussion  on  the  Refraction  of  the  Eye, 376 

Discussion  on  Ophthalmic  Surgery, 410 

Discussion  on  the  Study  and  Correction  of  Heterophoria,  ....  428 

Discussion  on  the  Efficacy  of  the  Vibrometer, 437 

Discussion  on  the  Homoeopathy  of  Aural  Therapeutics, 449 

Discussion  on  Some  Recent  Advancements  in  Otology, 464 

Discussion  on  Homoeopathy  in  Gynaecology,  .......  487 

Discussion  on  Some  of  the  Clinical  Aspects  of  Septic  Invasion,  . . . 501 

Discussion  on  the  Relation  of  Surgery  to  Homoeopathy, 516 

Discussion  on  Plastic  Surgery  of  the  Vagina, 528 

Discussion  on  Caesarian  Section,  551 

Discussion  on  Uterine  Fibroids 565 

Discussion  on  Vaginal  Hysterectomy, 577 

Discussion  on  Removal  of  Entire  Uterus  for  Uterine  Fibroids,  . . . 585 

Discussion  on  Sepia,  Pathological,  Clinical,  and  Comparative,  ....  594 

Discussion  on  My  Bry*onia  Day,  . , ........  607 

Discussion  on  The  Revival  in  Therapeutics, 612 

Discussion  on  Practical  Psychology  in  its  Relation  to  Pathogenesy,  . . 621 

Discussion  on  Scarlatina  in  the  Gestative  and  Puerperal  States,  . . . 663 

Discussion  on  the  Rational  Treatment  of  Certain  Puerperal  Disorders,  . . 693 

Drugs  a Cause  of  Melancholia, 964 

Dudgeon,  R.  E.,  M.D.,  of  London,  England.  Greetings  to  the  World’s  Con- 
gress from,  with  Presentation  of  a Copy  of  his  New  Translation  of  Hah- 
nemann’s Organon, 151 


INDEX. 


1101 


PAGE 

Dunn,  Wesley  A.,  M.D.  Nasal  Epithelioma, 993 

Dunn,  W.  A.,  M.D.  Report  on  Foreign  Correspondence  by,  ....  91 

Edmunds,  W.  A.,  M.D.  Moist  Heat  as  a Therapeutic  Agent,  ....  831 

Education,  Medical,  in  the  Homoeopathic  Hospitals  and  Colleges  of  the  Uni- 
ted States, 108 

Epiglottis,  Physiology  of, 987 

Epilepsy,  Idiocy  and  Allied  Disorders  by  Cranial  Excision  and  Incision,  The 

Treatment  of. 305 

Epilepsy,  Surgery  in, 305 

Episiotomy, 705 

Epistaxis, 980 

Ether,  Deaths  from, 228 

Ether  or  Chloroform,  ........  ....  227 

Eye  Diseases,  Some  Homoeopathic  Verities  in, 362 

Eye,  The  Refraction  of  the 376 

Fischer,  Charles  F.,  M.D.,  Address  by.  Homoeopathy  in  Australia,  . . 159 

Fisher,  H.  F.,  M.D.  Malignant  Growths  in  the  Larynx,  ....  999 

Foetal  Death,  Causes  of, 668 

Foreign  Correspondence,  Report  on, 91 

Future  of  Homoeopathy, 94 

Gangrenous  Intestine,  Treatment  of, . , . 225 

Gangrenous  Cavities  in  Lungs,  Surgical  Treatment  of, 273 

Gary,  Henry  F.,  M.D.  The  Efficacy  of  the  Vibrometer  in  Applying  Vi- 
bratory Massage  in  Aural  Diseases, 434 

Gastrotomy, 218 

Gatchell,  Charles,  M.D.  Sectional  Address  in  Clinical  Medicines.  Re- 
cent Discoveries  in  the  Treatment  of  Disease  by  the  Use  of  Disease- 

Products,  and  Their  Relations  to  Homoeopathy, 736 

Germany,  History  of  Homoeopathy  in, 117 

Green,  W.  E.,  M.D.  Plastic  Surgery  of  the  Vagina, 523 

Great  Britain,  Homoeopathy  in,  . . . 148 

Grosvenor,  L.  C.,  M.D.  Puerperal  Eclampsia, " . 718 

Greetings  to  the  World’s  Congress  from  R.  E.  Dudgeon,  M.D.,  of  London,  Eng., 
with  Presentation  of  a Copy  of  his  New  Translation  of  Hahnemann’s 

Organon, 151 

Gynaecology,  Homoeopathy  in, 487 

Gynaecology,  The  Relation  of  Surgery  to, 512 

Hawkes,  Alfred  E.,  M.D.  Address  by, 26 

Hawkes,  Alfred  E.,  M.D. , Address  by.  Homoeopathy  in  Great  Britain,  . 148 

Hay  Fever, 982 

Headache  in  Children, 1076 

Heart,  The  Curative  Action  of  Homoeopathic  Remedies  in  Cases  of  Organic 

Disease  of  the, 838 

Heat,  Moist,  as  a Therapeutic  Agent, 851 

Helmuth,  Wm.  Tod,  M.D.  Address  on  Surgery  in  the  Homoeopathic  School,  49 

Henrotin,  Mrs.  Charles.  Address  by, 20 

Hernia,  Radical  Cure  of, 223 

Hernia  Special  Varieties  of, 226 


1102 


INDEX. 


PAGE 

Heterophoria,  Homoeopathic  Remedies  in,  . . . . . 427,  429,  430,  432 

Heterophoria,  Treatment  of, 404,  410,  414,  428 

Heterophoria,  The  Study  and  Correction  of,  415 

Hill,  Lucy  Chaloner,  M.D.  Contagion  in  Public  Schools  and  Its  Prophy- 
laxis,   1070 

History  of  Homoeopathy  in  Germany, 117 

History  of  Homoeopathy  in  India,  . , • . . . . . . 152 

Homoeopathic  Materia  Medina,  The  Present  Condition  of,  ....  589 

Homoeopathic  Medical  Colleges  and  Psychiatry,  ......  937 

Homoeopathic  Remedy,  The  Selection  of  the, 125 

Homoeopathic  Verities  in  Ocular  Therapeutics,  .......  362 

Homoeopathy  in  Australia,  ...........  159 

Homoeopathy  and  the  Public  Health, 136 

Homoeopathy  in  Great  Britain,  148 

Homoeopathy  in  India,  History  of, 152 

Homoeopathy  in  Gynaecology,  ..........  487 

Homoeopathy  in  London,  England, 163 

Homoeopathy  in  Ontario,  Progress  of,  161 

Plomoeopathy  of  Aural  Therapeutics,  The,  . . . . . . 444 

Homoeopathy,  Observations  on  Some  of  the  Axioms,  Aphorisms  and  Rules  of,  207 
Plomoeopathy,  The  Development  of  Medical  Science  through,  ....  193 

Homoeopathy,  The  Future  of, 94 

Homoeopathy  vs.  Allopathy — Comparative  Vital  Statistics,  ....  167 

Honorary  President,  I.  T.  Talbot,  Introduction  of  President  Mitchell  by,  . 47 

Houghton,  Henry  C.,  M.D.  Aural  Therapeutics,  ......  451 

Hughes,  Richard,  M.D.,  Address  by.  The  Further  Improvement  of  Our 

Materia  Medica,  ............  69 

Idiocy,  Epilepsy  and  Allied  Disorders  by  Cranial  Excision  and  Incision,  The 

Treatment  of, 305 

Improvement  of  Our  Materia  Medica, 69 

Inaugural  Address  by  J.  S.  Mitchell,  M.D.,  President  of  the  Congress,  . . 35 

Index  to  Volume, 1097 

India,  History  of  Homoeopathy  in,  152 

Insanity,  Cranial  Surgery  in,  .........  310 

Insanity,  Some  Statistical  Facts  Concerning,  .......  969 

Insanity,  Puerperal, 956 

Intestinal  Suture,  215 

Introduction  of  President  Mitchell, 47 

Intubation, 989 

Ischio-Pubiotomy, 703 

Ivins,  Horace,  M.D.  Sectional  Address  in  Rhinology  and  Laryngology,  Re- 
cent Progress  in  Rhinology  and  Laryngology, 979 

Jones,  Charles  E.,  M.D.  The  Treatment  of  Phthisis, 1020 

Jousset,  P.,  M.D.  Bright’s  Disease, 803 

Kafka,  Theodore,  M.D.  Telegram  from, 32 

Kershaw,  J.  Martine,  M.D.  The  Treatment  of  Meningocele,  Encephalocele 

and  Hvdrencephalocele  by  Means  of  a Collodion  Cap,  ....  1092 

Knoll,  Walter  F.,  M.D.  Vivisection  and  Pulmonary  Surgery,  . . . 294 

Kraft,  Frank,  M.D.  My  Bryonia  Day 601 


INDEX. 


1103 


PAGE 

La  Grippe,  a Cause  of  Melancholia, 963 

Laryngeal  Phthisis, 988 

Laryngology  and  Rhinology,  Meeting  of  Sections  in, 209 

Larynx,  Malignant  Growths  in, 999 

Leavitt,  Sheldon,  M.D.  The  Year's  Progress  in  Obstetrics,  . . . 700 

Lee,  J.  M.,  M.D.  Vaginal  Hysterectomy 570 

Lewis,  F.  Parke,  M.D.  Address  on  The  Value  of  Specialties  in  Medicine,  . 82 

Linnell,  E.  H.,  M.D.  Ophthalmic  Therapeutics, 357 

London,  Eng.,  Homoeopathy  in, 163 

Ludlam,  R.,  M.D.  Homoeopathy  and  the  Public  Health,  Address  by,  . . 136 

Lung,  Resection  of  in  Incipient  Tuberculosis, 276 

Macdonald,  T.  L.,  M.D.  Essay  on  Surgical  Shock, 257 

Majumdar,  P.  C.,  M.D.  Address  by 30 

Ma.tumdar,  P.  C.,  M.D.  Address  on  The  History  of  Homoeopathy  in  India,  152 

Majumdar,  P.  C.,  M.D.  Cholera;  Its  Curative  Treatment,  ....  767 

Malignaut  Growths  in  the  Larynx, 999 

Mann,  Eugene  L.,  M.D.  Nasal  Surgery,  Its  Use  and  Its  Limitations,  . . 1040 

Massage  in  the  Treatment  of  Nasal  Stenosis, 1013 

Materia  Medica  and  Obstetrics,  Meetings  of  the  Sections  in,  ....  166 

Materia  Medica,  Further  Improvement  of  Our, 69 

Materia  Medica,  Report  of  the  Section  in, 588 

Materia  Medica,  The  Present  Condition  of  the, 589 

McClelland,  J.  II.,  M.D.  Address  by, 22 

Medical  Education  in  the  Homoeopathic  Hospitals  and  Colleges  of  the  United 

States, 108 

Meeting  of  the  Section  in  Surgery,  .........  91 

Meetings  of  the  Section  in  Rhinology  and  Laryngology 209 

Meetings  of  the  Section  in  Paedology,  .........  209 

Meetings  of  the  Sections  in  Clinical  Medicine  and  in  Mental  and  Nervous 

Diseases, 204 

Meetings  of  the  Sections  in  Materia  Medica  and  Obstetrics,  ....  166 

Meetings  of  the  Sections  in  Surgery  and  in  Ophthalmology,  etc.,  . . . 123 

Melancholia,  The  Causes  of  an  Increase  in,  * .......  963 

Mental  and  Nervous  Diseases,  and  Clinical  Medicine,  Meeting  of  the  Sec- 
tions in,  . 204 

Mental  and  Nervous  Diseases,  Report  and  Minutes  of  the  Section  in,  . . 923 

Microcephaly,  Cranial  Surgery  in, 312 

Mil^ted,  Rev.  T.  G.,  D.D.  Address  by, 32 

Minutes  of  the  Sectional  Meetings  in  Surgery,  .......  213 

Minutes  of  the  Sectional  Meetings  in  Ophthalmology  and  Otology,  . . . 347 

Minutes  of  the  Sectional  Meetings  in  Gynaecology,  ......  467 

Minutes  of  the  Sectional  Meetings  in  Materia  Medica, 588 

Minutes  of  the  Sectional  Meetings  in  Obstetrics, 649 

Minutes  of  the  Sectional  Meetings  in  Clinical  Medicine, 734 

Minutes  of  the  Sectional  Meetings  in  Mental  and  Nervous  Diseases,.  . . 923 

Minutes  of  t lie  Sectional  Meetings  in  Rhinology  and  Laryngology,  . . . 977 

Minutes  of  the  Sectional  Meetings  in  Paedology, 1044 

Mitchell,  J.  S.,  M.D.,  President.  Introduction  of  by  I.  T.  Talbot,  M.D.,  the 

Honorary  President, 47 

Mitchell,  J.  S.,  M.D.  Inaugural  Address  by, 35 

Mitchell,  J.  S.,  M.D.,  President.  Preparations  for  the  Congress  Described,  . 47 


1104 


INDEX. 


PAGE 

Mohr,  Charles,  M.D.  Primary  and  Secondary  Symptoms;  or  the  Opposite 

Action  of  Large  and  Small  Doses, 625 

Moist  Heat  as  a Therapeutic  Agent, 851 

Molsen,  J.  Cavendish,  M.D.  Address  by, 27 

Molson,  J.  Cavendish,  M.D.  Address  by,  Homoeopathy  in  London,  Eng.,.  163 
Monroe,  A.  L.,  M.D.  A Study  of  Sepia,  Pathological,  Clinical  and  Compara- 
tive,   . . 594 

Morgan,  John  C.,  M.D.  The  Study  of  Homoeopathy  as  a Distinct  and  Com- 
manding Department  of  Medicine, 858 

My  Bryonia  Day, 601 

Nasal  Epithelioma, 993 

Nasal  Neuroses, 982 

Nasal  Stenosis  a Cause  of  Ear  Defects, 981 

Nasal  Stenosis,  Massage  in  the  Treatment  of, 1013 

Nasal  Surgery,  Its  Use  and  Its  Limitations,  ; 1040 

Nervous  and  Mental  Diseases,  Meeting  of  the  Section  in 204 

Neurasthenia  and  its  Treatment, 781 

New  Suggestions  in  the  Treatment  of  Constriction  of  the  (Esophagus,  . . 1009 

Norton,  A.  B.,  M.D.  Sectional  Address  in  Ophthalmology  and  Otology,  . 349 

Obetz,  Henry  L.,  M.D.  A Contribution  to  Thoracic  Surgery,  . . . 265 

Observations  on  Some  of  the  Axioms,  Aphorisms  and  Buies  of  Homceopathy,  207 
Obstetrics,  and  of  Materia  Medica,  Meetings  of  the  Sections  in,  . . . 166 

Obstetrics,  Report  of  the  Section  in, 649 

Obstetrics,  The  Year’s  Progress  in, 700 

Ocular  Reflex  Neuroses,  ...........  467 

Old-School  Drugs  Used  in  Eye  Diseases, 360 

Ontario,  Progress  of  Homceopathy  in, 161 

Ophthalmic  Therapeutics, 357 

Ophthalmic  Surgery, 399 

Ophthalmology,  Homoeopathic  Specialists  in, 349 

Ophthalmology  and  Surgery,  Meetings  of  the  Sections  in,  ....  123 

Ophthalmology  and  Otology,  Minutes  and  Report  of  the  Section,  . . . 347 

Ophthalmometer,  The, 382 

Opposite  Action  of  Large  and  Small  Doses, 625 

Order  and  Rules  of  Business  Adopted, 48 

Organon,  New  Translation  of,  by  R.  E.  Dudgeon,  M.D.,  Presentation  of  a 

Copy,  151 

Orificial  Surgery,  A Report  on, 324 

Orme,  F.  IL,  M.D.  Biliousness, 833 

Ostrom,  Homer  I.,  M.D.  Removal  of  the  Entire  Uterus,  Together  with 

the  Appendages,  for  Uterine  Fibroids,  ........  580 

Otology  and  Ophthalmology,  Minutes  and  Report  of  the  Section,  . . . 347 

Otologjr,  Some  Recent  Advancements  in, . 457 

Paedology,  Meeting  of  the  Section  in, 209 

Paedology,  Report  and  Minutes  of  the  Section  in, 1044 

Paine,  N.  Emmons,  M.D.  Psychiatry  and  the  Homoeopathic  Medical  Col- 
leges,   937 

Packard,  Horace,  M.D.  Essay  on  Ether  or  Chloroform,  ....  227 

Papillomata  of  the  Nose, 982 


INDEX. 


1105 


PAGE 

Paralysis,  Cranial  Surgery  in, 311 

Parturient  Lacerations,  Immediate  Repair  of, 706 

Parturition,  The  Levator  Ani  as  Related  to, 671 

Peck,  George  B.,  M.D.  The  Rational  Treatment  of  Certain  Puerperal  Dis- 
orders,   691 

Pelvic  Deformity,  Operative  Procedures,  ........  679 

Phillips,  L.  A.,  M.D.  Homoeopathy  in  Gynaecology, 487 

Phthisis,  The  Treatment  of, 1020 

Phytolacca,  Botanical  History  of, 643 

Phytolacca,  Provings  of, 644 

Phytolacca,  Leaf,  Fruit,  Root,  The  Value  of  Each. 643 

Plastic  Surgery  of  the  Vagina, 521 

Plata,  Carlos,  M.D.  Presentation  of  a Letter  from, 205 

Plata,  Carlos,  M.D.  Address  by,  Observations  on  Some  of  the  Axioms, 

Aphorisms  and  Rules  of  Homoeopathy, 207 

Pleurisy  with  Effusion,  A Plea  for  Early  Operation  in, 746 

Pleuritic  Effusion,  Aspiration  in, 755 

Practical  Psychology  in  its  Relation  to  Pathogenesy, 615 

Pratt,  E.  H.,  M.D.  A Report  on  Orificial  Surgery,  Including  an  Aualysis 

of  1000  Cases, 324 

Pregnancy,  Some  of  the  Diseases  Preventing  and  Complicating,  . . . 728 

Pregnancy,  Vomiting  of, 730 

Pre-natal  Medication, 1030 

Preparations  for  the  Congress  Described  by  President  Mitchell,  ...  47 

Presentation  of  a Copy  of  Dr.  R.  E.  Dudgeon’s  New  Translation  of  Hahne- 
mann’s Organon,  ......  . 151 

Presentation  of  a Letter  from  Carlos  Plata,  M.D., 205 

President,  Honorary,  I.  T.  Talbot,  M.D.,  Introduction  of  President  Mitchell  by,  47 
Price,  Eldridge  C.,  M.D.  Practical  Psychology  in  its  Relation  to  Patho- 
genesy,   615 

Primary  and  Secondary  Symptoms ; or  the  Opposite  Action  of  Large  and 

Small  Doses, 625 

Progress  of  Homoeopathy  in  Ontario, 161 

Prophylaxis  in  Cholera, 765 

Pseudo-Cyesis,  Case  of, 730 

Psychiatry  and  the  Homoeopathic  Medical  Colleges, 937 

Psychology,  The  Octave  (Septenary)  in  Nature  and  in  Man  as  the  Key  to,  . 945 

Psychology,  Recent  Work  and  Progress  in, 925 

Psychology,  Practical,  in  its  Relation  to  Pathogenesy,  .....  615 

Public  Health,  Homoeopathy  and  ihe,  ........  136 

Puerperal  Disorders,  Their  Treatment, 691 

Puerperal  Eclampsia, 718 

Puerperal  Fever, 709 

Puerperal  Fever,  Homoeopathic  Remedies  in, 716 

Puerperal  Insanity,  723 

Puerperal  Insanity, 956 

Pulmonary  Surgery  and  Vivisection, 294 

Pyrexia  in  the  Puerperium,  704 

Rachitis, 1059 

Recent  Progress  in  Rhinology  and  Laryngology, 979 

Recent  Work  and  Progress  in  the  Field  of  Psychology, 925 

70 


1106 


INDEX. 


PAGE 

Reflex  Neuroses,  Ooular, t 467 

Refraction  of  the  Eye,  The, 376 

Refraction,  Appliances  for  Estimating,  . . . * 377 

Removal  of  the  Entire  Uterus,  Together  with  the  Appendages  for  Uterine 

Fibroids, 580 

Report  of  the  Section  in  Obstetrics, 640 

Report  of  the  Section  in  Clinical  Medicine,  734 

Report  of  the  Section  in  Surgery, 213 

Report  of  the  Section  in  Ophthalmology  and  Otology, 347 

Report  of  the  Section  in  Gynaecology, 478 

Report  of  the  Section  in  Mental  and  Nervous  Diseases, 923 

Report  of  the  Section  in  Rhinology  and  Laryngology, 977 

Report  of  the  Section  in  Paedology, 1044 

Report  on  Foreign  Correspondence, 91 

Report  on  Orificial  Surgery, 305 

Resolutions  of  Thanks  Adopted, 205 

Rhinitis,  The  Treatment  of  Chronic, 1031 

Rhinology  and  Laryngology,  Meeting  of  the  Section  in, 209 

Rhinology  and  Laryngology,  Report  and  Minutes  of, 977 

Rhinology  and  Laryngology,  Recent  Progress  in, 979 

Rules  and  Order  of  Business  Adopted, 48 

Runnels,  O.  S.;  M.D,  Sectional  Address,  The  Sine  Qua  Non,  . . . 480 

Sanders,  John  C.,  M.D.  Scarlatina  in  the  Gestative  and  Puerperal  States,  643 

Sanger  versus  Porro, 702 

Scarlatina  in  the  Gestative  and  Puerperal  States,  ......  663 

School  Systems  a Cause  of  Melancholia, 966 

Schools,  Contagion  in, 1070 

Schley,  J.  Montfort,  M.D.  A Plea  for  Early  Operation  in  Pleurisy  with 

Effusion, 746 

Section  in  Clinical  Medicine,  Report  and  Minutes  of  the, 734 

Section  in  Gynaecology,  Report  of.  Minutes  of  the  Sectional  Meeting,  . . 478 

Section  in  Mental  and  Nervous  Diseases,  Report  and  Minutes  of  the,  . . 923 

Section  in  Materia  Medica,  Report  and  Minutes  of  the, 588 

Section  in  Obstetrics,  Report  and  Minutes  of  the, 649 

Section  in  Ophthalmology,  Etc.,  Meetings  of,  ......  123 

Section  in  Ophthalmology,  Minutes  and  Report  of, 347 

Section  in  Paedology,  Meetings  of  the, 209 

Section  in  Paedology,  Report  and  Minutes  of  the, 1044 

Section  in  Rhinology  and  Laryngology,  Report  and  Minutes  of  the,  . . 977 

Section  in  Rhinology  and  Laryngology,  Meetings  of  the, 209 

Section  in  Surgery,  Meeting  of  the,  .........  91 

Section  in  Surgery,  Report  of  the.  Minutes  of  the  Sectional  Meetings,  . . 213 

Sections  in  Clinical  Medicine  and  in  Mental  and  Nervous  Diseases,  Meetings 

of  the, 204 

Sections  in  Materia  Medica  and  in  Obstetrics,  Meetings  of  the,  . . . 166 

Sectional  Address  in  Clinical  Medicine.  Recent  Discoveries  in  the  Treatment 
of  Disease  by  the  Use  of  Disease-Products  in  their  Relation  to  Homoeo- 
pathy,   736 

Sectional  Address  in  Gynaecology, 480 

Sectional  Address  in  Materia  Medica.  The  Present  Condition  of  the  Homoeo- 
pathic Materia  Medica, 589 


INDEX. 


1107 


PAGE 

Sectional  Address  in  Mental  and  Nervous  Diseases.  Recent  Work  and  Pro- 
gress in  the  Field  of  Psychology, 925 

Sectional  Address  in  Obstetrics, 

Sectional  Address,  in  Ophthalmology  and  Otology.  A.  B.  Norton,  M.D.,  . 349 

Sectional  Address  in  Paedology, 1046 

Sectional  Address  in  Rhinology  and  Laryngology.  Recent  Progress  in  Rhi- 

nology  and  Laryngology, 979 

Sectional  Address  in  Surgery, 215 

Selection  of  the  Homoeopathic  Remedy, 125 

Senile  Cataract,  Extraction  of, 406 

Sepia,  A Study  of,  Pathological,  Clinical  and  Comparative,  ....  594 

Septic  Invasion,  Some  of  the  Clinical  Aspects  of, 501 

Shears,  G.  F.,  M.D.  The  Treatment  of  Epilepsy,  Idiocy  and  Allied  Dis- 
orders by  Cranial  Excision  and  Incision, 305 

Smith,  Gerard,  M.D.,  M.R.C.S.  Some  Notes  on  Headache  in  Children,  . 1076 

Smith,  Julia  Holmes,  M.D.  Address  by, 23 

Some  Notes  Upon  Headache  in  Children, 1076 

Some  Observations  on  Neurasthenia  and  its  Treatment,  .....  781 

Some  of  the  Clinical  Aspects  of  Septic  Invasion,  ......  501 

Some  of  the  Diseases  Preventing  and  Complicating  Pregnancy,  . . . 728 

Some  Recent  Advancements  in  Otology, 457 

Spalding,  Henry  E.,  M.D.  The  Levator  Ani  as  Related  to  Parturition,  . 671 

Spasm  of  Accommodation,  Homoeopathic  Remedies  in, 372 

Specialties  in  Medicine,  The  Value  of, 82 

Statistical  Facts  Concerning  Insanity, . 969 

Statistics,  Homoeopathy  vs.  Allopathy, 167 

Sterling,  C.  F.,  M.D.  The  Homoeopathy  of  Aural  Therapeutics,  . . . 444 

Stewart,  Thomas  M.,  M.D.  The  Refraction  of  the  Eye,  ....  376 

Strabismus  Operations, 411,  412 

Strickler,  David  A.,  M.D.  Address  by.  Comparative  Vital  Statistics. 

Homoeopathy  vs.  Allopathy, 167 

Streeter,  John  W.,  M.D.  Uterine  Fibroids, 558 

Surgery  and  Ophthalmology,  Meetings  of  the  Sections  in,  ....  123 

Surgery  in  the  Homoeopathic  School,  . 49 

Surgery,  Meeting  of  the  Section  in, 91 

Surgery,  Report  of  the  Section  in.  Minutes  of  the  Sectional  Meetings,  . . 213 

Surgery,  Sectional  Address  in, 215 

Surgical  Shock, 251 

Surgery,  Thoracic,  A Contribution  to, 265 

Sutherland,  J.  P.,  M.D.  The  Scientific  Clinician, 825 

Symphyseotomy, 700 

Tabes  and  Pseudo-Tabes,  The  Homoeopathic  Treatment  of,  ...  913 

Table  of  Contents,  iii 

Talbot,  Dr.  I.  T.,  Honorary  President.  Introduction  of  President  Mitchell  by,  47 
Talbot,  Dr.  I.  T.,  Medical  Education  in  the  Homoeopathic  Hospitals  and 

Colleges  of  the  United  States, . . 108 

Talcott,  Selden  H.,  M.D.  Sectional  Address  in  Mental  and  Nervous  Dis- 
eases, Recent  Work  and  Progress  in  the  Field  of  Psychology,  . . . 925 

Taxis,  Dangers  of  Persistent, 225 

Teets,  Charles  E.,  M.D.  The  Treatment  of  Chronic  Rhinitis  by  the  Hom- 
oeopath,   1031 


1108 


INDEX. 


PAGE 

Telegram  from  Dr.  Theodore  Kafka, 32 

Telegram  from  Dr.  Alexander  Villers, 32 

Testicle,  Undescended, 225 

The  Awkward  Gait  of  Children, 1066 

Thanks,  Resolutions  of,  Adopted, 205 

The  Causes  of  an  Increase  in  Melancholia, 963 

The  Curative  Action  of  Homoeopathic  Remedies  in  Cases  of  Organic  Disease 

of  the  Heart, 838 

The  Efficacy  of  the  Vifcrometer  in  Applying  Vibratory  Massage  in  Aural 

Diseases 434 

The  Homoeopathic  Treatment  of  Tabes  and  Pseudo-Tabes,  ....  913 

The  Homoeopathy  of  Aural  Therapeutics, 444 

The  Levator  Ani  as  Related  to  Parturition, 671 

The  Octave  (Septenary)  in  Nature  and  in  Man  as  the  Key  to  Psychology,  . 945 

The  Present  Condition  of  the  Homoeopathic  Materia  Medica,  ....  589 

The  Rational  Treatment  of  Certain  Puerperal  Disorders, 691 

The  Refraction  of  the  Eye, 376 

The  Relation  of  Surgery  to  Gynecology, . 512 

The  Revival  in  Therapeutics, 606 

The  Scientific  Clinician, 825 

The  Sine  Qua  Non, 480 

The  Study  and  Correction  of  Heterophoria,  415 

The  Study  of  Homoeopathy  as  a Distinct  and  Commanding  Department  of 

Medicine,  858 

The  Treatment  of  Chronic  Rhinitis  by  the  Homoeopath, 1031 

The  Treatment  of  Epilepsy,  Idiocy  and  Allied  Disorders  by  Cranial  Excision 

and  Incision, 305 

The  Treatment  of  Meningocele,  Eucephaloeele  and  Hydrenceplialocele  by 

Means  of  a Collodion  Cap, 1092 

The  Treatment  of  Phthisis, 1020 

The  Year’s  Progress  in  Obstetrics, 700 

Thomas,  Wm.  Dulaney,  M.D.  Massage  in  the  Treatment  of  Nasal  Stenosis,  1013 

Thoracic  Surgery,  A Contribution  to, 265 

Thoracoplasty, 286 

Therapeutics,  The  Revival  in, 606 

Tonsils,  Physiology  of  the,  . 983 

Tookek,  Robert  N.,  M.D.  Rachitis 1059 

Trachoma,  Operations  for,  ...........  403 

Treatment  of  Certain  Puerperal  Disorders, ' . 691 

Treatment  of  Epilepsy,  Idiocy  and  Allied  Disorders  by  Cranial  Excision  and 

Incision,  The, 305 

Uraemic  Accidents,  Treatment  of, 817 

Uterine  Fibroids, 558 

Uterine  Fibroids,  Removal  of  the  Entire  Uterus  for, 580 

Uterus,  Removal  of,  for  Uterine  Fibroids. 580 

Vagina,  Plastic  Surgery  of  the, . . 521 

Vaginal  Hysterectomy, 570 

Value  of  Specialties  in  Medicine, 82 

Value  of  Specialties  in  Medicine,  Discussion  on, 93 

Van  Baun,  Wm.  W.,  M.D.  Albuminuria  in  Children,  . . . . . 1094 


INDEX. 


1109 


PAGE 

Van  Lennep,  W.  B.,  M.D.  Sectional  Address  in  Surgery 215 

Vernon,  E.,  M.D.  Address  on  Progress  of  Homoeopathy  in  Ontario,  . . 161 

Vibrometer,  The  Efficacy  of, 434 

Villers,  Alexander,  M.D.  Telegram  from 32 

Villers,  Alexander,  M.D.  Address  on  History  of  Homoeopathy  in  Ger- 
many,   117 

Villers,  Alexander,  M.D.  The  Homoeopathic  Treatment  of  Tabes  and 

Pseudo-Tabes, 913 

Vivisection  and  Pulmonary  Surgery, 294 

Walton,  Charles  E.,  M.D.  The  Relation  of  Surgery  to  Gynaecology,  . 512 

Wesselhoeft,  Conrad,  M.D.  Some  Observations  on  Neurasthenia  and  its 

Treatment, 781 

Wilcox,  Sidney  F.,  M.D.  The  Awkward  Gait  of  Children,  ....  1066 

Williamson,  A.  P.,  M.D.  Puerperal  Insanity, 956 

Wilson,  Harold,  M.D.  The  Study  and  Correction  of  Heterophoria,  . . 415 

Woodvine,  D.  G.,  M.D.  New  Suggestions  in  the  Treatment  of  Constriction 

of  the  (Esophagus,  . 1009 

Youngman,  M.  D.,  M.D.  Puerperal  Insanity, 723 


